{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T06:54:14Z","timestamp":1777877654878,"version":"3.51.4"},"reference-count":15,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2025,4,25]],"date-time":"2025-04-25T00:00:00Z","timestamp":1745539200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The Neurohospitalist"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:p>\n                    <jats:bold>Background:<\/jats:bold>\n                    Sialorrhea is associated with various neurological conditions. Among critically ill patients with acute neurological injuries (ANI), sialorrhea leads to several adverse consequences, including extubation failure, inability to initiate non-invasive ventilation, aspiration pneumonia and prolonged hospitalization. Botulinum toxin (BoTN) injections can reduce salivary production. Both BoTN-A and BoTN-B are effective in managing sialorrhea among patients with neurogenic dysphagia. BoTN utilization for sialorrhea in critically ill adult ANI patients is not well-studied.\n                    <jats:bold>Purpose:<\/jats:bold>\n                    The purpose of this study to evaluate the safety and feasibility of using BoTN-A salivary injections to reduce sialorrhea in ANI patients.\n                    <jats:bold>Research Design:<\/jats:bold>\n                    In this case series, we retrospectively reviewed the off-label use of BoTN-A for sialorrhea in ANI patients at the University of North Carolina Neurosciences Intensive Care Unit. Study Sample: Six patients with ANI who received BoTNA treatment for neurogenic sialorrhea in absence of infection and medications with known side-effect of sialorrhea.\n                    <jats:bold>Data Collection:<\/jats:bold>\n                    For safety evaluation, we reviewed any documented adverse effects of BoTN-A injection. For efficacy, we evaluated the drooling severity, suctioning frequency, oxygen requirements, continued days on the ventilator, and pneumonia diagnoses.\n                    <jats:bold>Results:<\/jats:bold>\n                    All patients had reduction in their documented drooling and suctioning requirements following BoTN-A injection. None had adverse events associated with BoTN-A injections. All patients experienced recurrent ventilator-associated pneumonias prior to BoTN-A injections whereas four patients had no pneumonia events after injections. Also, two patients were successfully weaned of oxygenation prior to discharge.\n                    <jats:bold>Conclusions:<\/jats:bold>\n                    This case series highlights the safety and potential efficacy of salivary gland BoTN-A for reducing refractory sialorrhea among critically ill ANI patients. Future studies are needed to evaluate whether sialorrhea reduction can lead to reduced hospital complications and overall length of hospital stay.\n                  <\/jats:p>","DOI":"10.1177\/19418744251338148","type":"journal-article","created":{"date-parts":[[2025,4,25]],"date-time":"2025-04-25T19:34:53Z","timestamp":1745609693000},"page":"377-380","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Salivary Gland Botulinum Toxin a Injections for Treating Sialorrhea Among Critically Ill Patients With Neurological Disorders"],"prefix":"10.1177","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9665-1830","authenticated-orcid":false,"given":"Fazila","family":"Aseem","sequence":"first","affiliation":[{"name":"Department of Neurology, University of North Carolina School of Medicine, Chapel Hill, NC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kayla E.","family":"John","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"King","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of North Carolina School of Medicine, Chapel Hill, NC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miriam","family":"Sklerov","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of North Carolina School of Medicine, Chapel Hill, NC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel A.","family":"Roque","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of North Carolina School of Medicine, Chapel Hill, NC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nina M.","family":"Browner","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of North Carolina School of Medicine, Chapel Hill, NC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julia M.","family":"Carlson","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of North Carolina School of Medicine, Chapel Hill, NC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2025,4,25]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1002\/mds.21646"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1212\/wnl.61.9.1279"},{"issue":"11","key":"e_1_3_3_4_2","first-page":"2628","article-title":"Sialorrhea: a management challenge","volume":"69","author":"Hockstein NG","year":"2004","unstructured":"Hockstein NG, Samadi DS, Gendron K, Handler SD. Sialorrhea: a management challenge. Am Fam Physician. 2004;69(11):2628-2634.","journal-title":"Am Fam Physician"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1358\/dot.2005.41.6.893628"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-022-06856-1"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-022-06825-8"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-2007-1016440"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1002\/lary.25444"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1001\/archoto.2009.110"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2013.1328"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1111\/ene.15083"},{"issue":"9","key":"e_1_3_3_13_2","first-page":"1085","article-title":"Formulation composition of botulinum toxins in clinical use","volume":"9","author":"Pickett A","year":"2010","unstructured":"Pickett A, Perrow K. Formulation composition of botulinum toxins in clinical use. J Drugs Dermatol. 2010;9(9):1085-1091.","journal-title":"J Drugs Dermatol"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1080\/14737175.2021.1958678"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.parkreldis.2016.07.001"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2019.4565"}],"container-title":["The Neurohospitalist"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/19418744251338148","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/19418744251338148","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/19418744251338148","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T22:58:02Z","timestamp":1777589882000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/19418744251338148"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,25]]},"references-count":15,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025,10]]}},"alternative-id":["10.1177\/19418744251338148"],"URL":"https:\/\/doi.org\/10.1177\/19418744251338148","relation":{},"ISSN":["1941-8744","1941-8752"],"issn-type":[{"value":"1941-8744","type":"print"},{"value":"1941-8752","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,25]]}}}