Risk Factors for Dysphagia in ICU Patients After Invasive Mechanical Ventilation

Zuercher, Patrick; Schenk, Noelle; Moret, C.; Berger, David; Abegglen, Roman; Schefold, Joerg C.

doi:10.1016/j.chest.2020.05.576

Cited by 41 publications

(49 citation statements)

References 44 publications

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“…34 In brief, proposed key independent risk factors for dysphagia following mechanical ventilation are baseline neurological disease [odds ratio (OR) 4.45, 95% CI: 2.74-7.24, P < 0.01], emergency admission (OR 2.04, 95% CI: 1.15-3.59, P < 0.01), days on mechanical ventilation (OR 1.19, 95% CI: 1.06-1.34, P < 0.01), days on renal replacement therapy (OR 1.1, 95% CI: 1-1.23, P = 0.03), and disease severity (Acute Physiology and Chronic Health Evaluation II score within first 24 h; OR 1.03, 95% CI: 0.99-1.07, P < 0.01). 34 Clinically, OD requires multidisciplinary efforts and should be systematically screened for in ICU patients at risk. 32,[35][36][37] Reports demonstrate that awareness for dysphagia can be improved.…”

Section: Dysphagiamentioning

confidence: 99%

“…At ICU discharge, 10.3% ( n = 96/933) of mixed medical–surgical ICU survivors were reported to have confirmed dysphagia and 60.4% ( n = 58/96) of affected patients remained dysphagia positive until hospital discharge 33 . Few studies are available on potential underlying risk factors in critically ill patients, and data show that risk factors for dysphagia and ICUAW may (at least partially) overlap 34 . In brief, proposed key independent risk factors for dysphagia following mechanical ventilation are baseline neurological disease [odds ratio (OR) 4.45, 95% CI: 2.74–7.24, P < 0.01], emergency admission (OR 2.04, 95% CI: 1.15–3.59, P < 0.01), days on mechanical ventilation (OR 1.19, 95% CI: 1.06–1.34, P < 0.01), days on renal replacement therapy (OR 1.1, 95% CI: 1–1.23, P = 0.03), and disease severity (Acute Physiology and Chronic Health Evaluation II score within first 24 h; OR 1.03, 95% CI: 0.99–1.07, P < 0.01) 34 …”

Section: Additional Clinical Presentations Of Neuromuscular Weakness mentioning

confidence: 99%

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Muscular weakness and muscle wasting in the critically ill

Schefold

Wollersheim

Grunow

et al. 2020

J cachexia sarcopenia muscle

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Background Muscular weakness and/or muscle wasting is recognized as a key medical problem in critically ill patients on intensive care units (ICUs) worldwide. Methods and Results Intensive care unit-acquired weakness (ICUAW) results from various diseases leading to critical illness and is observed in about 40% [1080/2686 patients, 95% confidence interval (CI): 38-42%] of mixed (medical-surgical) ICU patients. Muscle strength at ICU discharge is directly associated with mortality 5 years after discharge [hazard ratio 0.946, 95% CI: 0.928-0.968 per point increase in Medical Research Council (MRC) scores, P = 0.001]. ICUAW serves as umbrella term for the subgroups 'critical illness myopathy', 'critical illness polyneuropathy', and 'critical illness polyneuromyopathy', the latter distinguished using electrophysiology and/or biopsy studies. Diagnosing, studying, and developing treatments for ICUAW among the critically ill seems challenging due to the acuity and severity of the underlying heterogeneous diseases. Ventilator-induced diaphragmatic dysfunction occurs in up to 80% (n = 32/40) of ICUAW patients after mechanical ventilation and mostly results from distinct muscular pathologies, disuse, underlying critical illness, and/or effects imposed directly by mechanical ventilation. Swallowing disorders/dysphagia likely represent an additional (local) neuromuscular dysfunction/ICUAW sequelae and presents in 10.3% (n = 96/933) of mixed medical-surgical ICU survivors, with 60.4% (n = 58/96) of patients remaining dysphagia positive until hospital discharge. Key independent risk factors for dysphagia following mechanical ventilation are baseline neurological disease [odds ratio (

