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Long-term outcomes after surgery to prevent aspiration for patients with amyotrophic lateral sclerosis

BACKGROUND: Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease that affects motor neurons selectively. In particular, weakness in respiratory and swallowing muscles occasionally causes aspiration pneumonia and choking, which can be lethal. Surgery to prevent aspiration, w...

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Autores principales: Soga, Temma, Suzuki, Naoki, Kato, Kengo, Kawamoto-Hirano, Ai, Kawauchi, Yuko, Izumi, Rumiko, Toyoshima, Masaya, Mitsuzawa, Shio, Shijo, Tomomi, Ikeda, Kensuke, Warita, Hitoshi, Katori, Yukio, Aoki, Masashi, Kato, Masaaki
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8925201/
https://www.ncbi.nlm.nih.gov/pubmed/35296264
http://dx.doi.org/10.1186/s12883-022-02619-z
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author Soga, Temma
Suzuki, Naoki
Kato, Kengo
Kawamoto-Hirano, Ai
Kawauchi, Yuko
Izumi, Rumiko
Toyoshima, Masaya
Mitsuzawa, Shio
Shijo, Tomomi
Ikeda, Kensuke
Warita, Hitoshi
Katori, Yukio
Aoki, Masashi
Kato, Masaaki
author_facet Soga, Temma
Suzuki, Naoki
Kato, Kengo
Kawamoto-Hirano, Ai
Kawauchi, Yuko
Izumi, Rumiko
Toyoshima, Masaya
Mitsuzawa, Shio
Shijo, Tomomi
Ikeda, Kensuke
Warita, Hitoshi
Katori, Yukio
Aoki, Masashi
Kato, Masaaki
author_sort Soga, Temma
collection PubMed
description BACKGROUND: Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease that affects motor neurons selectively. In particular, weakness in respiratory and swallowing muscles occasionally causes aspiration pneumonia and choking, which can be lethal. Surgery to prevent aspiration, which separates the trachea and esophagus, can reduce the associated risks. Central-part laryngectomy (CPL) is a relatively minimally invasive surgery to prevent aspiration. No studies have been conducted on the long-term outcomes of surgery to prevent aspiration in patients with ALS. This case series aimed to determine the long-term outcomes of surgery to prevent aspiration and the use of a continuous low-pressure aspirator in patients with ALS by evaluating the frequency of intratracheal sputum suctions performed per day, intra- and postoperative complications, oral intake data, and satisfaction of patients and their primary caregiver to predict improvement in patients’ quality of life (QOL). METHODS: We report a case series of six patients with ALS who underwent CPL along with tracheostomy to prevent aspiration between January 2015 and November 2018. We evaluated their pre- and postoperative status and administered questionnaires at the time of last admission to the patients and their primary caregivers. RESULTS: The mean follow-up period after CPL was 33.5 months. Aerophagia was a common postoperative complication. The use of a continuous low-pressure aspirator resulted in reduced frequency of intratracheal sputum suctions. All cases avoided aspiration pneumonia. Oral intake was continued for 2–4 years after the tracheostomy and CPL. The satisfaction levels of the patient and primary caregiver were high. CONCLUSION: Our case series suggests that the use of a continuous low-pressure aspirator in patients undergoing CPL improves oral intake and reduces the frequency of intratracheal sputum suctions, which improves the QOL of patients with ALS and their families and caregivers. CPL and continuous low-pressure aspiration should be considered as a management option for ALS with significant bulbar and respiratory muscle weakness/dysfunction. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12883-022-02619-z.
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spelling pubmed-89252012022-03-23 Long-term outcomes after surgery to prevent aspiration for patients with amyotrophic lateral sclerosis Soga, Temma Suzuki, Naoki Kato, Kengo Kawamoto-Hirano, Ai Kawauchi, Yuko Izumi, Rumiko Toyoshima, Masaya Mitsuzawa, Shio Shijo, Tomomi Ikeda, Kensuke Warita, Hitoshi Katori, Yukio Aoki, Masashi Kato, Masaaki BMC Neurol Research Article BACKGROUND: Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease that affects motor neurons selectively. In particular, weakness in respiratory and swallowing muscles occasionally causes aspiration pneumonia and choking, which can be lethal. Surgery to prevent aspiration, which separates the trachea and esophagus, can reduce the associated risks. Central-part laryngectomy (CPL) is a relatively minimally invasive surgery to prevent aspiration. No studies have been conducted on the long-term outcomes of surgery to prevent aspiration in patients with ALS. This case series aimed to determine the long-term outcomes of surgery to prevent aspiration and the use of a continuous low-pressure aspirator in patients with ALS by evaluating the frequency of intratracheal sputum suctions performed per day, intra- and postoperative complications, oral intake data, and satisfaction of patients and their primary caregiver to predict improvement in patients’ quality of life (QOL). METHODS: We report a case series of six patients with ALS who underwent CPL along with tracheostomy to prevent aspiration between January 2015 and November 2018. We evaluated their pre- and postoperative status and administered questionnaires at the time of last admission to the patients and their primary caregivers. RESULTS: The mean follow-up period after CPL was 33.5 months. Aerophagia was a common postoperative complication. The use of a continuous low-pressure aspirator resulted in reduced frequency of intratracheal sputum suctions. All cases avoided aspiration pneumonia. Oral intake was continued for 2–4 years after the tracheostomy and CPL. The satisfaction levels of the patient and primary caregiver were high. CONCLUSION: Our case series suggests that the use of a continuous low-pressure aspirator in patients undergoing CPL improves oral intake and reduces the frequency of intratracheal sputum suctions, which improves the QOL of patients with ALS and their families and caregivers. CPL and continuous low-pressure aspiration should be considered as a management option for ALS with significant bulbar and respiratory muscle weakness/dysfunction. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12883-022-02619-z. BioMed Central 2022-03-16 /pmc/articles/PMC8925201/ /pubmed/35296264 http://dx.doi.org/10.1186/s12883-022-02619-z Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research Article
Soga, Temma
Suzuki, Naoki
Kato, Kengo
Kawamoto-Hirano, Ai
Kawauchi, Yuko
Izumi, Rumiko
Toyoshima, Masaya
Mitsuzawa, Shio
Shijo, Tomomi
Ikeda, Kensuke
Warita, Hitoshi
Katori, Yukio
Aoki, Masashi
Kato, Masaaki
Long-term outcomes after surgery to prevent aspiration for patients with amyotrophic lateral sclerosis
title Long-term outcomes after surgery to prevent aspiration for patients with amyotrophic lateral sclerosis
title_full Long-term outcomes after surgery to prevent aspiration for patients with amyotrophic lateral sclerosis
title_fullStr Long-term outcomes after surgery to prevent aspiration for patients with amyotrophic lateral sclerosis
title_full_unstemmed Long-term outcomes after surgery to prevent aspiration for patients with amyotrophic lateral sclerosis
title_short Long-term outcomes after surgery to prevent aspiration for patients with amyotrophic lateral sclerosis
title_sort long-term outcomes after surgery to prevent aspiration for patients with amyotrophic lateral sclerosis
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8925201/
https://www.ncbi.nlm.nih.gov/pubmed/35296264
http://dx.doi.org/10.1186/s12883-022-02619-z
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