Risk factors for dysphagia in ICU patients following invasive mechanical ventilation.

Zuercher, Patrick; Schenk, Noëlle V; Moret, Céline; Berger, David; Abegglen, Roman; Schefold, Joerg C. (2020). Risk factors for dysphagia in ICU patients following invasive mechanical ventilation. Chest, 158(5), pp. 1983-1991. Elsevier 10.1016/j.chest.2020.05.576

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BACKGROUND

Dysphagia is common and independently predicts death in ICU patients. Risk factors for dysphagia are largely unknown with sparse data available from mostly small cohorts without systematic dysphagia screening.

RESEARCH QUESTION

What are the key risk factors for dysphagia in ICU patients post invasive mechanical ventilation?

STUDY DESIGN AND METHODS

Post-hoc analysis of data from a monocentric prospective observational study ("DYnAMICS") using comprehensive statistical models to identify potential risk factors for post-extubation dysphagia. 933 primary admissions of adult medical-surgical ICU patients (median age 65 years [IQR 54-73], n=666 (71%) male) were investigated in a tertiary care academic centre. Patients received systematic bedside screening for dysphagia within 3 hours post extubation. Dysphagia screening positivity (n=116) was followed within 24 hours by a confirmatory exam.

RESULTS

After adjustment for confounders, baseline neurological disease (OR 4.45, 95%-CI: 2.74-7.24, p<0.01), emergency admission (OR 2.04, 95%-CI: 1.15-3.59, p<0.01), days on mechanical ventilation (OR 1.19, 95%-CI: 1.06-1.34, p<0.01), days on renal replacement therapy (OR 1.1, 95%-CI: 1-1.23, p=0.03), and disease severity (APACHE II score within first 24 hours; OR 1.03, 95%-CI: 0.99-1.07, p<0.01) remained independent risk factors for dysphagia post extubation. Increased Body Mass Index reduced the risk for dysphagia (6% per step increase, OR 0.94, 95%-CI: 0.9-0.99, p=0.03).

INTERPRETATION

In ICU patients, baseline neurological disease, emergency admission and duration of invasive mechanical ventilation appeared as prominent independent risk factors for dysphagia. As all ICU patients post mechanical ventilation should be considered at risk for dysphagia, systematic screening for dysphagia is recommended in respective critically ill patients.

CLINICAL TRIAL REGISTRATION

clinicaltrials.gov (NCT02333201).

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