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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2020 - Zürcher - Chest - PMID 32525018.pdf - Accepted Version Restricted to registered users only until 8 June 2021. Available under License Creative Commons: Attribution-Noncommercial-No Derivative Works (CC-BY-NC-ND). Download (1MB) | Request a copy |
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).
Item Type: |
Journal Article (Original Article) |
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Division/Institute: |
04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic of Intensive Care |
UniBE Contributor: |
Zürcher, Patrick; Berger, David and Schefold, Jörg Christian |
Subjects: |
600 Technology > 610 Medicine & health |
ISSN: |
1931-3543 |
Publisher: |
Elsevier |
Language: |
English |
Submitter: |
Jsabelle Arni |
Date Deposited: |
26 Jun 2020 17:49 |
Last Modified: |
10 Nov 2020 01:31 |
Publisher DOI: |
10.1016/j.chest.2020.05.576 |
PubMed ID: |
32525018 |
Uncontrolled Keywords: |
ICU acquired swallowing dysfunction critical illness deglutition disorder dysfunction post-extubation dysphagia sepsis swallowing |
BORIS DOI: |
10.7892/boris.144667 |
URI: |
https://boris.unibe.ch/id/eprint/144667 |