A Predictive Model for Dysphagia after Ventilator Liberation in Severe Pneumonia Patients Receiving Tracheostomy: A Single-Center, Observational Study

Abstract

The main purpose of this study was to develop a model predictive of dysphagia in hospital survivors with severe pneumonia who underwent tracheostomy during their hospital stay. The present study included 175 patients (72% male; mean age, 71.3 years) over 5 years. None of these patients had a history of deglutition disorder before hospital admission. Binary logistic regression analysis was performed to identify factors predicting dysphagia at hospital discharge. Dysphagia scores were calculated from β-coefficients and by assigning points to variables. Of the enrolled patients, 105 (60%) had dysphagia at hospital discharge. Factors prognostic of dysphagia at hospital discharge included being underweight (body mass index < 18.5 kg/m2), non-participation in a dysphagia therapy program, mechanical ventilation ≥ 15 days, age ≥ 74 years, and chronic neurologic diseases. Underweight and non-participation in a dysphagia therapy program were assigned +2 points and the other factors were assigned +1 point. Dysphagia scores showed acceptable discrimination (area under the receiver operating characteristic curve for dysphagia 0.819, 95% confidence interval: 0.754–0.873, p < 0.001) and calibration (Hosmer–Lemeshow chi-square = 9.585, with df 7 and p = 0.213). The developed dysphagia score was predictive of deglutition disorder at hospital discharge in tracheostomized patients with severe pneumonia.

Prediction Models for Dysphagia in Intensive Care Unit after Mechanical Ventilation: A Systematic Review and Meta‐analysis

“…[1][2][3] Dysphagia is highly prevalent in postextubated patients after oral endotracheal intubation, even in the absence of preexisting dysphagia during hospital admission [4][5][6] ; this is associated with anatomic and functional changes during invasive mechanical ventilation. [7][8][9] Each year, between 13 and 20 million critically ill patients worldwide rely on mechanical ventilation. 10 Within this group, rates of PED vary from 3% to 62%, which results in an estimated annual global PED incidence of up to 12.4 million individuals.…”

“…Swallowing dysfunction, known as post‐extubation dysphagia (PED), can arise following mechanical ventilation and result in complications like aspiration and pneumonia 1–3 . Dysphagia is highly prevalent in post‐extubated patients after oral endotracheal intubation, even in the absence of preexisting dysphagia during hospital admission 4–6 ; this is associated with anatomic and functional changes during invasive mechanical ventilation 7–9 . Each year, between 13 and 20 million critically ill patients worldwide rely on mechanical ventilation 10 .…”