Abstract
BackgroundPersistent 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.MethodsWe 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.ResultsAmong 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.ConclusionsBased 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: The study is registered with Clinical Trials (NCT01360580).
Highlights
Persistent swallowing disorders (SD) are non-pulmonary complications of mechanical ventilation (MV)
Based on a specific standardized test combining a swallowing test and a clinical evaluation of the cranial nerves involved in swallowing, we found that 25% of patients mechanically ventilated for 7 days or more exhibited
Reintubation (N, (%)) Antibiotics for pneumonia after extubation (N; (%)) Duration of exclusive tube feeding (D; mean ± SD)) Delay to exclusive oral feeding (D; mean ± SD) Duration of intensive care unit (ICU) stay after first extubation (D; mean ± SD) Return to exclusive oral feeding (N;(%)) SD swallowing disorders, ICU Intensive Care Unit
Summary
Persistent swallowing disorders (SD) are non-pulmonary complications of mechanical ventilation (MV). 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. There has been an increasing interest in non-pulmonary complications of mechanical ventilation (MV) in critically ill patients [1]. Among the complications associated with several days of tracheal intubation, the persistent dysfunction of swallowing has been poorly studied in the literature. The aim of this study was to systematically evaluate the incidence of clinical manifestations related to persistent SD in critically ill patients requiring more than 7 days of invasive MV
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
