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

Dobak, Stephanie; Kelly, Daniel P.

doi:10.1002/ncp.10602

Cited by 17 publications

(9 citation statements)

References 34 publications

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“…Postextubation dysphagia is defined as the difficulty or inability to effectively and safely transfer food and liquid from the mouth to the stomach, and may result in aspiration and respiratory complications [4]. Postextubation dysphagia has a widely variable incidence of 3%e62% depending upon the study consulted [5], and it is most common amongst critical care patients requiring endotracheal intubation for mechanical ventilation [6].…”

Section: Introductionmentioning

confidence: 99%

Dysphagia and mechanical ventilation in SARS-COV-2 pneumonia: It's real

et al. 2022

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Background & aims: Dysphagia can be a consequence of prolonged hospitalization in intensive care units (ICUs) due to severe SARS-CoV-2 pneumonia. This study aims at Identifying the risk factors for dysphagia in ICU patients with COVID-19 pneumonia requiring invasive mechanical ventilation, and at determining the frequency of postextubation dysphagia in this population. Methods: Observational, descriptive, retrospective, cohort study of SARS-CoV-2 pneumonia patients admitted into the ICUs from March to May 2020. The Modified Viscosity Volume Swallowing Test (mV-VST) was used to screening for dysphagia during the first 48 h of extubation in patients requiring mechanical ventilation. Descriptive statistics, univariate and multivariate analyses were conducted. A logistic regression was applied to construct a predictive model of dysphagia. Results: A total of 232 patients were admitted into the ICUs (age [median 60.5 years (95% CI: 58.5 to 61.9)]; male [74.1% (95% CI: 68.1 to 79.4)]; APACHE II score [median 17.7 (95% CI: 13.3 to 23.2)]; length of mechanical ventilation [median 14 days (95% CI: 11 to 16)]; prone position [79% (95% CI: 72.1 to 84.6)]; respiratory infection [34.5% (95% CI: 28.6 to 40.9)], renal failure [38.5% (95% CI: 30 to 50)])). 72% (167) of patients required intubation; 65.9% (110) survived; and in 84.5% (93) the mV-VST was performed. Postextubation dysphagia was diagnosed in 26.9% (25) of patients. APACHE II, prone position, length of ICU and hospital stay, length of mechanical ventilation, tracheostomy, respiratory infection and kidney failure developed during admission were significantly associated (p < 0.05) with dysphagia. Dysphagia was independently explained by the APACHE II score (OR: 1.1; 95% CI: 1.01 to 1.3; p ¼ 0.04) and tracheostomy (OR: 10.2; 95% CI: 3.2 to 32.1) p < 0.001). The predictive model forecasted dysphagia with a good ROC curve (AUC: 0.8; 95% CI: 0.7 to 0.9). Conclusions: Dysphagia affects almost one-third of patients with SARS-COV-2 pneumonia requiring intubation in the ICU. The risk of developing dysphagia increases with prolonged mechanical ventilation, tracheostomy, and poorer prognosis on admission (worst APACHE II score).

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Section: Introductionmentioning

confidence: 99%

Dysphagia and mechanical ventilation in SARS-COV-2 pneumonia: It's real

et al. 2022

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“…A competent‐level RDN in nutrition support could be an RDN starting practice after registration or an experienced RDN who has recently assumed responsibility to provide nutrition support care for patients/clients. Examples of patients/clients evaluated by a competent‐level RDN include those with malnutrition, 62–66 gastrointestinal disorders (eg, inflammatory bowel disease), cystic fibrosis, 67 and dysphagia 68–71 …”

Section: Application To Practicementioning

confidence: 99%

Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition: Revised 2021 standards of practice and standards of professional performance for registered dietitian nutritionists (competent, proficient, and expert) in nutrition support

Corrigan

Bobo²,

Rollins³

et al. 2021

Nut in Clin Prac

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Nutrition support is a therapy that crosses all ages, diseases, and conditions as health care practitioners strive to meet the nutrition requirements of individuals who are unable to meet nutrition and/or hydration needs with oral intake alone. Registered dietitian nutritionists (RDNs), as integral members of the nutrition support team provide needed information, such as identification of malnutrition risk, macro‐ and micronutrient requirements, and type of nutrition support therapy (eg, enteral or parenteral), including the route (eg, nasogastric vs nasojejunal or tunneled catheter vs port). The Dietitians in Nutrition Support Dietetic Practice Group, American Society for Parenteral and Enteral Nutrition, along with the Academy of Nutrition and Dietetics Quality Management Committee, have updated the Standards of Practice (SOP) and Standards of Professional Performance (SOPP) for RDNs working in nutrition support. The SOP and SOPP for RDNs in Nutrition Support provide indicators that describe the following 3 levels of practice: competent, proficient, and expert. The SOP uses the Nutrition Care Process and clinical workflow elements for delivering patient/client care. The SOPP describes the 6 domains that focus on professional performance. Specific indicators outlined in the SOP and SOPP depict how these standards apply to practice. The SOP and SOPP are complementary resources for RDNs and are intended to be used as a self‐evaluation tool for assuring competent practice in nutrition support and for determining potential education and training needs for advancement to a higher practice level in a variety of settings.

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“…Swallowing dysfunction (SD) is a major issue in post-extubated patients as it can lead to aspiration, acute respiratory failure, health-care associated pneumonia, reintubation, and, consequently, prolonged intensive care unit (ICU) and hospital length of stay [1][2][3]. Moreover, delayed enteral feeding after extubation could expose these patients to underfeeding [4], or the use of nasogastric tube feeding to laryngeal injury [5].…”

Section: Introductionmentioning

confidence: 99%