Post-extubation dysphagia incidence in critically ill patients: A systematic review and meta-analysis

McIntyre, Melanie; Doeltgen, Sebastian; Dalton, Nathan; Koppa, Mayank; Chimunda, Timothy

doi:10.1016/j.aucc.2020.05.008

Cited by 71 publications

(60 citation statements)

References 46 publications

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“…However, there are few studies on patients after neurosurgery, which contains all three factors. In our study cohort, the incidence of dysphagia was 23.2% (68/293), which is relatively low compared with other studies ( 6 , 7 ). The reason why there were fewer positive patients may be due to fewer emergency patients (47/293 patients with APACHE-II B score of 5) and a higher baseline APACHE-II C score (the median of the patient's APACHE II C score is 0) in our institutes.…”

Section: Discussioncontrasting

confidence: 72%

“…Post-extubation dysphagia is a common complication in mixed intensive care units (ICUs), causing aspiration pneumonia, malnutrition, and dehydration, and increasing the length of hospital stay and mortality (1)(2)(3)(4)(5). The prevalence of postextubation dysphagia ranges from 3 to 62%, which leads to increased healthcare-related costs (6,7). The condition is even worse in patients with neurological diseases.…”

Section: Introductionmentioning

confidence: 99%

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Risk Score for Predicting Dysphagia in Patients After Neurosurgery: A Prospective Observational Trial

et al. 2021

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Background: Acquired dysphagia is common in patients with tracheal intubation and neurological disease, leading to increased mortality. This study aimed to ascertain the risk factors and develop a prediction model for acquired dysphagia in patients after neurosurgery.Methods: A multicenter prospective observational study was performed on 293 patients who underwent neurosurgery. A standardized swallowing assessment was performed bedside within 24 h of extubation, and logistic regression analysis with a best subset selection strategy was performed to select predictors. A nomogram model was then established and verified.Results: The incidence of acquired dysphagia in our study was 23.2% (68/293). Among the variables, days of neurointensive care unit (NICU) stay [odds ratio (OR), 1.433; 95% confidence interval (CI), 1.141–1.882; P = 0.005], tracheal intubation duration (OR, 1.021; CI, 1.001–1.062; P = 0.175), use of a nasogastric feeding tube (OR, 9.131; CI, 1.364–62.289; P = 0.021), and Acute Physiology and Chronic Health Evaluation (APACHE)-II C score (OR, 1.709; CI, 1.421–2.148; P < 0.001) were selected as risk predictors for dysphagia and included in the nomogram model. The area under the receiver operating characteristic curve was 0.980 (CI, 0.965–0.996) in the training set and 0.971 (0.937–1) in the validation set, with Brier scores of 0.045 and 0.056, respectively.Conclusion: Patients who stay longer in the NICU, have a longer duration of tracheal intubation, require a nasogastric feeding tube, and have higher APACHE-II C scores after neurosurgery are likely to develop dysphagia. This developed model is a convenient and efficient tool for predicting the development of dysphagia.

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Section: Discussioncontrasting

confidence: 72%

Section: Introductionmentioning

confidence: 99%

Risk Score for Predicting Dysphagia in Patients After Neurosurgery: A Prospective Observational Trial

et al. 2021

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“…Silent aspiration is caused by desensitization of the pharynx and upper airways 8 and is diagnosed through instrumental swallow evaluations. One meta‐analysis and systematic review including 38 studies, 5798 patients, and 1957 dysphagic events noted a high incidence of postextubation silent aspiration 2 . The authors calculated the combined weighted incidence of PED to be 41% (95% confidence interval, 0.33–0.50), with 36% of the patients with PED having silent aspiration (95% confidence interval, 0.22–0.50).…”

Section: Dysphagia In the Icumentioning

confidence: 99%

“…Mechanical ventilation is the most common technological support, being required by 20%–40% of adult ICU admissions 1 . Patients liberated from mechanical ventilation are at increased risk for swallowing dysfunction 2 . The reported incidence of postextubation dysphagia (PED) varies significantly 2 .…”

Section: Introductionmentioning

confidence: 99%

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Tough Pill to Swallow: Postextubation Dysphagia and Nutrition Impact in the Intensive Care Unit

Dobak¹,

Kelly

2020

Nut in Clin Prac

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More than 5 million patients are admitted to US intensive care units (ICUs) each year. Many of these patients have risk factors for dysphagia. Dysphagia must be promptly addressed and appropriately treated to avoid the deleterious impacts of aspiration and malnutrition. Therefore, clinicians must be aware of ways to identify and treat dysphagia. This review will highlight the risk factors, mechanisms, and impact of dysphagia in the ICU as well as provide screening, diagnostic, and management options.

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Development of predictive score for postoperative dysphagia after emergency abdominal surgery in patients of advanced age

Iguchi

Mita

Iseda

et al. 2023

Annals of Gastroent Surgery

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AimPostoperative dysphagia after emergency abdominal surgery (EAS) in patients of advanced age has become problematic, and appropriate dysphagia management is needed. This study was performed to identify predictive factors of dysphagia after EAS and to explore the usefulness of swallowing screening tools (SSTs).MethodsThis retrospective study included 267 patients of advanced age who underwent EAS from 2012 to 2022. They were assigned to a dysphagia group and non‐dysphagia group using the Food Intake Level Scale (FILS) (dysphagia was defined as a FILS level of <7 on postoperative day 10). From 2018, original SSTs including a modified water swallowing test were performed by nurses.ResultsThe incidence of postoperative dysphagia was 22.8% (61/267). Patients were significantly older in the dysphagia than non‐dysphagia group. The proportions of patients who had poor nutrition, cerebrovascular disorder, Parkinson's disease, dementia, nursing‐care service, high intramuscular adipose tissue content (IMAC), and postoperative ventilator management were much higher in the dysphagia than non‐dysphagia group. Using logistic regression analysis, high IMAC, postoperative ventilator management, cerebrovascular disorder, and dementia were correlated with postoperative dysphagia and were assigned 10, 4, 3, and 3 points, respectively, according to each odds ratio. The optimal cut‐off value was 7 according to a receiver operating characteristics curve. Using 1:1 propensity score matching for high‐risk patients, the incidence of postoperative dysphagia was reduced by SSTs.ConclusionsThe new prediction score obtained from this study can identify older patients at high risk for dysphagia after EAS, and SSTs may improve these patients' short‐term outcomes.

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Post-extubation dysphagia incidence in critically ill patients: A systematic review and meta-analysis

Cited by 71 publications

References 46 publications

Risk Score for Predicting Dysphagia in Patients After Neurosurgery: A Prospective Observational Trial

Risk Score for Predicting Dysphagia in Patients After Neurosurgery: A Prospective Observational Trial

Tough Pill to Swallow: Postextubation Dysphagia and Nutrition Impact in the Intensive Care Unit

Development of predictive score for postoperative dysphagia after emergency abdominal surgery in patients of advanced age

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