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Mechanisms, predictors and clinical markers of dysphagia in cardiac surgical patients

Award Number: R01NR020175
ORGANIZATION: NATIONAL INSTITUTE OF NURSING RESEARCH
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 03/10/2022
PERIOD OF PERFORMANCE END DATE: 12/31/2025

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Mechanisms, predictors and clinical markers of dysphagia in cardiac surgical patients - Project Summary Dysphagia (swallowing impairment) is a common complication of cardiac surgical procedures, leading to malnutrition, dehydration, aspiration pneumonia, reintubation, increased health care utilization, length of hospitalization, and economic burden. Although preventable, dysphagia-related aspiration pneumonia is a major cause of mortality. Early detection and accurate monitoring of dysphagia are therefore important to facilitate timely interventions to mitigate developing sequelae. Currently, clinical care of dysphagia is hindered by fundamental gaps in knowledge, including 1) contributing risk factors of dysphagia are unknown, prohibiting the use of triaged personalized care pathways; 2) no validated tools to accurately detect and monitor dysphagia in the cardiac intensive care unit exist; and 3) governing mechanisms of swallowing impairment and recovery of function are unknown, impeding the development of mechanistically guided therapeutics and optimization of salient postoperative evaluation time points. Our three specific aims target these knowledge gaps with the broad goal to shift care toward a proactive, multifaceted, and data-driven perioperative Model of Swallowing Integrated Care (MOSAIC). To this end, we will enroll 360 cardiac surgical patients over a four-year period and identify 1) independent risk factors for dysphagia, 2) sensitive clinical markers of swallowing impairment, and 3) governing physiologic mechanisms of unsafe and inefficient swallowing throughout the acute, sub-acute, and long-term postoperative period. Enrolled participants will undergo a preoperative Fiberoptic Endoscopic Evaluation of Swallowing (FEES) to screen out patients with pre-existing dysphagia. Candidate predictor variables will be systematically collected throughout the perioperative time course. Following surgery and within 48 hours of extubation, a simultaneous videofluoroscopy and FEES (VF-FEES) will be performed as well as a battery of simple bedside clinical tests. Detailed blinded analyses will be performed using validated metrics of swallowing safety, efficiency, timing and kinematics to examine acute-phase swallowing function and associated physiologic mechanisms of unsafe or inefficient deglutition. Patients with acute postoperative phase dysphagia will be re-examined at one- and six-months to determine sub-acute and long-term dysphagia trajectories and governing mechanisms of impairment and recovery. Multivariable modeling of dysphagia risk factors will produce a practical dysphagia risk stratification tool to enable accurate forecasting and personalized triaged postoperative care pathways. An accompanying open-access electronic application will be developed to provide seamless clinical adoption and a data-driven clinical decision making tool. The discriminant ability of clinical markers will be determined, and a practical bedside dysphagia screening tool will be validated to enable accurate detection and monitoring of dysphagia in the cardiac intensive care unit. Outcomes will drive future targeted therapeutic and preventative strategies and enhance personalized health care models to ultimately improve patient outcomes.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2025 ( Subtotal = $623,363 )
2025	2025	OHIO STATE UNIVERSITY, THE	1960 KENNY RD	COLUMBUS	OH	43210	FRANKLIN	USA	Nursing Research	003	4	5/19/2025	CHANGE OF GRANTEE / TRAINING INSTITUTION / AWARDING INSTITUTION	$485,816
2025	2025	OHIO STATE UNIVERSITY, THE	1960 KENNY RD	COLUMBUS	OH	43210	FRANKLIN	USA	Nursing Research	001	4	4/4/2025	CHANGE OF GRANTEE / TRAINING INSTITUTION / AWARDING INSTITUTION	$623,363
2025	2024	UNIVERSITY OF FLORIDA	1523 UNION RD RM 207	GAINESVILLE	FL	32611	ALACHUA	USA	Nursing Research	000	3	4/4/2025	NON-COMPETING CONTINUATION	$0
2025	2024	UNIVERSITY OF FLORIDA	1523 UNION RD RM 207	GAINESVILLE	FL	32611	ALACHUA	USA	Nursing Research	002	3	5/19/2025	NON-COMPETING CONTINUATION	-$485,816
														Subtotal = $623,363

Issue Date FY: 2024 ( Subtotal = $618,828 )
2024	2024	UNIVERSITY OF FLORIDA	1523 UNION RD RM 207	GAINESVILLE	FL	32611	ALACHUA	USA	Nursing Research	001	3	5/8/2024	NON-COMPETING CONTINUATION	$61,882
2024	2024	UNIVERSITY OF FLORIDA	1523 UNION RD RM 207	GAINESVILLE	FL	32611	ALACHUA	USA	Nursing Research	000	3	1/30/2024	NON-COMPETING CONTINUATION	$556,946
														Subtotal = $618,828

Issue Date FY: 2023 ( Subtotal = $622,697 )
2023	2023	UNIVERSITY OF FLORIDA	1523 UNION RD RM 207	GAINESVILLE	FL	32611	ALACHUA	USA	Nursing Research	000	2	12/30/2022	NON-COMPETING CONTINUATION	$560,428
2023	2023	UNIVERSITY OF FLORIDA	1523 UNION RD RM 207	GAINESVILLE	FL	32611	ALACHUA	USA	Nursing Research	002	2	8/15/2023	NON-COMPETING CONTINUATION	$0
2023	2023	UNIVERSITY OF FLORIDA	1523 UNION RD RM 207	GAINESVILLE	FL	32611	ALACHUA	USA	Nursing Research	001	2	2/9/2023	NON-COMPETING CONTINUATION	$62,269
														Subtotal = $622,697

Issue Date FY: 2022 ( Subtotal = $619,393 )
2022	2022	UNIVERSITY OF FLORIDA	1523 UNION RD RM 207	GAINESVILLE	FL	32611	ALACHUA	USA	Nursing Research	000	1	3/10/2022	NEW	$619,393
														Subtotal = $619,393

Grand Total All Awards = $2,484,281

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Mechanisms, predictors and clinical markers of dysphagia in cardiac surgical patients

Award Number: R01NR020175

ORGANIZATION: NATIONAL INSTITUTE OF NURSING RESEARCH

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

PERIOD OF PERFORMANCE START DATE: 03/10/2022

PERIOD OF PERFORMANCE END DATE: 12/31/2025

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