Dysphagia in neurologic patients in the intensive care unit

Seminars in Neurology

Volumn 16, Issue 4, 1996, Pages 329-340

  Langmore, Susan E ^a  

^a VETERANS AFFAIRS MEDICAL CENTER   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

AMINOGLYCOSIDE ANTIBIOTIC AGENT; BENZODIAZEPINE DERIVATIVE; BOTULINUM TOXIN; CENTRAL DEPRESSANT AGENT;

AMYOTROPHIC LATERAL SCLEROSIS; ASPIRATION; BRAIN TUMOR; DYSPHAGIA; FIBEROSCOPE; GASTROESOPHAGEAL REFLUX; HOSPITAL INFECTION; HUMAN; HUNTINGTON CHOREA; HYPERTHYROIDISM; INTENSIVE CARE UNIT; INTUBATION; MALNUTRITION; NEUROLOGIC DISEASE; PARKINSON DISEASE; PNEUMONIA; POSTOPERATIVE COMPLICATION; PRIORITY JOURNAL; REVIEW; SCREENING; STROKE; TRACHEOSTOMY; TUBE FEEDING; VENTILATOR;

EID: 0030436373     PISSN: 02718235     EISSN: None     Source Type: Journal    
DOI: 10.1055/s-2008-1040991     Document Type: Review

References (144)

1. Groher ME. The prevalence of swallowing disorders in two teaching hospitals. Dysphagia 1986;1:3-6
2. Veis SL, Logemann JA. Swallowing disorders in persons with cerebrovascular accident. Arch Phys Med Rehabil 1985;66: 372-5
3. Wade DT, Skilbeck CE, Hewer RL. Predicting Barthel ADL score at 6 months after an acute stroke. Arch Phys Med Rehabil 1983;64:24-8
4. Albert MJ, Horner J, Gray L, Braxer SR. Aspiration after stroke: lesion analysis by brain MRI. Dysphagia 1992;7:170-3
5. Celifacrco A, Gerard G, Faegenburg D, Burakoff R. Dysphagia as the sole manifestation of bilateral strokes. Am J Gastroenterology 1990;85: 610-3
6. Massey CE, Gammal TE, Brooks BS. Giant posterior inferior cerebellar artery aneurysm with dysphagia. Surg Neurol 1984; 22:467-71
7. Buchholz DW. Neurogenic dysphagia: What is the cause when the cause is not obvious? Dysphagia 1994;9:245-55
8. Buchholz DW. Clinically probable brainstem stroke presenting primarily as dysphagia and nonvisualized by MRI. Dysphagia 1993;8 235-8
9. Henon H, Godefroy O, Leys D, Mounier-Behier F, Lucas C. Rondepierre P, Duhamel A, Pruvo JP. Early predictors of death and disability after acute cerebral ischemic event. Stroke 1995;26: 3920-98
10. Brown M, Blassenberg M. Mortality factors in patients with acute stroke. JAMA 1973;224:1493-5
11. Barer DH. The natural history and functional consequences of dysphagia after hemispheric stroke. J Neurol Neurosurg Psychiatry 1989;52:236-41
12. Kidd D, Lawson J, Nesbitt R, MacMahon J. The natural history and clinical consequences of aspiration in acute stroke. Q J Med 1995;88:409-13
13. Woratyla SP, Morgan AS, Mackay L, Bernstein B, Barba C. Factors associated with early onset pneumonia in the severely brain-injured patient. Conn Med 1995;59(11):643-7
14. Lazarus C, Logemann JA. Swallowing disorders in closed head trauma patients. Arch Phys Med Rehabil 1987;68:79-84
15. Winstein CJ. Neurogenic dysphagia. Phys Ther 1992;63:1992-7
16. Jennings KS, Siroky D, Jackson CG. Swallowing problems after excision of tumors of the skull base: diagnosis and management in 12 patients. Dysphagia 1992;7:40-4
17. Leonetti JP, Smith PG, Gurbb RL. Management of neurovascular complications in extended skull base surgery. Laryngoscope 1989;99:492-6
18. Biller HF, Som P, Lawson W, Rosenfield R. Glomus vagale tumors. Ann Otol Rhinol Laryngol 1989;98:21-6
19. Cece JA, Lawson W, Eden AR, Biller HF, Parisier SC. Complications in the management of large glomus jugulare tumors. Laryngoscope 1987;97:152-7
20. Poe DS, Jackson GJ, Glasscock M, Johnson GD. Long-term results after lateral cranial base surgery. Laryngoscope 1991; 101:372-8
