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  • 1
    Online Resource
    Online Resource
    Increase of Substance P Concentration in Saliva after Pharyngeal Electrical Stimulation in Severely Dysphagic Stroke Patients – an Indicator of Decannulation Success?
    S. Karger AG ; 2017
    In:  Neurosignals Vol. 25, No. 1 ( 2017), p. 74-87
    Details
    In: Neurosignals, S. Karger AG, Vol. 25, No. 1 ( 2017), p. 74-87
    Type of Medium: Online Resource
    ISSN: 1424-862X , 1424-8638
    URL: Article
    DOI: 10.1159/000482002
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2017
    detail.hit.zdb_id: 2061922-4
    SSG: 12
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  • 2
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    The Effect of Improved Dysphagia Care on Outcome in Patients with Acute Stroke: Trends from 8-Year Data of a Large Stroke Register
    S. Karger AG ; 2018
    In:  Cerebrovascular Diseases Vol. 45, No. 3-4 ( 2018), p. 101-108
    Details
    In: Cerebrovascular Diseases, S. Karger AG, Vol. 45, No. 3-4 ( 2018), p. 101-108
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 Early dysphagia screening and appropriate management are recommended by current guidelines to reduce complications and case fatality in acute stroke. However, data on the potential benefit of changes in dysphagia care on patient outcome are limited. Our objective was to assess the degree of implementation of dysphagia guidelines and determine the impact of modifications in dysphagia screening and treatment practices on disease complications and outcome in stroke patients over time. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 In this prospective register-based study (“Stroke Register of Northwestern Germany”), all adult stroke patients admitted to 157 participating hospitals between January, 2008 and December, 2015 were included ( 〈 i 〉 n 〈 /i 〉 = 674,423). Dysphagia incidence upon admission, the proportion of patients receiving a standardized swallowing screening, and the percentage of dysphagic patients being referred to a speech language therapist (SLT) for treatment were obtained per year. Pneumonia rate, modified Rankin Scale (mRS) at discharge, and in-hospital mortality were compared between groups of dysphagic vs. non-dysphagic patients over time. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 Screening proportions continuously increased from 47.2% in 2008 to 86.6% in 2015. But the proportion diagnosed with dysphagia remained stable with about 19%. The number of dysphagic patients receiving SLT treatment grew from 81.6 up to 87.0%. Pneumonia incidence was higher in dysphagic stroke cases (adjusted OR 5.4 [5.2–5.5], 〈 i 〉 p 〈 /i 〉 & #x3c; 0.001), accompanied by a worse mRS at discharge (adjusted OR for mRS ≥3: 3.1 [3.0–3.1], 〈 i 〉 p 〈 /i 〉 & #x3c; 0.001) and higher mortality (adjusted OR 3.1 [3.0–3.2], 〈 i 〉 p 〈 /i 〉 & #x3c; 0.001). The order of magnitude of these end points did not change over time. 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 Although advances have been made in dysphagia care, prevalent screening and treatment practices remain insufficient to reduce pneumonia rate, improve functional outcome, and decrease case fatality in dysphagic stroke patients. More research is urgently needed to develop more effective swallowing therapies.
    Type of Medium: Online Resource
    ISSN: 1015-9770 , 1421-9786
    URL: Article
    DOI: 10.1159/000487811
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2018
    detail.hit.zdb_id: 1482069-9
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  • 3
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    Online Resource
    Tracheostomy, Extubation, Reintubation: Airway Management Decisions in Intubated Stroke Patients
    S. Karger AG ; 2017
    In:  Cerebrovascular Diseases Vol. 44, No. 1-2 ( 2017), p. 1-9
    Details
    In: Cerebrovascular Diseases, S. Karger AG, Vol. 44, No. 1-2 ( 2017), p. 1-9
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 Both delayed and premature extubation increase complication rate, the need for tracheostomy (TT), the duration of intensive care unit stay, and mortality. In this study, we therefore investigated factors associated with primary TT and predictors for extubation failure (EF) in a sample of severely affected ventilated stroke patients. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 One hundred eighty five intubated stroke patients were prospectively analyzed in this observational study. Patients not meeting predefined clinical and respiratory extubation criteria received a TT. All other patients were extubated and followed up for the need of reintubation. Characteristics of patients with and without extubation attempt were examined. Additionally, within the group of extubated patients, subgroups of successfully vs. unsuccessfully extubated patients were compared. Clinical factors associated with reintubation, including a previously established semi-quantitative airway score, were determined and predictors of EF were assessed. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 Ninety-eight of 185 patients (53%) were primarily extubated; EF rate was 37% (36 patients). Eighty-seven (47%) were tracheostomized without a prior extubation attempt. Primarily tracheostomized patients had more severe strokes, which were more often hemorrhagic, presented with a lower level of consciousness, needed neurosurgical intervention more often, had a higher rate of obesity, and were more frequently intubated because of suspicion of compromised protective reflexes. EF was independently predicted by prior neurosurgical treatment and low airway management scores. No differences were found for the ability to follow simple commands and classical weaning criteria. 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 Airway management decisions in intubated stroke patients represent a clinical challenge. Classical weaning criteria and parameters reflecting the patient's state of consciousness are not reliably predictive of extubation success. Criteria more closely related to airway safety and secretion handling may provide the most relevant information and should therefore be assessed by specific clinical scoring systems.
