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.