Algoritmo para el manejo de la aspiración pulmonar crónica en pediatría / Algorithm for the management of chronic pulmonary aspiration in pediatrics

La aspiración pulmonar es el pasaje de alimentos, reflujo gastroesofágico y/o saliva a la vía aérea de manera suficiente que ocasione síntomas respiratorios crónicos o recurrentes. Es una ausa importante de neumonía recurrente, enfermedad pulmonar progresiva, bronquiectasias e, incluso, muerte. La aspiración es intermitente y, con frecuencia, ocurre en niños con anomalías médicas subyacentes o síndromes que ocasionan síntomas respiratorios similares a la aspiración pulmonar crónica, por lo que, muchas veces, el diagnóstico de aspiración se demora hasta que haya una lesión pulmonar significativa. Se describen los métodos diagnósticos disponibles y sus limitaciones, y las opciones de tratamiento de la aspiración pulmonar crónica en la población pediátrica.

Pulmonary aspiration is the passage of food, gastroesophageal reflux and/or saliva to the airway in a manner sufficient to cause chronic or recurrent respiratory symptoms. It is an important cause of recurrent pneumonia, progressive lung disease, bronchiectasis and even death.Aspiration is intermittent and often occurs in children with underlying medical conditions or syndromes that cause respiratory symptoms similar to chronic pulmonary aspiration, so diagnosis of aspiration is often delayed until there is a significant lung injury. The available diagnostic methods and their limitations, and treatment options of chronic pulmonary aspiration in the pediatric population are described.

Abordaje diagnóstico para aspiración de cuerpo extraño en pediatría / Diagnostic approach of foreign body aspiration in pediatrics

Foreign body aspiration in children is a frequent cause of consultation in the pediatric emergency department and can be a life-threatening event. It occurs mainly during the first 4 years of life and is more frequent in males. It is possible to find the clinical triad of cough, localized wheezing and decrease of respiratory noises in 50 percent of cases. The diagnosis is based on an adequate clinical history to detect an asphyxiation event. Chest radiography is an important diagnostic tool although it is possible to find normal results in 12 to 25 percent of cases. Several studies have reported the usefulness of flexible bronchoscopy in extracting foreign bodies; however, rigid bronchoscopy remains the best choice for foreign body aspiration

La aspiración de cuerpo extraño en niños es una causa frecuente de consulta en el departamento de urgencias pediátricas y puede ser un evento potencialmente mortal. Se presenta principalmente durante los primeros 4 años de vida y es mas frecuente en el género masculino. Clínicamente es posible encontrar en un 50 por ciento de los casos la triada clínica de tos, sibilancias localizadas y disminución de ruidos respiratorios. El diagnóstico se basa en una historia clínica adecuada en la cual se busca intencionadamente el antecedente de un evento de asfixia. La radiografía de tórax es una herramienta importante para el diagnóstico aunque es posible encontrarla normal del 12 al 25 por ciento de los casos. Diversos estudios reportan la utilidad de la broncoscopia flexible en la extracción de cuerpos extraños, sin embargo la broncoscopia rígida continua siendo el estándar de oro para el manejo de la aspiración de cuerpo extraño

Aspiración de cuerpo extraño: formas de presentación y complicaciones. A propósito de cuatro casos / Foreign body aspiration: presentation and complications. Study of four cases

