Postextubation dysphagia is persistent and associated with poor outcomes in survivors of critical illnessReportar como inadecuado




Postextubation dysphagia is persistent and associated with poor outcomes in survivors of critical illness - Descarga este documento en PDF. Documentación en PDF para descargar gratis. Disponible también para leer online.

Critical Care

, 15:R231

First Online: 29 September 2011Received: 19 July 2011Revised: 19 August 2011Accepted: 29 September 2011

Abstract

IntroductionDysphagia is common among survivors of critical illness who required mechanical ventilation during treatment. The risk factors associated with the development of postextubation dysphagia, and the effects of dysphagia on patient outcomes, have been relatively unexplored.

MethodsWe conducted a retrospective, observational cohort study from 2008 to 2010 of all patients over 17 years of age admitted to a university hospital ICU who required mechanical ventilation and subsequently received a bedside swallow evaluation BSE by a speech pathologist.

ResultsA BSE was performed after mechanical ventilation in 25% 630 of 2,484 of all patients. After we excluded patients with stroke and-or neuromuscular disease, our study sample size was 446 patients. We found that dysphagia was present in 84% of patients n = 374 and classified dysphagia as absent, mild, moderate or severe in 16% n = 72, 44% n = 195, 23% n = 103 and 17% n = 76, respectively. In univariate analyses, we found that statistically significant risk factors for severe dysphagia included long duration of mechanical ventilation and reintubation. In multivariate analysis, after adjusting for age, gender and severity of illness, we found that mechanical ventilation for more than seven days remained independently associated with moderate or severe dysphagia adjusted odds ratio AOR = 2.84 interquartile range IQR = 1.78 to 4.56; P < 0.01. The presence of severe postextubation dysphagia was significantly associated with poor patient outcomes, including pneumonia, reintubation, in-hospital mortality, hospital length of stay, discharge status and surgical placement of feeding tubes. In multivariate analysis, we found that the presence of moderate or severe dysphagia was independently associated with the composite outcome of pneumonia, reintubation and death AOR = 3.31 IQR = 1.89 to 5.90; P < 0.01.

ConclusionsIn a large cohort of critically ill patients, long duration of mechanical ventilation was independently associated with postextubation dysphagia, and the development of postextubation dysphagia was independently associated with poor patient outcomes.

AbbreviationsAORadjusted odds ratio

ARFacute respiratory failure

BMIbody mass index

BSEbedside swallow evaluation

CVAcerebrovascular accident

DOSSDysphagia Outcome and Severity Scale

EDemergency department

FEESflexible endoscopic evaluation of swallowing

GCSGlasgow Coma Scale

SOFASequential Organ Failure Assessment

VFSSvideofluoroscopic studies of swallowing.

Electronic supplementary materialThe online version of this article doi:10.1186-cc10472 contains supplementary material, which is available to authorized users.

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Autor: Madison Macht - Tim Wimbish - Brendan J Clark - Alexander B Benson - Ellen L Burnham - André Williams - Marc Moss

Fuente: https://link.springer.com/







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