Persistent swallowing disorders after extubation in mechanically ventilated patients in ICU: a two-center prospective study.
Mechanical ventilation
Mechanical ventilation weaning
Prolonged intubation
Swallowing disorder
Journal
Annals of intensive care
ISSN: 2110-5820
Titre abrégé: Ann Intensive Care
Pays: Germany
ID NLM: 101562873
Informations de publication
Date de publication:
14 Oct 2020
14 Oct 2020
Historique:
received:
25
05
2020
accepted:
03
10
2020
entrez:
14
10
2020
pubmed:
15
10
2020
medline:
15
10
2020
Statut:
epublish
Résumé
Persistent swallowing disorders (SD) are non-pulmonary complications of mechanical ventilation (MV). However, there are few clinical studies on persistent SD in critically ill patients undergoing tracheal intubation for MV. The aim of the present study was to assess the incidence and characteristics of clinical manifestations associated with persistent SD. We prospectively evaluated in patients requiring more than 7 days of invasive MV the incidence and characteristics of clinical manifestations related to persistent SD. For this purpose, quality of swallowing was assessed within 24 h after extubation by an experienced physical therapist not directly involved in patient management. Swallowing assessment consisted in a specific standardized test combining a swallowing test and a full clinical evaluation of the cranial nerves involved in swallowing. In patients with SD on the first test, a second test was done within 48 h in order to discriminate between transient and persistent SD. Among the 482 patients mechanically ventilated more than 7 days, 138 were enrolled in this study. The first test performed 24 h after extubation revealed SD in 35 patients (25%). According to the second test performed 48 h later, SD were considered transient in 21 (15%) and persistent in 14 (10%) cases. Patients with persistent SD were older (66 ± 16 vs 58 ± 15 years), had lower bodyweight at admission (76 ± 15 vs 87 ± 23 kg) and received less often neuromuscular blocking agents (36% vs 66%) compared to patients without or with only transient SD. Patients with persistent SD had longer duration of Intensive Care Unit (ICU) stay after first extubation and longer delay to oral feeding than patients without or with only transient SD, respectively, 11 ± 9 vs 7 ± 6 days and 23 ± 33 vs 5 ± 7 days. Based on a specific standardized clinical test, 25% of patients mechanically ventilated more than 7 days exhibited clinical manifestations of SD. However, SD were considered as persistent after extubation in only 10% of them. Persistent SD were associated with longer duration of ICU stay after extubation and longer time of enteral feeding. The study is registered with Clinical Trials (NCT01360580).
Sections du résumé
BACKGROUND
BACKGROUND
Persistent swallowing disorders (SD) are non-pulmonary complications of mechanical ventilation (MV). However, there are few clinical studies on persistent SD in critically ill patients undergoing tracheal intubation for MV. The aim of the present study was to assess the incidence and characteristics of clinical manifestations associated with persistent SD.
METHODS
METHODS
We prospectively evaluated in patients requiring more than 7 days of invasive MV the incidence and characteristics of clinical manifestations related to persistent SD. For this purpose, quality of swallowing was assessed within 24 h after extubation by an experienced physical therapist not directly involved in patient management. Swallowing assessment consisted in a specific standardized test combining a swallowing test and a full clinical evaluation of the cranial nerves involved in swallowing. In patients with SD on the first test, a second test was done within 48 h in order to discriminate between transient and persistent SD.
RESULTS
RESULTS
Among the 482 patients mechanically ventilated more than 7 days, 138 were enrolled in this study. The first test performed 24 h after extubation revealed SD in 35 patients (25%). According to the second test performed 48 h later, SD were considered transient in 21 (15%) and persistent in 14 (10%) cases. Patients with persistent SD were older (66 ± 16 vs 58 ± 15 years), had lower bodyweight at admission (76 ± 15 vs 87 ± 23 kg) and received less often neuromuscular blocking agents (36% vs 66%) compared to patients without or with only transient SD. Patients with persistent SD had longer duration of Intensive Care Unit (ICU) stay after first extubation and longer delay to oral feeding than patients without or with only transient SD, respectively, 11 ± 9 vs 7 ± 6 days and 23 ± 33 vs 5 ± 7 days.
CONCLUSIONS
CONCLUSIONS
Based on a specific standardized clinical test, 25% of patients mechanically ventilated more than 7 days exhibited clinical manifestations of SD. However, SD were considered as persistent after extubation in only 10% of them. Persistent SD were associated with longer duration of ICU stay after extubation and longer time of enteral feeding.
TRIAL REGISTRATION
BACKGROUND
The study is registered with Clinical Trials (NCT01360580).
Identifiants
pubmed: 33052476
doi: 10.1186/s13613-020-00752-x
pii: 10.1186/s13613-020-00752-x
pmc: PMC7560673
doi:
Banques de données
ClinicalTrials.gov
['NCT01360580']
Types de publication
Journal Article
Langues
eng
Pagination
138Références
Intensive Care Med. 2010 Jun;36(6):991-8
pubmed: 20237758
Crit Care. 2011;15(5):R231
pubmed: 21958475
Chest. 1996 Jan;109(1):167-72
pubmed: 8549181
Crit Care Med. 2013 Oct;41(10):2396-405
pubmed: 23939361
Arch Surg. 2001 Apr;136(4):434-7
pubmed: 11296115
Crit Care Med. 2015 Feb;43(2):492-3
pubmed: 25599480
Codas. 2013;25(1):1-7
pubmed: 24408163
Crit Care Med. 2015 Feb;43(2):365-72
pubmed: 25377021
Ann Intensive Care. 2019 Jan 22;9(1):13
pubmed: 30671726
Dysphagia. 2019 Aug;34(4):475-486
pubmed: 30684017
Intensive Care Med. 2017 Sep;43(9):1270-1281
pubmed: 28289812
Crit Care. 2013 Jun 20;17(3):R119
pubmed: 23786755
Chest. 2010 Mar;137(3):665-73
pubmed: 20202948
Crit Care Med. 2017 Dec;45(12):2061-2069
pubmed: 29023260
Crit Care. 2019 Mar 28;23(1):103
pubmed: 30922363
Intensive Care Med. 2003 Sep;29(9):1451-5
pubmed: 12904855