    Type of Medium: Online Resource
    ISSN: 1015-9770 , 1421-9786
    URL: Article
    DOI: 10.1159/000471892
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2017
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  • 4
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    Online Resource
    Pharyngolaryngeal Sensory Deficits in Patients with Middle Cerebral Artery Infarction: Lateralization and Relation to Overall Dysphagia Severity
    S. Karger AG ; 2017
    In:  Cerebrovascular Diseases Extra Vol. 7, No. 3 ( 2017-10-3), p. 130-139
    Details
    In: Cerebrovascular Diseases Extra, S. Karger AG, Vol. 7, No. 3 ( 2017-10-3), p. 130-139
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 Dysphagia is a frequent and dangerous complication of acute stroke. Apart from a well-timed oropharyngeal muscular contraction pattern, sensory feedback is of utmost importance for safe and efficient swallowing. In the present study, we therefore analyzed the relation between pharyngolaryngeal sensory deficits and post-stroke dysphagia (PSD) severity in a cohort of acute stroke patients with middle cerebral artery (MCA) infarction. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 Eighty-four first-ever MCA stroke patients (41 left, 43 right) were included in this trial. In all patients, fiberoptic endoscopic evaluation of swallowing (FEES) was performed according to a standardized protocol within 96 h after stroke onset. PSD was classified according to the 6-point fiberoptic endoscopic dysphagia severity scale. Pharyngolaryngeal sensation was semi-quantitatively evaluated by a FEES-based touch technique. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 PSD severity was closely related to the pharyngolaryngeal sensory deficit. With regards to lateralization of the sensory deficit, there was a slight but significant preponderance of sensory loss contralateral to the side of stroke. Apart from that, right hemispheric stroke patients were found to present with a more severe PSD. 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 This study provides evidence that an intact sensory feedback is of utmost importance to perform nonimpaired swallowing and highlights the key role of disturbed pharyngeal and laryngeal afferents in the pathophysiology of PSD.
    Type of Medium: Online Resource
    ISSN: 1664-5456
    URL: Article
    DOI: 10.1159/000479483
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2017
    detail.hit.zdb_id: 2651613-5
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  • 5
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    Online Resource
    Introducing a Virtual Lesion Model of Dysphagia Resulting from Pharyngeal Sensory Impairment
    S. Karger AG ; 2018
    In:  Neurosignals Vol. 26, No. 1 ( 2018), p. 1-1
    Details
    In: Neurosignals, S. Karger AG, Vol. 26, No. 1 ( 2018), p. 1-1
    Type of Medium: Online Resource
    ISSN: 1424-862X , 1424-8638
    URL: Article
    DOI: 10.1159/000487037
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2018
    detail.hit.zdb_id: 2061922-4
    SSG: 12
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  • 6
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    Navigated Deep Brain Stimulation Surgery: Evaluating the Combined Use of a Frame-Based Stereotactic System and a Navigation System
    S. Karger AG ; 2021
    In:  Stereotactic and Functional Neurosurgery Vol. 99, No. 1 ( 2021), p. 48-54
    Details
    In: Stereotactic and Functional Neurosurgery, S. Karger AG, Vol. 99, No. 1 ( 2021), p. 48-54
