Neuromodulation Effective for Dysphagia in Patients Who Experience Stroke and Reduces Length of Hospital Stay
Despite improvements in stroke care and patient outcomes, approximately 16% of patients who experience a stroke have a tracheostomy and ventilatory support. Dysphagia can significantly delay removal of tracheostomy tubes and extend the length of hospital stays.
A randomized single-blind pilot trial (ISRCTN18137204)of pharyngeal electrical stimulation (PES) (PHAST-TRAC; Phagenesis, Manchester, England) has shown that PES improves dysphagia while cannulated, increases safe decannulation, and results in decreased hospital stays. (Lancet Neurology. 2018; August 28.) The device used for PES in this study is available only in Europe and not in the US at present.
Patients with recent stroke who required tracheotomy were randomly assigned to receive 3 days of either PES (n = 35) or sham treatment (n = 34). Readiness for removal of the tracheostomy tube was assessed by a separate blinded investigator 24–72 h after treatment using fibreoptic endoscopic evaluation of swallowing based on a standardized protocol. Patients were assessed for absence of massive pooling of saliva, presence of 1 or more spontaneous swallows, and presence of laryngeal sensation. Decannulation was achieved safely in 49% of patients from the PES group vs 9% in the control group (P = .0008). Patients who responded to PES treatment had an average reduction in hospital length of stay of 22 days.
"In addition to these obvious benefits, we are pleased to observe in PHAST-TRAC no serious adverse events related to the PES treatment. Thus, PES represents a real treatment option for these critically ill patients," reports the principal investigator of PHAST-TRAC, Rainer Dziewas, MD from the Department of Neurology at the University Hospital Münster.