21. Buchholz DW. Oropharyngeal dysphagia due to iatrogenic neurological dysfunction Dysphagia 1995;10:248-54
22. Neumann S, Buchholz D, Wuttge-Hannig A, Hannig C, Prosiegel M, Schroter-Morasch H. Bilateral pharyngeal dysfunction after lateral medullary infarction. Dysphagia 1994;9:263
23. Neumann S, Buccholz D, Jones B, Palmer J. Pharyngeal dysfunction after lateral medullary infarction is bilateral: Review of 15 additional cases. Dysphagia 1995;10:136
24. Newton HB, Newton C, Pearl D, Davidson T. Swallowing assessment in primary brain tumor patients with dysphagia. Neurology 1994;44:1927-32
25. Leckman JF, de Lotbiniere AJ, Marek K, Gracco C, Scahill L, Cohen DJ. Severe disturbances in speech, swallowing, and gait following stereotactic infrathalamic lesions in Gilles de la Tourette's syndrome. Neurology 1993;43:890-4
26. Watanabe H, Makishima K, Arima T, Mitsuyama S. Dynamics of swallowing in tetanus. J Laryngol Otol 1984;98:953-6
27. Ekberg O, Sjoberg S Neck pain and dysphagia: MRI of retropharyngitis. J Comput Assist Tomogr 1995;19:555-8
28. Horner J, Riski JE, Ovelmen-Levitt J, Nashold BS. Swallowing in torticollis before and after rhizotomy. Dysphagia 1992;7: 117-25
29. Hoehn MM, Maier M. Parkinson's disease: progression and mortality. Adv Neurol 1988;45:260-2
30. Edmonds C. Huntington's chorea, dysphagia and death. Med J Aust 1966;2:273-4
31. Lanska DJ, Lanska MJ, Lavine L, Schoenberg BS. Conditions associated with Huntington's disease at death: a case-control study. Arch Neurol 1988;45:878-80
32. Bine JE, Frank EM, McDade HL. Dysphagia and dementia in subjects with Parkinson's disease. Dysphagia 1995;10:160-4
33. Strand EA, Miller RM, Yorkston KM, Hillel AD. Management of oral-pharyngeal dysphagia symptoms in amyotrophic lateral sclerosis. Dysphagia 1996;11:129-39
34. Bach JR. Amyotrophic lateral sclerosis: communication status and survival with ventilatory support. Am J Phys Med Rehabil 1993;72:343-9
35. Willig TN, Paulus J, Guily JLS, Beon C, Navarro J. Swallowing problems in neuromuscular disorders. Arch Phys Med Rehabil 1994;75:1175-81
36. Sheppard JJ, Liou J, Hochman R, Laroia S, Langlois D. Nutritional correlates of dysphagia in individuals institutionalized with mental retardation. Dysphagia 1988;3:85-9
37. Detoledo J, Icovinno J, Haddad H. Swallowing difficulties and early CNS injuries correlation with the presence of axial skeletal deformities. Brain Injury 1994;8:607-11
38. Horner J, Albert MJ, Dawson DV, Cook GM. Swallowing in Alzheimer's Disease and Assoc Disorders 1994;8(3): 177-89
39. Scott AG, Austin HE. Nasogastric feeding in the management of severe dysphagia in motor neurone disease. Palliative Med 1994; 8:45-9
40. Branski D, Levy J, Globus M, Aviad I, Keren A, Chowers I. Dysphagia as a primary manifestation of hyperthyroidism. J Clin Gastroenterol 1984;6:437-40
41. Henderson RD, Boszko A, VanNostrand AWP. Pharyngoesophageal dysphagia and recurrent laryngeal nerve palsy. J Thorac Cardiovasc Surg 1974;68:507-12
42. Ekberg O, Lindgren S, Schultze T. Pharyngeal swallowing in patients with paresis of the recurrent nerve. Acta Radiol Diagn 1986;276:697-700
43. Mandelstam P, Siegel CL, Lieber A, Siegel M. The swallowing disorder in patients with diabetic neuropathy-gastroenteropathy. Gastroenterology 1969;56:1-12
44. Murakami K, Nambu S, Tsushima M, Nishioheda Y, Koh H, Hayashi R, Toho H, Ikeda M. Coma preceded by severe dysphagia in type II diabetes mellitus. Jpn J Med 1982;21:197-202
45. Borgstrom PS, Olsson R, Sundkvist G, Ekberg O. Pharyngeal and oesophageal function in patients with diabetes mellitus and swallowing complaints. Br J Radiol 1988;61:817-21