La aspiración de cuerpo extraño (ACE) es un evento provocado por un agente externo, esta forma de lesión puede ser evitada con medidas preventivas. Los episodios de aspiración pueden pasar desapercibidos provocando lesiones en sectores distales del árbol bronquial manifestándose en la evolución por la presencia de complicaciones. Este artículo presenta 4 casos clínicos que plantearon dificultades diagnósticas y complicaciones en su evolución. Los mismos presentan similitudes con la literatura internacional en cuanto a sus características epidemiológicas ya que predominan en menores de 3 años, varones, en días festivos, predomina el maní como cuerpo extraño y existió un retraso en el diagnóstico en la mayoría de los casos. En el diagnóstico de la ACE se debe tener en cuenta el antecedente de sofocación o tos con dificultad respiratoria en un niño previamente asintomático que se encontraba jugando o comiendo. El examen físico y radiológico pueden ser normales después que el episodio de sofocación ha pasado, por lo que es necesario un alto índice de sospecha para el diagnóstico. Frente a la sospecha de ACE se debe realizar broncoscopía rígida porque ésta constituye el mejor método diagnóstico y terapéutico. Asimismo, hay que considerar el diagnóstico en pacientes que presentan neumonías recurrentes o lesiones persistentes sin otra causa, fundamentalmente si se asocian a otras lesiones como atelectasia y episodios de obstrucción bronquial.

The foreign body aspiration event is caused by an external agent, this form of injury can be avoided by preventive measures. The episodes of aspiration may go unnoticed causing injury to distal areas of the bronchial tree, manifesting the presence of complications in the evolution. This article presents four clinical cases that raised diagnostic difficulties and complications in its evolution. These cases have similarities with the international literature regarding their epidemiological characteristics: prevalence in children under 3 years, male, in festive days, peanuts being the most common foreign body and there being a delay in diagnosis in most cases. Diagnosis must take into account the history of choking or coughing respiratory distress in a previously asymptomatic child who was playing or eating. The physical and radiological examination may be normal after the episode of suffocation has passed, so a high index of suspicion is necessary for diagnosis. Upon suspicion of foreign body aspiration event, a rigid bronchoscopy should be performed, since this is the best diagnostic and therapeutic method. Also, in patients with persistent or recurrent pneumonia lesions without other cause, mainly this diagnosis should be considered, if associated with other lesions such as atelectasis and episodes of bronchial obstruction.

Clinical factors predicting risk for aspiration and respiratory aspiration among patients with Stroke / Fatores clínicos preditores do risco para aspiração e aspiração respiratória em pacientes com Acidente Vascular Cerebral / Factores clínicos predictores del riesgo para aspiración y aspiración respiratoria en pacientes con accidente cerebro vascular

Objective: to investigate the association of risk factors with the Risk for aspiration nursing diagnosis and respiratory aspiration. Method: cross-sectional study assessing 105 patients with stroke. The instrument used to collect data addressing sociodemographic information, clinical variables and risk factors for Risk for aspiration. The clinical judgments of three expert RNs were used to establish the diagnosis. The relationship between variables and strength of association using Odds Ratio (OR) was verified both in regard to Risk for aspiration and respiratory aspiration. Results: risk for aspiration was present in 34.3% of the patients and aspiration in 30.5%. The following stood out among the risk factors: Dysphagia, Impaired or absent gag reflex, Neurological disorders, and Impaired physical mobility, all of which were statistically associated with Risk for aspiration. Note that patients who develop such a diagnosis were seven times more likely to develop respiratory aspiration. Conclusion: dysphagia, Impaired or absent gag reflex were the best predictors both for Risk for aspiration and respiratory aspiration. .

Objetivo: investigar a associação dos fatores de risco com o diagnóstico de enfermagem Risco de aspiração e a aspiração respiratória. Método: estudo transversal, no qual se avaliaram 105 pacientes com acidente vascular cerebral. O instrumento utilizado para a coleta de dados continha os dados sociodemográficos, clínicos e os fatores de risco para o Risco de aspiração. Para determinação do diagnóstico, utilizou-se o julgamento clínico de três enfermeiras experts. Investigou-se a relação entre as variáveis e a sua força de associação por meio da Razão de Chance (OR) tanto para a relação com o diagnóstico de enfermagem Risco de aspiração como para aspiração respiratória. Resultados: o diagnóstico Risco de aspiração esteve presente em 34,3% dos pacientes e o de aspiração em 30,5%. Quanto aos fatores de risco, destacaramse Disfagia, Reflexo de vômito diminuído ou ausente, Desordens neurológicas e Mobilidade corporal diminuída associados estatisticamente com o diagnóstico Risco de aspiração. Ressaltase que os pacientes que desenvolveram tal diagnóstico aumentaram em sete vezes a chance de desenvolver aspiração respiratória. Conclusão: os fatores Disfagia, Reflexo de vômito diminuído ou ausente e Mobilidade corporal diminuída foram os melhores preditores tanto do Risco de aspiração, como da aspiração respiratória. .

