Post-extubation dysphagia is associated with longer hospitalization in survivors of critical illness with neurologic impairment

Critical Care

Marc Moss³  André Williams²  Ellen L Burnham³  Alexander B Benson³  Brendan J Clark³  Tim Wimbish¹  Christopher J King³  Madison Macht³ 

[1] University of Colorado Hospital, Rehabilitation Therapy, 12700 E 19th Avenue, Aurora, CO 80045, USA;Division of Biostatistics and Bioinformatics, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, USA;Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Denver, 12700 E 19th Avenue, Aurora, CO 80045, USA

关键词: respiratory;    aspiration;    dysphagia;    swallowing disorders;    intratracheal;    intubation;    mechanical ventilation;   

Others  :  818110
DOI  :  10.1186/cc12791

 received in 2012-12-14, accepted in 2013-06-20,  发布年份 2013

【 摘 要 】

Introduction

Critically ill patients can develop acute respiratory failure requiring endotracheal intubation. Swallowing dysfunction after liberation from mechanical ventilation, also known as post-extubation dysphagia, is common and deleterious among patients without neurologic disease. However, the risk factors associated with the development of post-extubation dysphagia and its effect on hospital lengthofstay in critically ill patients with neurologic disorders remains relatively unexplored.

Methods

We conducted a retrospective, observational cohort study from 2008 to 2010 of patients with neurologic impairment who required mechanical ventilation and subsequently received a bedside swallow evaluation (BSE) by a speech-language pathologist.

Results

A BSE was performed after mechanical ventilation in 25% (630/2,484) of all patients. In the 184 patients with neurologic impairment, post-extubation dysphagia was present in 93% (171/184), and was classified as mild, moderate, or severe in 34% (62/184), 26% (48/184), and 33% (61/184), respectively. In univariate analyses, statistically significant risk factors for moderate/severe dysphagia included longer durations of mechanical ventilation and the presence of a tracheostomy. In multivariate analysis, adjusting for age, tracheostomy, cerebrovascular disease, and severity of illness, mechanical ventilation for >7 days remained independently associated with moderate/severe dysphagia (adjusted odds ratio = 4.48 (95%confidence interval = 2.14 to 9.81), P<0.01). The presence of moderate/severe dysphagia was also significantly associated with prolonged hospital lengthofstay, discharge status, and surgical placement of feeding tubes. When adjusting for age, severity of illness, and tracheostomy, patients with moderate/severe dysphagia stayed in the hospital 4.32 days longer after their initial BSE than patients with none/mild dysphagia (95% confidence interval = 3.04 to 5.60 days, P <0.01).

Conclusion

In a cohort of critically ill patients with neurologic impairment, longer duration of mechanical ventilation is independently associated with post-extubation dysphagia, and the development of post-extubation dysphagia is independently associated with a longer hospital length of stay after the initial BSE.

【 授权许可】

   
2013 Macht et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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