46. Bubl R, Schon B. Dysphagia in dermatologie disease. Dysphagia 1993;8:85-90
47. Jones B, Ravich WJ, Donner MW. Dysphagia in systemic disease. Dysphagia 1993;6:868-83
48. Deron P. Dysphagia with systemic diseases. Acta Oto-Rhino-Laryngol Belg 1994;48:191-200
49. Darrow DH, Hoffman HT, Barnes GJ, Wiley CA. Management of dysphagia in inclusion body myositis. Arch Otolaryngol Head Neck Surg 1992;118:313-7
50. Riminton DS, Chambers ST, Parkin PJ, Pollock M, Donaldson IM. Inclusion body myositis presenting solely as dysphagia. Neurology 1993;43.1241-3
51. Kaufman RL, Glenn WV. Rheumatoid cervical myelopathy: Evaluation by computerized tomography with multiplanar reconstruction. J Rheumatol 1983;10:42-54
52. Roy TM, Ossorio MA, Cipolla LM, Fields CL, Snider HL, Anderson WH. Pulmonary complications after tricyclic antidepressant overdose. Chest 1989.96:852-6
53. Hughes TAT, Shone G, Lindsay G, Wiles CM. Severe dysphagia associated with major tranquilizer treatment. Postgrad Med J 1994;70:581-3
54. Craig TJ, Richardson MA, Bark NM, Klebanov R. Impairment of swallowing, tardive dyskinesia, and anticholinergic drug use. Psychopharmacol Bull 1982;18(1):84-6
55. Bazemore PH, Tonkonogy J, Ananth R. Dysphagia in psychiatric patients: Clinical and videofluoroscopic study. Dysphagia 1991; 6:2-5
56. Gregory RP, Smith PT, Rudge P. Tardive dyskinesia presenting as severe dysphagia. J Neurol Neurosurg Psychiatry 1992;55: 1203-4
57. Sliwa JA, Lis S. Drug-induced dysphagia. Arch Phys Med Rehabil 1993,74:445-7
58. Mistretta N. Difficulty in swallowing accompanied by fever in a 66-year-old man with a history of schizophrenia. J Emerg Nurs 1990;16(6):417-8
59. Ebaldi M, Pfeiffer RF, Murrin LC. Pathogenesis and treatment of neuroleptic malignant syndrome. Gen Pharmacol 1990; 21(4): 367-86
60. Craig TJ, Richardson MA, Bark MD, Klebanov R. Impairment of Swallowing, tardive dyskinesia, and anticholinergic drug use. PsychoPharmacology Bulletin 1982;18(1):84-6
61. Weiden P, Harrigan M. A clinical guide for diagnosing and managing patients with drug-induced dysphagia. Hosp Commun Psychiatry 1986;37:396-8
62. Kuncl RW, Wiggins WW. Toxic myopathies. Neurol Clin 1988; 6:593-619
63. Selley WG, Glack FC, Ellis RE, Brooks WA. The Exeter dysphagia assessment technique. Dysphagia 1990;4:227-35
64. Hughes CV, Baum BJ, Fox PC, Marmary Y, Yen C, Sonies BC. Oral-pharyngeal dysphagia: a common sequela of salivary gland dysfunction. Dysphagia 1987;1:173-7
65. Loesche WJ, Bromberg J, Terpenning MS, Bretz WA, Dominguez BL, Grossman NS, Langmore SE. Xerostomia, xerogenic medications and food avoidances in selected geriatric groups. JAGS 1995;43:401-7
66. Hambraeus GM, Ekberg O, Fletcher R. Pharyngeal dysfunction after total and subtotal oesophagectomy. Acta Radiol 1987; 28 409-13
67. Heitmiller RF, Jones B. Transient diminished airway protection after transhiatal esophagectomy. Am J Surg 1991;162:442-6
68. Griffin SM, vanHasselt CA, Li AKC. Late swallowing and aspiration problems after esophagectomy for cancer: malignant infiltration of the recurrent laryngeal nerves and its management. Surgery 1992;112:533-5
69. Hirano M, Fujita M, Tanaka S, Fujita H. Vocal cord paralysis caused by esophageal cancer surgery. Ann Otol Rhinol Laryngol 1993;102:182-5
70. Bulger RF, Rejowski JE, Beatty RA. Vocal cord paralysis associated with anterior cervical fusion: considerations for prevention and treatment. J Neurosurg 1985;62:657-61