Objetivo: investigar la asociación de los factores de riesgo con el diagnóstico de enfermería riesgo de aspiración y de aspiración respiratoria. Método: estudio transversal, en el cual se evaluaron 105 pacientes con accidente vascular cerebral. El instrumento utilizado para la recolección de datos contenía los datos sociodemográficos, clínicos y los factores de riesgo para el riesgo de aspiración. Para determinación del diagnóstico, se utilizó el juicio clínico de tres enfermeras especialistas. Se investigó la relación entre las variables y su fuerza de asociación por medio de la Razón de Probabilidades (OR) tanto para la relación con el diagnóstico de enfermería riesgo de aspiración, como para la aspiración respiratoria. Resultados: el diagnóstico riesgo de aspiración estuvo presente en 34,3% de los pacientes y el de aspiración en 30,5%. En lo que se refiere a los factores de riesgo, se destacaron: disfagia, reflejo de vómito disminuido o ausente, desordenes neurológicos y movilidad corporal disminuida, asociados estadísticamente con el diagnóstico de riesgo de aspiración. Se destaca que los pacientes que desarrollaron ese diagnóstico aumentaron en 7 veces la probabilidad de desarrollar aspiración respiratoria. Conclusión: los factores disfagia, reflejo de vómito disminuido o ausente y movilidad corporal disminuida fueron los mejores predictores tanto del riesgo de aspiración, como de la aspiración respiratoria. .

Analysis of Dysphagia Patterns Using a Modified Barium Swallowing Test Following Treatment of Head and Neck Cancer

PURPOSE: The purposes of this study were to evaluate specific dysphagia patterns and to identify the factors affecting dysphagia, especially aspiration, following treatment of head and neck cancer. MATERIALS AND METHODS: A retrospective analysis of 57 patients was performed. Dysphagia was evaluated using a modified barium swallow (MBS) test. The MBS results were rated on the 8-point penetration-aspiration scale (PAS) and swallowing performance status (SPS) score. RESULTS: Reduced base of the tongue (BOT) retraction (64.9%), reduced laryngeal elevation (57.9%), and cricopharyngeus (CP) dysfunction (47.4%) were found. Reduced BOT retraction was correlated with clinical stage (p=0.011) and treatment modality (p=0.001). Aspiration in 42.1% and penetration in 33.3% of patients were observed. Twenty-four patients had PAS values over 6, implying aspiration. Forty-one patients had a SPS score of more than 3, 25 patients had a score greater than 5, and 13 patients had a SPS score of more than 7. Aspiration was found more often in patients with penetration (p=0.002) and in older patients (p=0.026). In older patients, abnormal swallowing caused aspiration even in those with a SPS score of more than 3, irrespective of stage or treatment, contrary to younger patients. Tube feeders (n=20) exhibited older age (65.0%), dysphagia/aspiration related structures (DARS) primaries (75.0%), higher stage disease (66.7%), and a history of radiotherapy (68.8%). CONCLUSION: Reduced BOT retraction was the most common dysphagia pattern and was correlated with clinical stage and treatment regimens including radiotherapy. Aspiration was more frequent in patients who had penetration and in older patients. In contrast to younger patients, older patients showed greater risk of aspiration even with a single abnormal swallowing irrespective of stage or treatment.

