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      Biomechanical mechanism of reduced aspiration by the Passy-Muir valve in tracheostomized patients following acquired brain injury: Evidences from subglottic pressure

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          Abstract

          Objective

          Aspiration is a common complication after tracheostomy in patients with acquired brain injury (ABI), resulting from impaired swallowing function, and which may lead to aspiration pneumonia. The Passy-Muir Tracheostomy and Ventilator Swallowing and Speaking Valve (PMV) has been used to enable voice and reduce aspiration; however, its mechanism is unclear. This study aimed to investigate the mechanisms underlying the beneficial effects of PMV intervention on the prevention of aspiration.

          Methods

          A randomized, single-blinded, controlled study was designed in which 20 tracheostomized patients with aspiration following ABI were recruited and randomized into the PMV intervention and non-PMV intervention groups. Before and after the intervention, swallowing biomechanical characteristics were examined using video fluoroscopic swallowing study (VFSS) and high-resolution manometry (HRM). A three-dimensional (3D) upper airway anatomical reconstruction was made based on computed tomography scan data, followed by computational fluid dynamics (CFD) simulation analysis to detect subglottic pressure.

          Results

          The results showed that compared with the non-PMV intervention group, the velopharynx maximal pressure (VP-Max) and upper esophageal sphincter relaxation duration (UES-RD) increased significantly ( P < 0.05), while the Penetration-Aspiration Scale (PAS) score decreased in the PMV intervention group ( P < 0.05). Additionally, the subglottic pressure was successfully detected by CFD simulation analysis, and increased significantly after 2 weeks in the PMV intervention group compared to the non-PMV intervention group ( P < 0.001), indicating that the subglottic pressure could be remodeled through PMV intervention.

          Conclusion

          Our findings demonstrated that PMV could improve VP-Max, UES-RD, and reduce aspiration in tracheostomized patients, and the putative mechanism may involve the subglottic pressure.

          Clinical trial registration

          [ http://www.chictr.org.cn], identifier [ChiCTR1800018686].

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          Most cited references56

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          Tracheostomy in the COVID-19 era: global and multidisciplinary guidance

          Summary Global health care is experiencing an unprecedented surge in the number of critically ill patients who require mechanical ventilation due to the COVID-19 pandemic. The requirement for relatively long periods of ventilation in those who survive means that many are considered for tracheostomy to free patients from ventilatory support and maximise scarce resources. COVID-19 provides unique challenges for tracheostomy care: health-care workers need to safely undertake tracheostomy procedures and manage patients afterwards, minimising risks of nosocomial transmission and compromises in the quality of care. Conflicting recommendations exist about case selection, the timing and performance of tracheostomy, and the subsequent management of patients. In response, we convened an international working group of individuals with relevant expertise in tracheostomy. We did a literature and internet search for reports of research pertaining to tracheostomy during the COVID-19 pandemic, supplemented by sources comprising statements and guidance on tracheostomy care. By synthesising early experiences from countries that have managed a surge in patient numbers, emerging virological data, and international, multidisciplinary expert opinion, we aim to provide consensus guidelines and recommendations on the conduct and management of tracheostomy during the COVID-19 pandemic.
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            An Airway Protection Program Revealed by Sweeping Genetic Control of Vagal Afferents

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              The effect of 5Hz high-frequency rTMS over contralesional pharyngeal motor cortex in post-stroke oropharyngeal dysphagia: a randomized controlled study.

              We sought to find the therapeutic effect of 5Hz high-frequency repetitive transcranial magnetic stimulation (rTMS) over the unaffected pharyngeal motor cortex in post-stroke dysphagic patients.
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                Author and article information

                Contributors
                Journal
                Front Neurosci
                Front Neurosci
                Front. Neurosci.
                Frontiers in Neuroscience
                Frontiers Media S.A.
                1662-4548
                1662-453X
                31 October 2022
                2022
                : 16
                : 1004013
                Affiliations
                [1] 1Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University , Guangzhou, China
                [2] 2Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University , Guangzhou, China
                [3] 3School of Mechanical and Automotive Engineering, South China University of Technology , Guangzhou, China
                Author notes

                Edited by: Allison B. Reiss, New York University, United States

                Reviewed by: Michael J. Brenner, University of Michigan, United States; Haining Ou, Fifth Affiliated Hospital of Guangzhou Medical University, China; Yue Lan, Guangzhou First People’s Hospital, China

                *Correspondence: Zulin Dou, douzulin@ 123456mail.sysu.edu.cn

                These authors have contributed equally to this work

                This article was submitted to Translational Neuroscience, a section of the journal Frontiers in Neuroscience

                Article
                10.3389/fnins.2022.1004013
                9659960
                36389236
                9a38db0e-f7dd-4a20-a014-e2a4720bb2a9
                Copyright © 2022 Han, Ye, Meng, Pan, Wei, Wen and Dou.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 26 July 2022
                : 06 October 2022
                Page count
                Figures: 6, Tables: 2, Equations: 0, References: 56, Pages: 13, Words: 8025
                Funding
                Funded by: National Natural Science Foundation of China, doi 10.13039/501100001809;
                Award ID: 81472153
                Award ID: 81802236
                Categories
                Neuroscience
                Clinical Trial

                Neurosciences
                aspiration,tracheostomy,acquired brain injury,passy-muir tracheostomy and ventilator swallowing and speaking valve (pmv),swallowing biomechanics,subglottic pressure

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