71. Welsh LW, Welsh JJ, Chinnici JC. Dysphagia due to cervical spine surgery. Ann Otol Rhinol Laryngol 1987;96:112-5
72. Graham JJ. Complications of cervical spine surgery: a 5 year report on a survey of the membership of the cervical spine research society by the morbidity and mortality committee. Spine 1989;14:1048-50
73. Clements DH, O'Leary PF. Anterior cervical discectomy and fusion. Spine 1990;15:1023-5
74. Buchholz DW, Jones B, Ravich WJ. Dysphagia following anterior cervical fusion Dysphagia 1993;8:390
75. Ekberg O, Bergqvist D, Takolander R, Uddman R, Kitzing P. Pharyngeal function after carotid endarterectomy. Dysphagia 1989;4:151-4
76. Rosenbloom M, Friedman SG, Lamparello PJ, Riles TS, Imparato AM. Glossopharyngeal nerve injury complicating carotid endarterectomy. J Vasc Surg 1987;5:469-71
77. Hogue CW, Lappas GD, Creswell LL, Ferguson TB, Sample M, Pugh D, Balfe D, Cox JL, Lappas G. Swallowing dysfunction after cardiac operations: associated adverse outcomes and risk factors including intraoperative transesophageal echocardiography. J Thorac Cardiovasc Surg 1995;100:517-22
78. Tuman KJ, McCarthy RJ, Najafi H, Ivankovich AD. Differential effects of advanced age on neurologic and cardiac risks of coronary artery operations. J Thorac Cardiovasc Surg 1992;104:1510-7
79. Ricotta JJ, Faggioli GL, Castilone A, Hassen JM. Risk factors for stroke after cardiac surgery: Buffalo cardiac-cerebral study group. J Vasc Surg 1995;21:359-64
80. George DL. Epidemiology of nosocomial pneumonia in intensive care unit patients. Clin Chest Med 1995;16(1):29-44
81. Higuchi JH, Johanson WG. The relationship between adherence of Pseudomonas aeruginosa to upper respiratory cells in vitro and susceptibility to colonization in vivo. J Lab Clin Med 1980; 95:698-704
82. Craven DE, Driks MR. Nosocomial pneumonia in the intubated patient. Semin Respir Infect 1987;2:20-3
83. Harkness GA, Bentley DW, Roghmann KJ Risk factors for nosocomial pneumonia in the elderly. Am J Med 1990;89:457-63
84. Niederman MS. Nosocomial pneumonia in the elderly patient. Clin Chest Med Pulmon Dis Elderly Patient 1993;14: 479-90
85. Sitzmann JV. Nutritional support of the dysphagic patient: methods, risks, and complications of therapy. J Parent Enter Nutr 1990;14(1):60-3
86. Finegold SM. Aspiration pneumonia. Rev Infect Dis 1991; 13(Suppl 9):S737-42
87. Verghese A, Berk SL. Bacterial pneumonia in the elderly. Medicine 1983;62:271-85
88. Schmidt J, Holas M, Halvorson K, Reding M. Videofluoroscopic evidence of aspiration predicts pneumonia and death but not dehydration following stroke. Dysphagia 1994;9:7-11
89. Martin BJW, Corlew MM, Wood H, Olson D, Golopol LA, Wingo M, Kirmani N. The association of swallowing dysfunction and aspiration pneumonia. Dysphagia 1994;9:1-6
90. Johnson ER, McKenzie SW, Sievers A. Aspiration pneumonia in stroke. Arch Phys Med Rehabil 1993;74:973-6
91. Holas MA, DePippo KL, Reding MJ. Aspiration and relative risk of medical complications following stroke. Arch Neurol 1994;51:1051-3
92. Johanson WG, Higuchi JH, Chaudhuri TR, Woods DE. Bacterial adherence to epithelial cells in bacillary colonization of the respiratory tract. Am Rev Respir Dis 1980;121:55-63
93. Johanson WG, Pierce AK, Sanford JP. Changing bacterial flora of hospitalizated patients: emergence of gram-negative bacilli. N Engl J Med 1969;281:1137-40
94. Johanson WG, Woods DE, Chaudhuri T. Association of respiratory tract colonization with adherence of gram-negative bacilli to epithelial cells. J Infect Dis 1979;139:667-73