Association between pharyngeal residue and posterior oral spillage with penetration and aspiration in Stroke / Associação entre presença de resíduos faríngeos e escape oral posterior e a ocorrência de penetração e aspiração no Acidente Vascular Encefálico

PURPOSE: This study aimed at showing association between the posterior oral spillage and pharyngeal residue with tracheal aspiration and/or laryngeal penetration in stroke. METHODS: Clinical cross-sectional retrospective multicenter study. The study included 63 videofluoroscopic tests of post-ischemic stroke individuals and oropharyngeal dysphagia data of the three reference centers providing care for patients with dysphagia (43 men and 20 women; age range: from 40 to 90 years). These individuals were divided into two groups. Group I consisted of 35 participants with the presence of penetration and/or laryngotracheal aspiration, and Group II consisted of 28 individuals with no penetration and/or aspiration. Videofluoroscopic swallowing test results were analyzed to divide the groups, and the presence of posterior oral spillage and pharyngeal residue was observed. RESULTS: No association was found between the groups with posterior oral spillage (χ2=1.65; p=0.30; φ2=0.02), but there was statistical difference for the association between pharyngeal residue (χ2=12.86; p=0.003; φ2=0.20) and the groups. CONCLUSION: There is an association between pharyngeal residue and penetration with tracheal aspiration in post-stroke individuals. .

OBJETIVO: Este estudo teve por objetivo verificar a associação entre a ocorrência de escape oral posterior e a presença de resíduos faríngeos com penetração laríngea e/ou aspiração laringotraqueal no acidente vascular encefálico (AVE). MÉTODOS: Estudo clínico transversal, retrospectivo e multicêntrico. Foram incluídos neste estudo 63 exames videofluoroscópicos de indivíduos pós-AVE isquêmico e disfagia orofaríngea do banco de dados dos serviços de três centros públicos de referência no atendimento do indivíduo disfágico, sendo 43 do gênero masculino e 20 do gênero feminino, faixa etária variando de 40 a 90 anos. Estes foram divididos em dois grupos. O Grupo I foi composto por exames de 35 indivíduos com presença de penetração e/ou aspiração laringotraqueal e o Grupo II, por exames de 28 indivíduos com ausência de penetração e/ou aspiração. Foram analisados exames de videofluoroscopia da deglutição para dividir os grupos e observou-se a presença de escape posterior e resíduos faríngeos. RESULTADOS: Não houve associação entre os grupos com o escape oral posterior (χ2=1,65; p=0,30; φ2=0,02), porém houve associação entre resíduos faríngeos (χ2=12,86; p=0,003; φ2=0,20) e os grupos. CONCLUSÃO: Diante dos resultados obtidos, concluiu-se que há associação entre a presença de resíduos faríngeos com a ocorrência de penetração com aspiração laringotraqueal em indivíduos pós-AVE. .

Clinical validation of the nursing diagnosis Risk for Aspiration among patients who experienced a cerebrovascular accident / Validação clínica do diagnóstico de enfermagem "risco de aspiração" em pacientes com acidente cerebrovascular / Validación clínica del diagnóstico de enfermería riesgo de aspiración en pacientes con accidente cerebrovascular

OBJECTIVE: the study's objective was the clinical validation of the nursing diagnosis Risk for Aspiration among patients who experienced cerebrovascular accidents (CVA). METHOD: a prospective cohort study was conducted with 24 patients hospitalized due to a CVA. The instrument used to collect the data addressed the risk factors for respiratory aspiration, validated by concept analysis and by experts. RESULTS: the most frequent risk factors for respiratory aspiration were: dysphagia (54.2%) and impaired physical mobility (41.7%). The prevalence of the nursing diagnosis Risk for Aspiration was 58.3% and the prevalence of respiratory aspiration over the span of 48 hours (monitoring period) was 37.5%. Risk factors for dysphagia and impaired physical mobility were significantly associated with respiratory aspiration. CONCLUSION: the risk factors dysphagia and impaired physical mobility are good predictors of the nursing diagnosis Risk for Aspiration. This study contributed to improving the NANDA-I Taxonomy and the systematization of the nursing process.

