Maximum Tongue Pressure as a Measure of Post-Extubation Swallowing Ability

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  • Ryo Ichibayashi
    Department of Critical Care Center, Toho University Medical Center Omori Hospital
  • Mitsuru Honda
    Department of Critical Care Center, Toho University Medical Center Omori Hospital
  • Hideki Sekiya
    Department of Oral Surgery, Toho University Medical Center Omori Hospital
  • Hiroki Yokomuro
    Department of Critical Care Center, Toho University Medical Center Omori Hospital
  • Katsunori Yoshihara
    Department of Critical Care Center, Toho University Medical Center Omori Hospital
  • Yoshihisa Urita
    Department of Critical Care Center, Toho University Medical Center Omori Hospital

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Original Article

Background: Approximately half of all patients requiring mechanical ventilation with endotracheal intubation develop swallowing problems after extubation. Swallowing can be examined in several ways, but the preferred clinical methods are videofluoroscopic examination of swallowing or other imaging methods, which allow visual detection of abnormal swallowing patterns. Unfortunately, these imaging techniques do not allow quantitative analysis. If a device could provide numerical values in evaluating swallowing capability, research could then collect useful data to help determine when to reintroduce oral intake of food and liquids and whether aspiration is likely during such intake. Evidence suggests a relationship between maximum tongue pressure and the ability to swallow correctly. We therefore evaluated changes in tongue pressure over time in patients who had just been extubated and investigated whether significant pressure differences existed between patients who later aspirated and those who did not. Methods: The participants were 36 patients who had received mechanical ventilation by means of endotracheal intubation. Maximum tongue pressure was measured repeatedly for 1 week after extubation. The values for participants who did and did not subsequently aspirate were then compared. Results: Post-extubation tongue pressure values were lower than normal in all patients, but they increased over time. However, values for patients who aspirated were significantly lower than those for patients who could swallow normally. Conclusion: The results suggest that tongue pressure is a useful test of post-extubation swallowing ability and that it can help determine when to restart oral intake of food and liquids and identify aspiration risk.

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