Abstract
BackgroundTo meet the surging demands for intubation and invasive ventilation as more COVID-19 patients begin their recovery, clinicians are challenged to find an ultra-brief and minimally invasive screen for postextubation dysphagia predicting feeding-tube dependence persisting for 72 h after extubation.MethodsThis study examined the predictive validity of a two-item swallowing screen on feeding-tube dependence over 72 h in patients following endotracheal extubation. Intensive-care-unit (ICU) patients (≥ 20 years) successfully extubated after ≥ 48 h endotracheal intubation were screened by trained nurses using the swallowing screen (comprising oral stereognosis and cough-reflex tests) 24 h postextubation. Feeding-tube dependence persisting for 72 h postextubation was abstracted from the medical record by an independent rater. To verify the results and cross-check whether the screen predicted penetration and/or aspiration during fiberoptic endoscopic evaluation of swallowing (FEES), participants agreeing to receive FEES were analyzed within 30 min of screening.ResultsThe results showed that 95/123 participants (77.2%) failed the screen, which predicted ICU patients’ prolonged (> 72 h) feeding-tube dependence, yielding sensitivity of 0.83, specificity of 0.35, and accuracy of 0.68. Failed-screen participants had 2.96-fold higher odds of feeding-tube dependence (95% CI, 1.13–7.76). For the 38 participants receiving FEES, the swallowing screen had 0.89 sensitivity to detect feeding-tube dependence and 0.86 sensitivity to predict penetration/aspiration, although specificity had room for improvement (0.36 and 0.21, respectively).ConclusionThis ultra-brief swallowing screen is sufficiently sensitive to identify high-risk patients for feeding-tube dependence persisting over 72 h after extubation. Once identified, a further assessment and care are indicated to ensure the prompt return of patients’ oral feeding.Trial registrationNCT03284892, registered on September 15, 2017.
Highlights
Identifying critically ill patients at risk for swallowing dysfunction is a priority after extubation
Postextubation dysphagia (PED) observed in previously dysphagia-naïve intensive care unit (ICU) patients is well recognized as a common sequela of intubation and can have serious consequences, including feeding-tube dependence [1], Siao et al BMC Pulmonary Medicine (2021) 21:403 increased risk of pneumonia [2,3,4], malnutrition [5], prolonged lengths of ICU and hospital stays [2, 6], and higher 90-day mortality [6]
Postextubation dysphagia observed in previously dysphagia-naïve ICU patients is associated with poor outcomes
Summary
Identifying critically ill patients at risk for swallowing dysfunction is a priority after extubation. Postextubation dysphagia (PED) observed in previously dysphagia-naïve intensive care unit (ICU) patients is well recognized as a common sequela of intubation and can have serious consequences, including feeding-tube dependence [1], Siao et al BMC Pulmonary Medicine (2021) 21:403 increased risk of pneumonia [2,3,4], malnutrition [5], prolonged lengths of ICU and hospital stays [2, 6], and higher 90-day mortality [6]. PED prevalence is, highly variable, ranging between 3 and 93% [1] This wide range is likely exacerbated by heterogeneity in study design, including diagnostic and screening methods. All three currently available PED screens (a bedside swallowing evaluation [administered only by speech therapists] [8], the Yale Swallow Protocol [9], and Postextubation Dysphagia Screening [10]) target aspiration risk and include a 3-oz water-swallow test. To meet the surging demands for intubation and invasive ventilation as more COVID-19 patients begin their recovery, clinicians are challenged to find an ultra-brief and minimally invasive screen for postextubation dyspha‐ gia predicting feeding-tube dependence persisting for 72 h after extubation
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