    Abstract: Deep brain stimulation (DBS) is a complex surgical procedure that requires detailed anatomical knowledge. In many fields of neurosurgery navigation systems are used to display anatomical structures during an operation to aid performing these surgeries. In frame-based DBS, the advantage of visualization has not yet been evaluated during the procedure itself. In this study, we added live visualization to a frame-based DBS system, using a standard navigation system and investigated its accuracy and potential use in DBS surgery. As a first step, a phantom study was conducted to investigate the accuracy of the navigation system in conjunction with a frame-based approach. As a second step, 5 DBS surgeries were performed with this combined approach. Afterwards, 3 neurosurgeons and 2 neurologists with different levels of experience evaluated the potential use of the system with a questionnaire. Moreover, the additional personnel, costs and required set up time were noted and compared to 5 consecutive standard procedures. In the phantom study, the navigation system showed an inaccuracy of 2.1 mm (mean SD 0.69 mm). In the questionnaire, a mean of 9.4/10 points was awarded for the use of the combined approach as a teaching tool, a mean of 8.4/10 for its advantage in creating a 3-dimensional (3-D) map and a mean of 8/10 points for facilitating group discussions. Especially neurosurgeons and neurologists in training found it useful to better interpret clinical results and side effects (mean 9/10 points) and neurosurgeons appreciated its use to better interpret microelectrode recordings (mean 9/10 points). A mean of 6/10 points was awarded when asked if the benefits were worth the additional efforts. Initially 2 persons, then one additional person was required to set up the system with no relevant added time or costs. Using a navigation system for live visualization during frame-based DBS surgery can improve the understanding of the complex 3-D anatomy and many aspects of the procedure itself. For now, we would regard it as an excellent teaching tool rather than a necessity to perform DBS surgeries.
    Type of Medium: Online Resource
    ISSN: 1011-6125 , 1423-0372
    URL: Article
    DOI: 10.1159/000510528
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2021
    detail.hit.zdb_id: 1483576-9
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  • 7
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    Safety, Tolerability and Clinical Effects of a Rapid Dose Titration of Subcutaneous Treprostinil Therapy in Pulmonary Arterial Hypertension: A Prospective Multi-Centre Trial
    S. Karger AG ; 2016
    In:  Respiration Vol. 92, No. 6 ( 2016), p. 362-370
    Details
    In: Respiration, S. Karger AG, Vol. 92, No. 6 ( 2016), p. 362-370
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 Subcutaneous treprostinil has dose-dependent beneficial effects in patients with severe pulmonary arterial hypertension, but adverse effects like infusion site pain can lead to treatment discontinuation. 〈 b 〉 〈 i 〉 Objectives: 〈 /i 〉 〈 /b 〉 The objective of this study was to evaluate safety, tolerability and clinical effects of a rapid up-titration dosing regimen of subcutaneous treprostinil using proactive infusion site pain management. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 Effects of rapid up-titration dosing regimen on tolerability and clinical parameters were evaluated in this 16-week, open-label multi-centre study. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 Thirty-nine patients with idiopathic or heritable pulmonary arterial hypertension on stable treatment with oral pulmonary arterial hypertension-approved drugs (90% on dual combination therapy) were included. Patients achieved a median treprostinil dosage of 35.7 ng/kg/min after 16 weeks. A good overall safety profile was demonstrated with 3 patients (8%) withdrawing due to infusion site pain, which occurred in 97% of patients. After 16 weeks, median 6-min walking distance, cardiac index, pulmonary vascular resistance, and tricuspid annular plane systolic excursion improved. 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 Rapid up-titration of subcutaneous treprostinil was well tolerated, achieving a clinically effective dose associated with improvement of exercise capacity and haemodynamics after 16 weeks. A rapid dose titration regimen and proactive infusion site pain management may improve the handling of this therapy and contribute to better treatment outcome.