OBJETIVO: o estudo teve por objeto a validação clínica do diagnóstico de enfermagem "risco de aspiração" em pacientes com acidente cerebrovascular. MÉTODO: estudo de coorte prospectivo, desenvolvido com 24 pacientes internados, para o tratamento do acidente cerebrovascular agudo. O instrumento utilizado para a coleta de dados continha os fatores de risco para a aspiração respiratória, validados por análise de conceito e por especialistas. RESULTADOS: os fatores de risco para aspiração respiratória mais presentes nos pacientes foram: disfagia (54,2%) e mobilidade corporal diminuída (41,7%). A prevalência do diagnóstico de enfermagem "risco de aspiração" foi de 58,3% e a prevalência em 48 horas (tempo de acompanhamento) da aspiração respiratória foi de 37,5%. Os fatores de risco disfagia e mobilidade corporal diminuída apresentaram associação estatisticamente significativa com a aspiração respiratória. CONCLUSÃO: os fatores de risco disfagia e mobilidade corporal diminuída são bons preditores para o diagnóstico de enfermagem "risco de aspiração". Este trabalho possibilitou contribuir para o aperfeiçoamento da Taxonomia da NANDA-I e, por conseguinte, da linguagem da sistematização da assistência de enfermagem.

OBJETIVO: el estudio tiene como objetivo la validación clínica del diagnóstico de enfermería riesgo de aspiración en pacientes con accidente cerebrovascular. MÉTODO: un estudio de cohorte prospectivo desarrollado con 24 pacientes hospitalizados para el tratamiento del ictus agudo. El instrumento utilizado para la recolección de datos contiene los factores de riesgo de aspiración respiratoria, validado en el análisis conceptual y por expertos. RESULTADOS: los factores de riesgo para aspiración respiratoria más presentes en los pacientes fueron: disfagia (54,2%) y disminución de la movilidad física (41,7%). La prevalencia del diagnóstico de enfermería riesgo de aspiración fue del 58,3% y la prevalencia en 48 horas (el tiempo del seguimiento) de la aspiración respiratoria fue de 37,5%. Los factores de riesgo disfagia y la disminución de la movilidad física se asociaron significativamente con la aspiración respiratoria. CONCLUSIÓN: los factores de riesgo disminución de la movilidad física y disfagia son buenos predictores para el diagnóstico de enfermería riesgo de aspiración. Este trabajo permitió contribuir a la mejora de la taxonomía NANDA-I y, por lo tanto, el lenguaje de la sistematización de la atención de enfermería.

Broncoaspiração no perioperatório e na emergência: diagnóstico e manejo / Perioperatory and emergency bronchial aspiration: diagnosis and management

A broncoaspiração consiste em um evento frequente nas internações hospitalares, nos processos de anestesia geral e é um importante motivo de procura à emergência. O diagnóstico precoce, aliado a um manejo ágil, evita possíveis complicações e gera redução da mortalidade. O principal objetivo em relação à broncoaspiração é a sua prevenção.

Aspiration is a usual event during hospitalization, also in the process of general anesthesia and further it is an important reason for seeking emergency medical care. Early diagnosis associated with a fast management avoids possible complications and reduces mortality. The main purpose regarding aspiration is its prevention.

Aporte del estudio por imágenes en el estudio de alteraciones respiratorias en niños con limitaciones neurológicas / Contribution of imaging in the study of the respiratory complications in the neurologically impaired child

Neurologically impaired children have a high incidence of coexistent respiratory problems, of multifactorial etiology. Among the main related factors are: ineffective cough, hypersalivation, dysphagia, gastroesophageal reflux and lung restriction secondary to chest wall deformity. Because of this, patients with cerebral palsy and neuromuscular diseases present a high prevalence of pulmonary aspiration, which has very varied and sometimes complex clinical manifestations. a variety of imaging exams are available to clarify the etiological diagnosis of the neurological affectation (Computed Tomography -CT- and magnetic Resonance –mR), and evaluate the gastrointestinal compromise of this patients, including the diagnosis of anterograde and retrograde aspiration (upper gi Barium Radiography and Videofluoroscopic swallowing study). An early and accurate imaging diagnosis allows an appropriate clinical management, which anticipates the possible complications and allows us to choose the therapies that improve the quality of life of these children.

