689: POST-EXTUBATION DYSPHAGIA IN CHILDREN AFTER MECHANICAL VENTILATORY SUPPORT

Abstract

Introduction: Post-extubation dysphagia (PED) is prevalent among critically ill adult patients after mechanical ventilatory support and is associated with significant morbidity including aspiration pneumonia, alteration of feeding, malnutrition, decreased quality of life, prolonged hospitalization and mortality. Sparse studies exist detailing the prevalence, contributing risk factors and health-related outcomes of PED in critically ill children. Methods: Single-center, retrospective chart review of patients without a pre-existing dysphagia diagnosis admitted to the pediatric intensive care unit at Shands Children’s Hospital at University of Florida from June 2015 through June 2020. Patients with instrumental dysphagia evaluations after >24 hours of mechanical ventilatory support were included in the data analysis and categorized based on the presence of aspiration or dysphagia. This study aimed to determine PED prevalence, demographic and intubation risk factors contributing to PED, and the impact PED on health-related outcomes. Results: There were 36 patients included in the analysis (median age: 5 years). 72% of patients were emergently intubated (median number of attempts: 2; 86% with cuffed endotracheal tube) with a median duration of 11.5 days of mechanical ventilatory support. Aspiration was present in 64% (n=23) of the cohort. 92% (n=21) of patients with PED were silent aspirators. No demographic (age, weight, sex, pre-existing conditions) or intubation risk factors (intubation attempts, duration of mechanical ventilation, presence of cuffed endotracheal tube, endotracheal tube size) were significantly associated with the development of PED (p>0.05). Patients with PED were more likely to be re-intubated secondary to weakness or neuromuscular compromise (p=0.04). There was no significant association between PED and in-hospital mortality. However, PED was significantly associated with the need for home oxygen after discharge (p=0.03; OR 6.25; 95%CI 1.3-29.4), and modification of home feeds at both ICU (p=0.001; OR 15.0; 95% CI 2.8-81.4) and hospital discharge (p=0.001; OR 16.8; 95%CI 2.7-104.8). Conclusions: PED is prevalent and associated with worse-health related outcomes among critically ill children after mechanical ventilatory support.