95. Joshi M, Ciesla N, Caplan E. Diagnosis of pneumonia in critically ill patients. Chest 1988;98:4S
96. Joshi N, Localio AR, Hamory BH. A predictive risk index for nosocomial pneumonia in the intensive care unit. Am J Med 1992;93:135-42
97. Elpern EH, Jacobs ER, Bone RC. Incidence of aspiration in tracheally intubated adults. Heart Lung 1987;16:527-31
98. Ciocon JO, Silverstone FA, Graver M, Foley CJ. Tube feedings in elderly patients. Arch Intern Med 1988;148:429-33
99. Olivares L, Segovia A, Revuelta R. Tube feeding and lethal aspiration in neurological patients: a review of 720 autopsy cases. Stroke 1974;5:645-7
100. Metheny NA, Eisenber P, Spies M. Aspiration pneumonia in patients fed through enterai tubes. Heart Lung 1986;15: 256-61
101. Kingston GW, Phang PT, Leathley MJ. Increased incidence of nosocomial pneumonia in mechanically ventilated patients with subclinical aspiration. Am J Surg 1991;161:589-92
102. Splaingard ML, Hutchins B, Sulton LD, Chaudhuri G. Aspiration in rehabilitation patients Videofluoroscopy vs bedside clinical assessment. Arch Phys Med Rehabil 1988;69:637-40
103. Spray SB, Zuidema GD, Cameron JL. Aspiration pneumonia: Incidence of aspiration with endotracheal tubes. Am J Surg 1976;31:701-3
104. Colice GL, Stukel TA, Dain B. Laryngeal complications of prolonged intubation. Chest 1989;96(4):877-84
105. DeVita MA, Spierer-Rundback L. Swallowing disorders in patients with prolonged orotracheal intubation or tracheostomy tubes. Crit Care Med 1990;18:1328-30
106. de Larminat V, Montravers P, Dureuil B, Desmonts JM. Alteration in swallowing reflex after extubation in intensive care unit patients. Crit Care Med 1995;23:486-90
107. Tolep K, Getch CL, Criner GJ. Swallowing dysfunction in patients receiving prolonged mechanical ventilation. Chest 1996; 109:167-72
108. Stauffer JL, Olson DE, Petty TL. Complications and consequences of endotracheal intubation and tracheotomy. Am J Med 1981;70:65-74
109. Sasaki CT, Buckwalter J. Laryngeal function. Am J Otolaryngol 1984;5:281-91
110. Terpenning M, Bretz W, Lopatin D, Langmore S, Dominguez B, Loesche W. Bacterial colonization of saliva and plaque in the elderly. Clin Infect Dis 1993;16(Suppl 4):S314-6
111. Opper FH, Burakoff R. Nutritional support of the elderly patient in an intensive care unit. Clin Geriatr Med 1994;10:31-49
112. Veldee MS, Peth LD. Can protein-calorie malnutrition cause dysphagia? Dysphagia 1992;7:86-101
113. Langmore SE, Logemann JA. After the clinical bedside swallowing examination: What next? Am J Speech Lang Pathol 1991;1:13-20
114. Davies AE, Kidd D. Prevalence of the gag reflex and pharyngeal sensation in healthy elderly subjects. Age Ageing 1993;23(S1):15
115. Smithard D. Gag and stroke J R Coll Psysicians London 1994; 28(6):584
116. Linden P, Siebens AA. Dysphagia: Predicting laryngeal penetration. Arch Phys Med Rehabil 1983;64:281-4
117. Linden P, Kuhlemeier KV, Patterson C. The probability of correctly predicting subglottic penetration from clinical observations. Dysphagia 1993;8:170-9
118. Kennedy G, Pring T, Fawcus R. No place for motor speech acts in the assessment of dysphagia? Intelligibility and swallowing difficulties in stroke and Parkinson's disease patients. Eur J Dis Commun 1993;28:213-26
119. McFadden JP, Price RC, Eastwood HD, Briggs RS. Raised respiratory rate in elderly patients: a valuable physical sign. Br Med J 1982;284:626-7
120. Teba L, Omert LA. Postoperative respiratory insufficiency. Am Fam Physician 1995;51:1473-80
