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. (In Press). Chest 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).

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

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:

26 Jun 2020 17:49

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

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