Factors associated with the readiness for oral intake in post‐extubated critically ill adult patients: A prospective observational study

Abstract

BackgroundPost‐extubation dysphagia (PED) is a common post‐extubation complication that may lead to serious problems, such as malnutrition and longer hospital and intensive care unit (ICU) stays.AimTo explore factors associated with the readiness for oral intake in post‐extubated critically ill adult patients.Study DesignThis prospective observational study involved 125 extubated patients. Readiness for oral intake was assessed using the Gugging Swallowing Screen (GUSS), and regression analysis was used to determine its predictors.ResultsThe median age of the participants was 40.0 years, and 51.2% were female. The median GUSS score was 12.0 (possible range, 0–20), and 35.2% of the studied patients had severe dysphagia (scored 0–9). Bivariate regression analysis showed that older age, male, higher APACHE II score, body mass index (BMI) ≥30, smoking history, longer ICU stay, muscle relaxants use, large‐bore endotracheal and orogastric tubes and frequent intubation attempts were associated with lower GUSS score (p‐value <.05). Multivariate regression analysis showed that age, BMI and smoking history predicted 37.2% of the variability in the GUSS score (F = 23.865, p‐value <.001). Adding the ICU length of stay, muscle relaxants use, size of the endotracheal tube, size of the orogastric tube and frequency of intubation attempts to the regression model raised the predictability to 86.0% (F = 88.809, p‐value <.001).ConclusionsMore than one‐third of extubated patients have severe PED with a high risk of aspiration. Several modifiable factors, such as muscle relaxant use and endotracheal and orogastric tube size, predict post‐extubation readiness for oral intake.Relevance to Clinical PracticeUsing endotracheal and orogastric tubes of appropriate sizes, careful assessment of patients with a high risk for difficult intubation, and minimal use of muscle relaxants may help increase patients' readiness for post‐extubation oral intake.