Pharyngeal Electrical Stimulation Treatment of Critically Ill Intensive Care Tracheostomized Patients Presenting with Severe Neurogenic Dysphagia: A Case Series

Abstract

Purpose: To assess the benefits of Pharyngeal Electrical Stimulation (PES) in critically ill tracheostomized patients with severe neurogenic dysphagia. Methods: A retrospective outcome analysis of tracheostomized patients weaned from mechanical ventilation and treated with PES in a medical ICU. Results: Nineteen patients (mean age: 64 years), admitted to the ICU mainly because of severe acute infections, were treated with PES whilst still tracheostomized (mean duration of intubation prior to tracheostomy: 12 days). Following the start of PES, 15/19 patients were successfully decannulated during their hospital stay (mean time to decannulation: 13 days); 11 of the 15 surviving patients experienced a complete restoration of swallowing function. Among patients with available data, the mean time to improved feeding status from “nil by mouth” was three days with thickened fluids and ten days with thin oral fluid. The mean length of stay was eleven days in the ICU and 56 days in the hospital. PES treated tracheostomized patients had a shorter mean LOS in the ICU (47 vs 58 days) and in the hospital (109 vs 125 days) compared to non- PES treated ones. No serious adverse events related to PES treatment were observed, and no patients required recannulation. Conclusions: In this mixed population, PES led to improved swallowing function resulting in successful decannulation of 15/19 patients and return to normal oral intake at hospital discharge in 11/15 patients with severe neurogenic swallowing disorders and tracheostomy.