    Type of Medium: Online Resource
    ISSN: 0025-7931 , 1423-0356
    URL: Article
    DOI: 10.1159/000450759
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2016
    detail.hit.zdb_id: 1464419-8
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  • 8
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    Online Resource
    Measurement of Oxygen Desaturation Is Not Useful for the Detection of Aspiration in Dysphagic Stroke Patients
    S. Karger AG ; 2017
    In:  Cerebrovascular Diseases Extra Vol. 7, No. 1 ( 2017-3-4), p. 44-50
    Details
    In: Cerebrovascular Diseases Extra, S. Karger AG, Vol. 7, No. 1 ( 2017-3-4), p. 44-50
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 Dysphagia is one of the most dangerous symptoms of acute stroke. Various screening tools have been suggested for the early detection of this condition. In spite of conflicting results, measurement of oxygen saturation (SpO 〈 sub 〉 2 〈 /sub 〉 ) during clinical swallowing assessment is still recommended by different national guidelines as a screening tool with a decline in SpO 〈 sub 〉 2 〈 /sub 〉 ≥2% usually being regarded as a marker of aspiration. This paper assesses the sensitivity of SpO 〈 sub 〉 2 〈 /sub 〉 measurements for the evaluation of aspiration risk in acute stroke patients. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 Fifty acute stroke patients with moderate to severe dysphagia were included in this study. In all patients, fiberoptic endoscopic evaluation of swallowing (FEES) was performed according to a standardised protocol. Blinded to the results of FEES, SpO 〈 sub 〉 2 〈 /sub 〉 was monitored simultaneously. The degree of desaturation during/after swallows with aspiration was compared to the degree of desaturation during/after swallows without aspiration in a swallow-to-swallow analysis of each patient. To minimise potential confounders, every patient served as their control. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 In each subject, a swallow with and a swallow without aspiration were analysed. Overall, aspiration seen in FEES was related to a minor decline in SpO 〈 sub 〉 2 〈 /sub 〉 (mean SpO 〈 sub 〉 2 〈 /sub 〉 without aspiration 95.54 ± 2.7% vs. mean SpO 〈 sub 〉 2 〈 /sub 〉 with aspiration 95.28 ± 2.7%). However, a significant desaturation ≥2% occurred only in 5 patients during/after aspiration. There was no correlation between aspiration/dysphagia severity or the amount of aspirated material and SpO 〈 sub 〉 2 〈 /sub 〉 levels. 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 According to this study, measurement of oxygen desaturation is not a suitable screening tool for the detection of aspiration in stroke patients.
    Type of Medium: Online Resource
    ISSN: 1664-5456
    URL: Article
    DOI: 10.1159/000453083
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2017
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  • 9
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    Predicting Dysphagia with National Institute of Health Stroke Scale: Distinction between Infra- and Supratentorial Region is Essential
    S. Karger AG ; 2018
    In:  Cerebrovascular Diseases Vol. 46, No. 3-4 ( 2018), p. 150-158
    Details
    In: Cerebrovascular Diseases, S. Karger AG, Vol. 46, No. 3-4 ( 2018), p. 150-158
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 For the early detection of post-stroke dysphagia (PSD), valid screening parameters are crucial as part of a step-wise diagnostic procedure. This study examines the role of the National Institute of Health Stroke Scale (NIH-SS) as a potential low-threshold screening parameter. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 During a ten-year period, 687 newly admitted patients at University Hospital Muenster were included in a retrospective analysis, if they had ischemic or haemorrhagic stroke confirmed by neuroimaging and had received NIH-SS scoring and endoscopic swallowing evaluation upon admission. The NIH-SS score was correlated with dysphagia severity as measured by the validated 6-point fiberoptic endoscopic dysphagia severity score (FEDSS), and the ideal cut-off score to predict PSD, defined as FEDSS & #x3e; 1, was calculated. Supra- and infratentorial strokes were analysed separately due to their differing role in the pathophysiology of neurogenic dysphagia. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 NIH-SS and dysphagia severity show a significant positive correlation in the whole study population ( 〈 i 〉 R 〈 /i 〉 〈 sup 〉 2 〈 /sup 〉 = 0.745) as well as in both analysed subgroups ( 〈 i 〉 R 〈 /i 〉 〈 sup 〉 2 〈 /sup 〉 = 0.494 for supra- and 〈 i 〉 R 〈 /i 〉 〈 sup 〉 2 〈 /sup 〉 = 0.646 for infratentorial strokes, 〈 i 〉 p 〈 /i 〉 & #x3c; 0.0005, respectively). For supratentorial strokes, the ideal NIH-SS cut-off is & #x3e; 9 (sensitivity 68.3%, specificity 61.5%, positive predictive value 89.7%, negative predictive value 28.4%). For infratentorial strokes, a lower ideal cut-off & #x3e; 5 was calculated (sensitivity 67.4%, specificity 85.0%, positive predictive value 95.1%, negative predictive value 37.8%). 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 NIH-SS may be used as an adjunct to predict dysphagia in acute stroke patients with moderate sensitivity and specificity. Differentiation between supra- and infratentorial regions is essential not to miss dysphagia in infratentorial stroke.
    Type of Medium: Online Resource
    ISSN: 1015-9770 , 1421-9786
    URL: Article
    DOI: 10.1159/000493371
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2018
    detail.hit.zdb_id: 1482069-9
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