Swallowing Dysfunction After Critical Illness

Abstract

Critical care practitioners must frequently make decisions about their patients' ability to swallow food, liquids, and pills. These decisions can be particularly diffi cult given the incompletely defi ned epidemiology, diagnostic criteria, and prognostic features of swallowing disorders in critically ill patients. Furthermore, the consequences of improper decisions-namely, aspiration, malnutrition, hunger, and thirst-can be devastating to patients and their families.This review outlines the problem of swallowing dysfunction in critically ill patients and then addresses the most clinically relevant questions that critical care practitioners face today.First, we review the epidemiology of swallowing dysfunction in critically ill patients. Next, we describe the diff erent diagnostic tests for swallowing dysfunction and describe a general approach to the initial assessment for swallowing disorders. Finally, we explore the existing treatments for swallowing dysfunction. Given the burden of swallowing dysfunction in patients recovering from critical illness, enabling critical care practitioners to manage these disorders, while stimulating new investigation into their pathophysiology, diagnosis, and management, will enhance our care of critically ill patients.

Frequency and outcome of post‐extubation dysphagia using nurse‐performed swallowing screening protocol

“…In recent years, many reports have been published on dysphagia in the ICU, and the influence of swallowing disorders on patient prognosis has been attracting attention (Macht et al, , ; Rassameehiran et al, ). The development of post‐extubation dysphagia is independently associated with poor patient outcomes, including post‐extubation pneumonia, re‐intubation, in‐hospital mortality, longer hospital stay, re‐admission to the hospital or entry into nursing home facilities (Macht et al, ).…”

Subtherapeutic Posaconazole Exposure and Treatment Outcome in Patients With Invasive Fungal Disease

“…Because the tablet cannot be crushed or chewed, the oral suspension will remain a treatment option for patients who are unable to take tablets, such as patients with dysphagia, which is present in 16%-23% of the general population 43,44 and in up to 51% of critically ill patients. 45 The posaconazole oral suspension can also be used in patient with a nasogastric tube; however, the posaconazole absorption is reduced in these patients and TDM is therefore recommended to ensure sufficient posaconazole exposure. The different posaconazole formulations in combination with TDM can help to ensure sufficient posaconazole exposure and assure the efficacy of the antifungal treatment.…”

What's in this issue

“…Post-extubation dysphagia is a cause of concern in the care of critically ill patients in view of its high incidence (Skoretz et al, 2010) and its association with poor patient outcomes (Macht et al, 2014), some of which persist for a long time after discharge (Brodsky et al, 2017). Nonetheless, earlier research suggests that the frequency of swallowing assessment is less than desirable and varies substantially between settings (Brodsky et al, 2014).…”