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Section: Dysphagiamentioning

confidence: 99%

Section: Additional Clinical Presentations Of Neuromuscular Weakness mentioning

confidence: 99%

Muscular weakness and muscle wasting in the critically ill

Schefold

Wollersheim

Grunow

et al. 2020

J cachexia sarcopenia muscle

Self Cite

View full text Add to dashboard Cite

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“…NICU, neurointensive care unit; APACHE-II, Acute Physiology and Chronic Health Evaluation. a crucial factor for dysphagia (11,12), concentrating on the main diseases with less attention to nutrition and activity (19). However, there are few studies on patients after neurosurgery, which contains all three factors.…”

Section: Discussionmentioning

confidence: 99%

“…Even in patients with a non-traumatic subarachnoid hemorrhage, the incidence of dysphagia is 16.33% (10). In fact, previous clinical studies have identified neurological diseases as a significant risk factor for the development of dysphagia (11,12). Therefore, early and timely assessment of whether the patient has dysphagia can significantly reduce the occurrence of pneumonia and further reduce mortality (13).…”

Section: Introductionmentioning

confidence: 99%

Risk Score for Predicting Dysphagia in Patients After Neurosurgery: A Prospective Observational Trial

et al. 2021

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Background: Acquired dysphagia is common in patients with tracheal intubation and neurological disease, leading to increased mortality. This study aimed to ascertain the risk factors and develop a prediction model for acquired dysphagia in patients after neurosurgery.Methods: A multicenter prospective observational study was performed on 293 patients who underwent neurosurgery. A standardized swallowing assessment was performed bedside within 24 h of extubation, and logistic regression analysis with a best subset selection strategy was performed to select predictors. A nomogram model was then established and verified.Results: The incidence of acquired dysphagia in our study was 23.2% (68/293). Among the variables, days of neurointensive care unit (NICU) stay [odds ratio (OR), 1.433; 95% confidence interval (CI), 1.141–1.882; P = 0.005], tracheal intubation duration (OR, 1.021; CI, 1.001–1.062; P = 0.175), use of a nasogastric feeding tube (OR, 9.131; CI, 1.364–62.289; P = 0.021), and Acute Physiology and Chronic Health Evaluation (APACHE)-II C score (OR, 1.709; CI, 1.421–2.148; P < 0.001) were selected as risk predictors for dysphagia and included in the nomogram model. The area under the receiver operating characteristic curve was 0.980 (CI, 0.965–0.996) in the training set and 0.971 (0.937–1) in the validation set, with Brier scores of 0.045 and 0.056, respectively.Conclusion: Patients who stay longer in the NICU, have a longer duration of tracheal intubation, require a nasogastric feeding tube, and have higher APACHE-II C scores after neurosurgery are likely to develop dysphagia. This developed model is a convenient and efficient tool for predicting the development of dysphagia.

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“…Swallowing dysfunction is induced by damage to the central nervous system, tracheal intubation, and presence of a nasogastric tube or a tracheostomy [ 26 ]. The duration of mechanical ventilation seems to be a prominent risk factor [ 27 ]. Reported incidences are highly variable, depending on the patient selection, the timing, and the method of assessment.…”

Section: Strategies To Optimize Oral Nutrition During and After Crmentioning

confidence: 99%

Oral Nutrition during and after Critical Illness: SPICES for Quality of Care!

et al. 2020

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Malnutrition is associated to poor outcomes in critically ill patients. Oral nutrition is the route of feeding in less than half of the patients during the intensive care unit (ICU) stay and in the majority of ICU survivors. There are growing data indicating that insufficient and/or inadequate intakes in macronutrients and micronutrients are prevalent within these populations. The present narrative review focuses on barriers to food intakes and considers the different points that should be addressed in order to optimize oral intakes, both during and after ICU stay. They are gathered in the SPICES concept, which should help ICU teams improve the quality of nutrition care following 5 themes: swallowing disorders screening and management, patient global status overview, involvement of dieticians and nutritionists, clinical evaluation of nutritional intakes and outcomes, and finally, supplementation in macro-or micronutrients.

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Risk Factors for Dysphagia in ICU Patients After Invasive Mechanical Ventilation

Cited by 41 publications

References 44 publications

Muscular weakness and muscle wasting in the critically ill

Muscular weakness and muscle wasting in the critically ill

Risk Score for Predicting Dysphagia in Patients After Neurosurgery: A Prospective Observational Trial

Oral Nutrition during and after Critical Illness: SPICES for Quality of Care!

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