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Swallowing dysfunction following endotracheal intubation

View Article: PubMed Central - PubMed

ABSTRACT

To evaluate postextubation swallowing dysfunction (PSD) 21 days after endotracheal extubation and to examine whether PSD is time-limited and whether age matters.

For this prospective cohort study, we evaluated 151 adult critical care patients (≥20 years) who were intubated for at least 48 hours and had no pre-existing neuromuscular disease or swallowing dysfunction. Participants were assessed for time (days) to pass bedside swallow evaluations (swallow 50 mL of water without difficulty) and to resume total oral intake. Outcomes were compared between younger (20–64 years) and older participants (≥65 years).

PSD, defined as inability to swallow 50 mL of water within 48 hours after extubation, affected 92 participants (61.7% of our sample). At 21 days postextubation, 17 participants (15.5%) still failed to resume total oral intake and were feeding-tube dependent. We found that older participants had higher PSD rates at 7, 14, and 21 days postextubation, and took significantly longer to pass the bedside swallow evaluations (5.0 vs 3.0 days; P = 0.006) and to resume total oral intake (5.0 vs 3.0 days; P = 0.003) than their younger counterparts. Older participants also had significantly higher rates of subsequent feeding-tube dependence than younger patients (24.1 vs 5.8%; P = 0.008).

Excluding patients with pre-existing neuromuscular dysfunction, PSD is common and prolonged. Age matters in the time needed to recover. Swallowing and oral intake should be monitored and interventions made, if needed, in the first 7 to 14 days postextubation, particularly for older patients.

No MeSH data available.


Trajectories of oral intake level per postextubation day between age groups. FOIS level 1: nothing by mouth; FOIS level 4: total oral diet of a single consistency; FOIS level 7: multiple food consistencies without specific food limitations. Curves differ significantly by generalized estimating equation analysis, after adjusted for Charlson index and length of intubation (P < 0.001). FOIS = Functional Oral Intake Scale.
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Figure 2: Trajectories of oral intake level per postextubation day between age groups. FOIS level 1: nothing by mouth; FOIS level 4: total oral diet of a single consistency; FOIS level 7: multiple food consistencies without specific food limitations. Curves differ significantly by generalized estimating equation analysis, after adjusted for Charlson index and length of intubation (P < 0.001). FOIS = Functional Oral Intake Scale.

Mentions: Moreover, the Charlson index and length of intubation were significantly correlated with time to resume total oral intake (Pearson r = 0.31 and 0.25, respectively), suggesting the need to adjust for these 2 confounding factors. Indeed, with adjustment for participants’ Charlson index and length of intubation, older participants’ trajectory for recovery of oral intake levels was significantly longer (GEE, P < 0.001) than that for younger participants (Fig. 2).


Swallowing dysfunction following endotracheal intubation
Trajectories of oral intake level per postextubation day between age groups. FOIS level 1: nothing by mouth; FOIS level 4: total oral diet of a single consistency; FOIS level 7: multiple food consistencies without specific food limitations. Curves differ significantly by generalized estimating equation analysis, after adjusted for Charlson index and length of intubation (P < 0.001). FOIS = Functional Oral Intake Scale.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4998458&req=5

Figure 2: Trajectories of oral intake level per postextubation day between age groups. FOIS level 1: nothing by mouth; FOIS level 4: total oral diet of a single consistency; FOIS level 7: multiple food consistencies without specific food limitations. Curves differ significantly by generalized estimating equation analysis, after adjusted for Charlson index and length of intubation (P < 0.001). FOIS = Functional Oral Intake Scale.
Mentions: Moreover, the Charlson index and length of intubation were significantly correlated with time to resume total oral intake (Pearson r = 0.31 and 0.25, respectively), suggesting the need to adjust for these 2 confounding factors. Indeed, with adjustment for participants’ Charlson index and length of intubation, older participants’ trajectory for recovery of oral intake levels was significantly longer (GEE, P < 0.001) than that for younger participants (Fig. 2).

View Article: PubMed Central - PubMed

ABSTRACT

To evaluate postextubation swallowing dysfunction (PSD) 21 days after endotracheal extubation and to examine whether PSD is time-limited and whether age matters.

For this prospective cohort study, we evaluated 151 adult critical care patients (&ge;20 years) who were intubated for at least 48&#8202;hours and had no pre-existing neuromuscular disease or swallowing dysfunction. Participants were assessed for time (days) to pass bedside swallow evaluations (swallow 50&#8202;mL of water without difficulty) and to resume total oral intake. Outcomes were compared between younger (20&ndash;64 years) and older participants (&ge;65 years).

PSD, defined as inability to swallow 50&#8202;mL of water within 48&#8202;hours after extubation, affected 92 participants (61.7% of our sample). At 21 days postextubation, 17 participants (15.5%) still failed to resume total oral intake and were feeding-tube dependent. We found that older participants had higher PSD rates at 7, 14, and 21 days postextubation, and took significantly longer to pass the bedside swallow evaluations (5.0 vs 3.0 days; P = 0.006) and to resume total oral intake (5.0 vs 3.0 days; P = 0.003) than their younger counterparts. Older participants also had significantly higher rates of subsequent feeding-tube dependence than younger patients (24.1 vs 5.8%; P = 0.008).

Excluding patients with pre-existing neuromuscular dysfunction, PSD is common and prolonged. Age matters in the time needed to recover. Swallowing and oral intake should be monitored and interventions made, if needed, in the first 7 to 14 days postextubation, particularly for older patients.

No MeSH data available.