Dysphagic patient after lung transplant and intubation

Data courtesy of Wythenshawe Hospital, University Hospital of South Manchester NHS Foundation Trust, UK

Introduction

Intubation after double lung transplant is life-sustaining, but it may contribute to post-extubation swallowing dysfunction, delaying oral intake. Management of dysphagia is essential for a good outcome and fast recovery of the patient.

Case Report

A 63-year-old male who underwent double lung transplant surgery, needed a tracheotomy and intubation for breathing support.

Fiberoptic Endoscopic Evaluation of Swallowing (FEES) at baseline showed sensory impairment, a SSRS=3, an AP=4 and a PAS=8. The clinical recommendation was no oral intake and placement of a Percutaneous Endoscopic Gastrostomy (PEG) tube to deliver nutrition.

Treatment

At this point, 40 days post admission, the patient received local dysphagia management standard of care, and in addition, Pharyngeal Electrical Stimulation (PES) treatment using the Phagenyx® system. The treatment consisted of 10 minutes of patient optimised electrical stimulation once per day for 3 consecutive days with stimulation intensities of 23mA, 21mA and 31mA respectively.

 Dysphagia patient case study Dysphagia patient case study 

Results

A FEES evaluation was carried out 1 day after the last of the three Phagenyx® treatments and showed the scores had improved as follows: a SSRS=0, an AP=3 and a PAS=2. On the basis of these results the clinical recommendation changed to normal diet with modified fluids and no requirement for placement of a PEG tube.

A follow up VFS evaluation after discharge confirmed a complete restoration of swallow function and the patient was able to have a normal diet with normal fluid intake.

Conclusion

Intubation following transplant surgery may lead to severe dysphagia. Phagenyx® treatment can support the recovery of a safe swallow, a return to normal dietary intake and may in addition help to avoid the need to place a PEG tube.

PAS=Penetration-Aspiration Scale; AP scale=Airway Protection Scale; NG tube=nasogastric tube; SSRS=Secretion Severity Rating Scale

Phagenyx® system is CE marked and is available for sale only in the European Economic Area and Switzerland. The statements by Phagenesis’ customers described herein are based on results that were achieved in the customer’s unique setting. There cannot be any guarantee that other customers will achieve the same results.