Los niños con severos déficits neurológicos tienen una alta incidencia de problemas respiratorios, de etiología multifactorial. Entre los factores asociados destacan la tos inefectiva, sialorrea, disfagia, reflujo gastroesofágico y restricción pulmonar secundaria a deformidades de la caja torácica. Por lo anterior, los pacientes con parálisis cerebral y enfermedades neuromusculares presentan una alta incidencia de aspiración pulmonar cuyas manifestaciones clínicas son variadas y a veces complejas. La imaginología cuenta con exámenes que resultan de utilidad en precisar el diagnóstico etiológico del compromiso neurológico (tomografía computarizada, TC, y resonancia magnética), diagnosticar y evaluar el compromiso pulmonar (radiografías simples y TC) y valorar el compromiso gastrointestinal, incluyendo el diagnóstico de aspiración anterógrada y retrógrada (radiografía de esófago-estómago-duodeno y videofluoroscopía de deglución). Un adecuado diagnóstico por imágenes permite un manejo clínico adecuado que se anticipe a las posibles complicaciones y permita elegir terapias que mejoren la calidad de vida de estos niños.

Patología respiratoria y alteraciones funcionales respiratorias y deglutorias / Respiratory disease and respiratory and swallowing functional impairment

In daily clinical practice pediatricians, pneumonologists and phonoaudiologists deal with children’s complex respiratory pathologies. This has generated the necessity of interrelating us to analyze deglutition function alterations that could lead to respiratory pathology and vice versa, establishing an interdisciplinary way of doing anamnesis, organic and functional physical examination, diagnosis and treatment. In this paper we analyze deglutition, its alterations, respiratory-deglutition disruptions, aspiration’s pathophysiology, videofluoroscopy diagnosis and treatment.

En la práctica clínica diaria pediatras, neumonólogos y fonoaudiólogos nos enfrentamos a niños con patologías respiratorias complejas. Esto generó la necesidad de interrelacionarnos para analizar alteraciones en la función deglutoria que pudieran llevar a patología respiratoria y viceversa, estableciendo anamnesis, examen físico orgánico y funcional, diagnóstico y tratamiento en forma interdisciplinarias. En este artículo analizamos la deglución, sus alteraciones, las disrupciones respiración-deglución, la fisiopatología de la aspiración, el diagnóstico videofluoroscópico así como su tratamiento.

Foreign body aspiration in children

A case series descriptive study,was carried out from September 2007 to September 20010 at Paediatrics unit Sheikh Zayed Hospital, Rahim Yar Khan, Pakistan. The aim of the study was bronchoscopic evaluation of children suspicious of inhaled foreign body [FB] such as beetlenut, seeds, peanuts, tiny objects and fragments of tooth and presented with persistent cough. Fory [n-40] children [male and female] in age range of 1-3 years [toddlers] presented with persistent cough with no history of foreign body [FB] aspiration were included. The chronic persisting cough was defined as cough lasting for 30 days or >30 days as guided by WHO. They had bouts of cough mimicking pertussis and had clinical findings of decreased air entry with rales and rhonchi. Oxygen saturation was monitored by pulse oxymetry. X-rays chest were obtained. The pulmonary tuberculosis, pertussis and other chronic lung diseases were ruled out by history, clinical examination and investigations available in hospital laboratory. The cases with suspicion of FB inhalation were subjected to bronchoscopy. Rigid broncoscope was an essential tool for investigation and removal of FB in study. The data were processed in soft wear SPSS 16.Male: Female ratio was 2:1 and had height and weight above 10[th] percentile and vaccinated as per EPIschedule. The clinical examination of chest revealed dull or hyper resonant, decreased or no air entry with or without rales and rhonchi on the side of chest where FB lodged the lung. X-rays chest had no radio opaque FB, hyper inflation in cases 15 [n-15] and collapse in 10 cases [n-10] were the main findings. The clinical and radiological findings supported the empirical diagnosis of foreign body aspiration [FBA] and these children underwent rigid bronchoscopy. Bronchoscopically visualized FB were retrieved and the air ways were cleared of inflammatory debris and pus. The oxygen saturation retuned to normal and marked clinical improvement occurred soon after bronchoscopy. The commonest FB in our study was the beetle nut [Chalia/Supari]. The radiological changes were also seen after bronchoscopy. FBA should be considered in children presenting with persisting cough and after thorough clinical and radiological examination the suspected cases be evaluated by rigid bronchoscopy

