Clinical Approaches to Assess Post-extubation Dysphagia (PED) in the Critically Ill.

Perren, Andrea; Zürcher, Patrick; Schefold, Joerg C. (2019). Clinical Approaches to Assess Post-extubation Dysphagia (PED) in the Critically Ill. Dysphagia, 34(4), pp. 475-486. Springer 10.1007/s00455-019-09977-w

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Swallowing disorders and respective consequences (including aspiration-induced pneumonia) are often observed in extubated ICU patients with data indicating that a large number of patients are affected. We recently demonstrated in a large-scale analysis that the incidence of post-extubation dysphagia (PED) is 12.4% in a general ICU population and about 18% in emergency admissions to the ICU. Importantly, PED was mostly sustained until hospital discharge and independently predicted 28- and 90-day mortality. Although oropharyngeal/laryngeal trauma, neuromuscular ICU-acquired weakness, reduced sensation/sensorium, dyssynchronous breathing, and gastrointestinal reflux, are all considered to contribute to PED, little is known about the underlying pathomechanisms and risk factors leading to PED in critically ill patients. Systematic screening of all potential ICU patients for oropharyngeal dysphagia (OD) seems key for early recognition and follow-up, as well as the design and testing of novel therapeutic interventions. Today, screening methods and clinical investigations for dysphagia differ considerably. In the context of a recently proposed pragmatic screening algorithm introduced by us, we provide a concise review on currently available non-instrumental techniques that could potentially serve for non-instrumental OD assessment in critically ill patients. Following systematic literature review, we find that non-instrumental OD assessments were mostly tested in different patient populations with only a minority of studies performed in critically ill patients. Due to little available data on non-instrumental dysphagia assessment in the ICU, future investigations should aim to validate respective approaches in the critically ill against an instrumental (gold) standard, for example, flexible endoscopic evaluation of swallowing. An international expert panel is encouraged to addresses critical illness-related definitions, screening and confirmatory assessment approaches, treatment recommendations, and identifies optimal patient-centered outcome measures for future clinical investigations.

Item Type:

Journal Article (Review Article)

Division/Institute:

04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic of Intensive Care

UniBE Contributor:

Zürcher, Patrick and Schefold, Joerg C.

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1432-0460

Publisher:

Springer

Language:

English

Submitter:

Mirella Aeberhard

Date Deposited:

21 Feb 2019 14:21

Last Modified:

23 Oct 2019 11:50

Publisher DOI:

10.1007/s00455-019-09977-w

PubMed ID:

30684017

Uncontrolled Keywords:

ICU-ASD ICU-AW Neuromuscular Non-instrumental Sepsis Swallowing disorder

BORIS DOI:

10.7892/boris.125366

URI:

https://boris.unibe.ch/id/eprint/125366

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