121. Zaidi NH, Smith HA, King SC, Park C, O'Neill PA, Connolly MJ. Oxygen desaturation on swallowing as a potential marker of aspiration in acute stroke. Age Ageing 1995;24:267-70
122. Rogers B, Msall M, Shucard D. Hypoxemia during oral feedings in adults with dysphagia and severe neurological disabilities. Dysphagia 1993;8:43-8
123. Chapman KR, Rebuck AS. Dysphagia as a manifestation of occult hypoxemia. Chest 1991;99:1030-2
124. DePippo KL, Lolas MA, Reding MJ. Validation of the 3-oz water swallow test for aspiration following stroke. Arch Neurol 1992;49:1259-61
125. Thompson-Henry S, Braddock B. The modified Evans blue dye procedure fails to detect aspiration in tracheostomized patient: 5 case reports. Dysphagia 1995;10:172-4
126. Cameron J, Reynolds J, Zuidema G. Aspiration in patients with tracheostomies. Surg Gynecol Obstet 1973;136:68-70
127. Potts RG, Zaroukian MH, Guerrero PA, Baker CD. Comparison of blue dye visualization and glucose oxidase test strip methods for detecting pulmonary aspiration of enteral feedings in intubated adults. Chest 1993;103:117-21
128. Logemann JA. Evaluation and treatment of swallowing disorders. San Diego: College-Hill Press, 1983
129. Langmore SE, Schatz K, Olsen N. Fiberoptic endoscopic examination of swallowing safety: a new procedure. Dysphagia 1988;2:216-9
130. Murray J, Langmore SE, Ginsberg S, Dostie A. The significance of accumulated oropharyngeal secretions and swallowing frequency in predicting aspiration. Dysphagia 1996;11:99-103
131. Aviv JE, Martin JH, Sacco RL, Zagar D, Diamond B, Keen MS, Blitzer A. Supraglottic and pharyngeal sensory abnormalities in stroke patients with dysphagia. Ann Otol Rhinol Laryngol 1996;105:92-7
132. Valles J, Artigas A, Rello J, Bonsoms N, Fontanals D, Blanch L, Fernandez R, Baigotti F, Mestre J. Continuous aspiration of subglottic secretions in preventing ventilator-associated pneumonia. Ann Intern Med 1995;122:179-86
133. Meguto K, Yamagauchi S, Doi C, Nakamura T, Sekizawa K, Sasaki H. Prevention of respiratory infections in elderly bed-bound nursing home patients. Tohoku J Exp Med 1992;167: 135-42
134. Duncan RA, Seger KA, Craven DE. Selective decontamination of the digestive tract: risks outweigh benefits for intensive care unit patients. Semin Respir Infect 1993;8:308-24
135. Ahronheim JC. Nutrition and hydration in the terminal patient. Clin Geriatr Med 1996;12:379-91
136. DiSario JA, Foutch PG, Sanowski RA. Poor results with percutaneous endoscopic jejunostomy. Gastrointest Endosc 1990; 36:257-60
137. Kaplan DS, Murthy UK, Linscheer WG. Percutaneous endoscopic jejunostomy: long-term follow-up of 23 patients. Gastrointest Endosc 1989;35:403-6
138. Feinberg MJ, Knebi J, Tully J. Prandial aspiration and pneumonia in an elderly population followed over 3 years. Dysphagia 1996;11:104-9
139. Croghan JE, Burke EM, Caplan S, Denman S. Pilot study of 12-month outcomes in nursing home patients with aspiration on videofluoroscopy. Dysphagia 1994;9:141-6
140. Leff B, Cheuvront N, Russell W. Discontinuing feeding tubes in a community nursing home. Gerontologist 1994;34: 130-3
141. McCann RM, Hall WJ, Groth-Juncker A. Comfort care for terminally ill patients: The appropriate use of nutrition and hydration. JAMA 1994;272:1263-6
142. Groher ME. Ethical dilemmas in providing nutrition. Dysphagia 1990;5:102-9
143. Nash M. Swallowing problems in the tracheotomized patient. Otolaryngol Clin North Am 1988;21:701-9
144. Dettelbach MA, Gross RD, Mahlmann J, Eibling DE. Effect of the Passy-Muir valve on aspiration in patients with tracheostomy. Head Neck 1995;17:297-30