Dysphagia and Associated Risk Factors Following Extubation in Cardiovascular Surgical Patients

Abstract

Following cardiovascular (CV) surgery, prolonged mechanical ventilation of >48 h increases dysphagia frequency over tenfold: 51 % compared to 3-4 % across all durations. Our primary objective was to identify dysphagia frequency following CV surgery with respect to intubation duration. Our secondary objective was to explore characteristics associated with dysphagia across the entire sample. Using a retrospective design, we stratified all consecutive patients who underwent CV surgery in 2009 at our institution into intubation duration groups defined a priori: I (≤ 12 h), II (>12 to ≤ 24 h), III (>24 to ≤ 48 h), and IV (>48 h). Eligible patients were >18 years old who survived extubation following coronary artery bypass alone or cardiac valve surgery. Patients who underwent tracheotomy were excluded. Pre-, peri-, and postoperative patient variables were extracted from a pre-existing database and medical charts by two blinded reviewers. Disagreements were resolved by consensus. Across the entire sample, multivariable logistic regression analysis determined independent predictors of dysphagia. Across the entire sample, dysphagia frequency was 5.6 % (51/909) but varied by group: I, 1 % (7/699); II, 8.2 % (11/134); III, 16.7 % (6/36); and IV, 67.5 % (27/40). Across the entire sample, the independent predictors of dysphagia included intubation duration in 12-h increments (p < 0.001; odds ratio [OR] 1.93, 95 % confidence interval [CI] 1.63-2.29) and age in 10-year increments (p = 0.004; OR 2.12, 95 % CI 1.27-3.52). Patients had a twofold increase in their odds of developing dysphagia for every additional 12 h with endotracheal intubation and for every additional decade in age. These patients should undergo post-extubation swallow assessments to minimize complications.

Fatores relacionados à disfagia orofaríngea no pós-operatório de cirurgia cardíaca: revisão sistemática

“…The study sample ranged from 254 (18) to 1042 (10) individuals (mean 781.2). Age varied from 65.4±12.1 (18) to 74.3±8.7 (11) years between the groups of patients with dysphagia and from 62.8±11.8 (10) to 63±0.4 (17) years between the groups of patients without dysphasia. The study by Rousou et al (9) did not consider age as a factor for the development of dysphagia between the groups of individuals undergoing TEE.…”

“…Only studies published in English conducted in the United States (60%) (9,10,17) and Canada (40%) (11,18) were included in this literature review. The study sample ranged from 254 (18) to 1042 (10) individuals (mean 781.2).…”

“…Impairment of the swallowing function may be present in various conditions in hospitalized patients, such as in the cases of trauma, stroke, and chronic obstructive pulmonary disease, as well as in patients with cardiopathies (8) . In this context, in recent years, research has indicated a possible relationship between cardiac surgery and the development of oropharyngeal dysphagia in the postoperative period due to exposure of patients to various risk factors, such as endotracheal intubation (OTI), cardiopulmonary bypass (CPB), transesophageal echocardiography (TEE), among others (8)(9)(10)(11) . A study conducted with 361 patients undergoing CABG showed an incidence of 53.5% of respiratory infection postoperatively (12) , indicating the need to evaluate the presence of oropharyngeal dysphagia in this population, especially in individuals at risk for aspiration (13) .…”

Achados da avaliação clínica da deglutição em lactentes cardiopatas pós-cirúrgicos

“…There are few studies that investigate the relationship between TI and changes in swallowing in pediatrics, there is a predominance of the publication of researches performed with adults in which a high prevalence of dysphagia is observed, with 44% to 85%, highlighting multifactor causes that include: oropharyngeal muscle inactivity, glottis lesions, mucosal inflammation and vocal fold ulcerations, as well as mechanical and sensory alterations (25)(26)(27) . A systematic review has shown that prolonged TI may be an independent predictor of dysphagia, and its use increases the risk of upper airway and larynx lesions, which in turn affect the mechanics, aerodynamics, and reflex protection of the upper airways (27) .…”

“…There is no established consensus in the literature regarding the definition of prolonged TI. Its description varies as: greater than 24 hours, greater than 48 hours or up to eight days (25) , being commonly considered as a period greater than 48 hours for the adult population. The present study identified that the presence of dysphagia is associated with a TI time greater than 24 hours, since, from this period, the presence of the orotracheal tube may alter the mechanics and chemoreceptors of the pharyngeal and laryngeal mucosa, causing a change in swallowing reflex and disorder to laryngeal function, which has an impact on the protection mechanisms of the lower airways (23) .…”