Verification of feasibility in exceedingly-early-oral-intake
after lung resection
Yusuke Takahashi1, Yohei Matsukawa1, Yukio Koutani1, Hironori Hayashi1, Hiroaki Harada2,3,
Yoshinori Yamashita2,3, Kiyomi Taniyama4)
１ Department of Rehabilitation, NHO Kure Medical Center/ Chugoku Cancer Center, Kure, Japan
２ Department of Respiratory Surgery, NHO Kure Medical Center/ Chugoku Cancer Center, Kure, Japan
３ Institute for Clinical Research, NHO Kure Medical Center/ Chugoku Cancer Center, Kure, Japan
４ President, NHO Kure Medical Center/ Chugoku Cancer Center, Kure, Japan

BackgroundPic1 swallowing test after operation.

Pic2 early mobilization after operation.

In our respiratory surgery department, if the state of
the patient is good, exceedingly-early-mobilizationand food-intake are implemented 4 hours afteroperation(Pic1 Pic2). Since food-intake is generally
started on the next day after operation, pulmonary
complications such as aspiration-related neumonia
need to be considered in the case of exceedinglyearly-oral-intake.

Objective and Methods
To verify the feasibility of exceedingly-early-oralintake, the difference in the swallowing function
between the operative day and postoperative day 1(POD1) was assessed.
Twelve consecutive patients were enrolled thatwere targeted for exceedingly-early-mobilizationand oral-intake after lung resection in our hospitalfrom September to November 2015. The followings
were assessed and recorded on the operation dayand POD1: Food Intake LEVEL Scale of Fujishima(Table1 FILS), a repetitive saliva swallowing test
(Pic3 RSST), a modified water swallow test (Pic4MWST), a food test (Pic5 FT), and Dysphasia
Severity Scale (Table2 DSS). The mean value ofRSST and the medianvalues of other examinations
Resultson the operative day were compared with those ofPOD1.

Table1 FILS
1: No swallowing training is performed except for oral care
2: Swallowing training not using food is performed
3: Swallowing training using a small quantity of food is performed
4: Easy-to-swallow food less than the quantity of a meal (enjoyment level) is ingested orally
5: Easy-to-swallow food is orally ingested in one to two meals, but alternative nutrition is also given
6: The patient is supported primarily by ingestion of easy-to-swallow food in three meals, but alternative
nutrition is used as a complement
7: Easy-to-swallow food is orally ingested in three meals. No alternative nutrition is given.
8: The patient eats three meals by excluding food that is particularly difficult to swallow
9: There is no dietary restriction, and the patient ingests three meals orally, but medical considerations are given.
10: There is no dietary restriction, and the patient ingests three meals orally (normal).

Pic3 RSST

To swallow the cold water 3ml.
1:No swallow
2:Swallow there, choking there, Respiratorychange3:Swallow there, choking there, wethoarseness there
4:Swallow there, no choking, no wet
hoarseness
5:add 4 and add swallowing possible
twice within 30 seconds

Instructed to perform a lot as long as the sky
swallowing after wetting to moderate in the oralcavity can in 30 econds. It is referred to as positive
less than 3 times in 30 seconds.

Table2 DSS
1:Aspiration of saliva
2:Aspiration of food
3:Aspiration of water
4:Aspiration is opportunity
5:Oral problem
6:Minor problem
7:Normal

Pic5 FT .
To eating a teaspoon of pudding.
1:No swallow
2:Swallow there, choking there, Respiratorychange3:Swallow there, choking there, wet hoarsenessthere Intraoral residual.
4:Swallow there, no choking, no wet hoarseness,
no Intraoral residual
5:add 4 and add swallowing possible twice within
30 seconds

Results and Conclusions
The average age of patients was 60.5 years old.
The mean operative time was 2 hours 8 minutes.
The swallow assessments of the operation day
were 5.42 time (RSST), MWST5, FT5, FILS Level9,DSS Level6. Those of POD1 were 5.42 time (RSST),
MWST5, FT5, FILS Level10, DSS Level7.
There was no significant difference in the swallow
assessments between the operation day and POD1.
As such, it was suggested that the start of oralintake on the operation day was feasible. We willcontinue this protocol and verify the results of thisstudy through assessment of an increased numberof future cases.

Pic4 MWST

Intraoral residualFig1 Average of each tests.

Operative day

POD1

121086420RSSTRSSTMWSTMWSTFILS
藤島Gr

FT
FTDSS
臨床重症度分類

table3 Score or each case
Case Case Case Case Case Case Case Case Case Case Case CaseAve.
12345678910 1112Age

50s

50s

70s

50s

10s

70s

50s

70s

50s 70s70s

60s 60.5

RSST
MWST
FT
FILS
DSS
RSST
MWST
FT
FILS
DSS

75596
755
10
7

55
5
94
4
5
5
10
7

4
55
96
5
5
5
10
7

7
5
566
3
55
966
5
566
105510
77
35964
3
596

5
55
96
5
55
10
7

555
96
7
5510
76
55
96
6
5
5107

7559695547

1346301142

555645551075.42
5596
5.42
55107

Orepativeday

POD1