Avaliação fonoaudiológica e cintilográfica da deglutição de pacientes pós acidente vascular encefálico / Clinical and scintigraphic swallowing evaluation of post-stroke patients

TEMA: a deglutição em pacientes pós Acidente Vascular Encefálico (AVE). OBJETIVO: estudar a deglutição de pacientes pós-AVE através de avaliação clínica fonoaudiológica e do método cintilográfico. MÉTODO: estudou-se 26 pacientes, sendo o primeiro AVE ocorrido há no máximo dois meses; o grupo controle continha 15 voluntários saudáveis; ambos grupos foram submetidos a avaliação clínica e cintilográfica da deglutição, ingerindo 5ml de líquido e 5ml de pastoso. A avaliação clínica constou de anamnese, avaliação estrutural (sem alimento) e funcional (com alimento). RESULTADOS: durante avaliação fonoaudiológica, o grupo controle apresentou elevação laríngea ineficiente e sinais clínicos de aspiração em um indivíduo. Quanto aos pacientes, 27 por cento apresentaram, na fase oral, um preparo ineficiente do líquido e 42 por cento do pastoso. Na fase faríngea, 12 por cento apresentaram tosse e engasgo. Na avaliação cintilográfica, três pacientes foram excluídos da análise, pois dois deles não deglutiram durante o tempo de aquisição do exame e um engoliu antes da instrução da pesquisadora. Os pacientes apresentaram maior quantidade de resíduo oral e menor duração de trânsito faríngeo na deglutição de pastoso, comparado ao grupo controle. CONCLUSÃO: a complementaridade da avaliação clínica e instrumental no estudo da deglutição de pacientes com AVE é necessária e importante para o desempenho do trabalho fonoaudiológico e para o paciente que será reabilitado. O método cintilográfico deve ser mais utilizado como instrumento de pesquisa para quantificar o tempo de trânsito, o resíduo e o tempo de depuração em cada fase da deglutição, estabelecendo-se parâmetros para outros estudos.

BACKGROUND: deglutition of post-stroke patients. AIM: to study the swallowing of post-stroke patients through clinical and scintigraphic evaluations. METHOD: participants were 26 patients, who had suffered their first stroke within the last two months. The control group was composed by 15 healthy volunteers. Both groups were submitted to a clinical and scintigraphic evaluation of swallowing; using 5ml of liquid (water) and 5ml of paste bolus. Clinical evaluation was composed by an interview, an assessment of the oral structures (without food) and by a functional assessment (with food). RESULTS: during the clinical evaluation, one individual of the control group presented inefficient larynx elevation and clinical signs of aspiration. As for the group of post-stroke patients, 27 percent presented inefficient prepare of the liquid bolus and 42 percent presented inefficient prepare of the paste bolus, in the oral phase. Considering the pharyngeal phase, 12 percent presented cough and choked. In the scintigraphy evaluation, three post-stroke patients were excluded from this analysis for the following reasons: two did not swallow during the exam acquisition time and one swallowed before the instruction given by the researcher. The group of post-stroke patients presented more oral residues and shorter pharyngeal transit with the paste bolus when compared to the control group. CONCLUSION:clinical and objective swallowing evaluations of post-stroke patients are necessary and important to determine therapy intervention and possible outcomes. Patients who have suffered stroke have more residues and shorter pharyngeal transit than healthy individuals. The scintigraphic method should be used more often as a research instrument to quantify the residue, transit time and clearance in each of the swallowing phases.