Dysphagia in Mechanically Ventilated ICU Patients (DYnAMICS): A Prospective Observational Trial.

Schefold, Joerg C.; Berger, David; Zürcher, Patrick; Lensch, Michael; Perren, Andrea; Jakob, Stephan; Parviainen, Ilkka; Takala, Jukka (2017). Dysphagia in Mechanically Ventilated ICU Patients (DYnAMICS): A Prospective Observational Trial. Critical care medicine, 45(12), pp. 2061-2069. Lippincott Williams & Wilkins 10.1097/CCM.0000000000002765

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OBJECTIVES Swallowing disorders may be associated with adverse clinical outcomes in patients following invasive mechanical ventilation. We investigated the incidence of dysphagia, its time course, and association with clinically relevant outcomes in extubated critically ill patients. DESIGN Prospective observational trial with systematic dysphagia screening and follow-up until 90 days or death. SETTINGS ICU of a tertiary care academic center. PATIENTS One thousand three-hundred four admissions of mixed adult ICU patients (median age, 66.0 yr [interquartile range, 54.0-74.0]; Acute Physiology and Chronic Health Evaluation-II score, 19.0 [interquartile range, 14.0-24.0]) were screened for postextubation dysphagia. Primary ICU admissions (n = 933) were analyzed and followed up until 90 days or death. Patients from an independent academic center served as confirmatory cohort (n = 220). INTERVENTIONS Bedside screening for dysphagia was performed within 3 hours after extubation by trained ICU nurses. Positive screening triggered confirmatory specialist bedside swallowing examinations and follow-up until hospital discharge. MEASUREMENTS AND MAIN RESULTS Dysphagia screening was positive in 12.4% (n = 116/933) after extubation (18.3% of emergency and 4.9% of elective patients) and confirmed by specialists within 24 hours from positive screening in 87.3% (n = 96/110, n = 6 missing data). The dysphagia incidence at ICU discharge was 10.3% (n = 96/933) of which 60.4% (n = 58/96) remained positive until hospital discharge. Days on feeding tube, length of mechanical ventilation and ICU/hospital stay, and hospital mortality were higher in patients with dysphagia (all p < 0.001). The univariate hazard ratio for 90-day mortality for dysphagia was 3.74 (95% CI, 2.01-6.95; p < 0.001). After adjustment for disease severity and length of mechanical ventilation, dysphagia remained an independent predictor for 28-day and 90-day mortality (excess 90-d mortality 9.2%). CONCLUSIONS Dysphagia after extubation was common in ICU patients, sustained until hospital discharge in the majority of affected patients, and was an independent predictor of death. Dysphagia after mechanical ventilation may be an overlooked problem. Studies on underlying causes and therapeutic interventions seem warranted.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic of Intensive Care
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > Forschungsbereich Pavillon 52 > Forschungsgruppe Intensivmedizin

UniBE Contributor:

Schefold, Joerg C.; Berger, David; Zürcher, Patrick; Lensch, Michael; Jakob, Stephan and Takala, Jukka

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0090-3493

Publisher:

Lippincott Williams & Wilkins

Language:

English

Submitter:

Mirella Aeberhard

Date Deposited:

13 Dec 2017 08:53

Last Modified:

23 Oct 2019 01:58

Publisher DOI:

10.1097/CCM.0000000000002765

PubMed ID:

29023260

BORIS DOI:

10.7892/boris.106255

URI:

https://boris.unibe.ch/id/eprint/106255

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