Association between clinical risk factors and severity of dysphagia after extubation based on a videofluoroscopic swallowing study

Abstract

Background/Aims: This study aimed to evaluate the correlation between clinical risk factors of post-extubation dysphagia (PED) and the severity of impaired pharyngeal swallowing function assessed via videofluoroscopic swallowing studies (VFSSs). Methods: This study was a retrospective review of medical records. Of 116 patients who were admitted to the intensive care unit and underwent VFSS, 32 who had non-neurologic disorders and experienced prolonged intubation (for more than 48 hours) were diagnosed with PED. The severity of PED was evaluated by using a functional dysphagia scale (FDS) and a penetration aspiration scale (PAS), on the basis of VFSS. Results: The Simplified Acute Physiology Score 3 and total FDS score were positively correlated (r = 0.40, p = 0.02). Intubation duration was positively correlated with total PAS and FDS scores (r = 0.62, p < 0.001; r = 0.65, p < 0.001, respectively). The amounts of residue in the valleculae (RV) and pyriform sinuses (RP) were associated with intubation duration (r = 0.58, p < 0.001; r = 0.57, p < 0.001, respectively). Multivariate regression analysis revealed that intubation duration was significantly associated with the total FDS score, RV and RP subscales of the FDS, and total PAS score. Conclusions: The severity of impaired swallowing function, particularly the amount of residue in the pharyngeal recesses assessed via VFSS, was strongly associated with both severity of medical illness and intubation duration. Intubation duration could be a prognostic factor for assessing impaired swallowing function on the basis of VFSS.

Dysphagic disorder in a cohort of COVID-19 patients: evaluation and evolution

“…In patients ventilated for more than 10 days, prevalence of dysphagia was even higher, up to 95.5%. According to literature, in non-COVID-19 patients 7,36,37 , severe dysphagia seems to be strictly correlated with MV length and ICU LOS. In our study, we reported for the first time data on dysphagia in COVID-19 patients, who seem to be burdened by a higher incidence of dysphagia already at a very early stage, when compared to other patients, as seen in the studies of Kim et al 7 , Oliveira et al 36 and Yang et al 37 .…”

“…According to literature, in non-COVID-19 patients 7,36,37 , severe dysphagia seems to be strictly correlated with MV length and ICU LOS. In our study, we reported for the first time data on dysphagia in COVID-19 patients, who seem to be burdened by a higher incidence of dysphagia already at a very early stage, when compared to other patients, as seen in the studies of Kim et al 7 , Oliveira et al 36 and Yang et al 37 . This may be explained by the strong inflammatory response induced by SARS-CoV-2 and by its consequent systemic effects, potentially triggering a severe generalized neuromuscular impairment also involving pharyngeal muscles.…”

Dysphagic disorder in a cohort of COVID-19 patients: Evaluation and evolution

“…In patients ventilated for more than 10 days, prevalence of dysphagia was even higher, up to 95.5%. According to literature, in non-COVID-19 patients [ 7 , 38 , 39 ], severe dysphagia seems to be strictly correlated with MV length and ICU LOS. In our study, we reported for the first time data on dysphagia in COVID-19 patients, who seem to be burdened by a higher incidence of dysphagia already at a very early stage, when compared to other patients, as seen in the studies of Kim et al [ 7 ], Oliveira et al [ 38 ] and Yang et al [ 39 ].…”

“…According to literature, in non-COVID-19 patients [ 7 , 38 , 39 ], severe dysphagia seems to be strictly correlated with MV length and ICU LOS. In our study, we reported for the first time data on dysphagia in COVID-19 patients, who seem to be burdened by a higher incidence of dysphagia already at a very early stage, when compared to other patients, as seen in the studies of Kim et al [ 7 ], Oliveira et al [ 38 ] and Yang et al [ 39 ]. This may be explained by the strong inflammatory response induced by SARS-CoV-2 and by its consequent systemic effects, potentially triggering a severe generalized neuromuscular impairment also involving pharyngeal muscles.…”

Correction to: Abnormalities of Aspiration and Swallowing Function in Survivors of Acute Respiratory Failure

“…One previously underrecognized consequence of ARF is post-extubation dysphagia and subsequent aspiration [3,4]. More than 30% of ARF survivors aspirate when formally tested and many still have dysphagia at the time of hospital discharge [3][4][5][6][7][8][9][10][11][12][13][14]. Aspiration is associated with many deleterious consequences including pneumonia, percutaneous feeding tube placement, long term care facility admission, and increased mortality [3][4][5]14],…”