Optimizing Outcomes Following Lung Transplant with Dysphagia Evaluations

Pulmonary transplant is considered a gold-standard treatment for individuals experiencing end-stage lung disease. Advances in lung transplantation including surgical techniques, donor organ management protocols, and improved immunosuppressive regimens, among other factors, have improved survival rates (Atkins et al., 2010). Current literature demonstrates that individuals undergoing lung transplants experience an increased risk for the development of dysphagia as well as morbidity (Atkins et al., 2010; Dallal-York et al., 2022; Reedy et al., 2023). Risk factors for dysphagia following lung transplant include venous-venous extracorporeal membrane oxygenation, increased duration of intubation, cardiopulmonary bypass, tracheostomy, and re-intubation (Dallal-York et al., 2021; Dallal-York et al., 2022).

Protocols to identify dysphagia for those undergoing lung transplant help improve outcomes and may include early consultation with speech pathology postoperatively utilizing the clinical swallow evaluation as well as flexible endoscopic evaluation of swallowing (FEES) and/or videofluoroscopic swallowing study (VFSS) (Atkin et al., 2007; Atkins et al., 2010).Lung transplant may result in airway invasion, with many studies utilizing the Penetration-Aspiration Scale (PAS) to detail airway invasion depth and response (Smaoui et al., 2024). Patients who aspirate following lung transplant most commonly present with silent aspiration however, they may also present with an ineffective cough response to aspirated material (Dallal-York et al., 2021; Reedy et al., 2023). Individuals who aspirate following lung transplant are at an increased risk for longer wait times to resume a regular diet, increased likelihood of developing pneumonia, and the potential need for acute rehabilitation (Dallal-York et al., 2021).

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