Intensive Care Medicine

, Volume 29, Issue 9, pp 1451–1455 | Cite as

Swallowing disorders post orotracheal intubation in the elderly

  • Ali El Solh
  • Mifue Okada
  • Abid Bhat
  • Celestino Pietrantoni



The purpose of this study was to assess the prevalence and recovery time of swallowing dysfunction after prolonged endotracheal intubation in critically ill elderly patients compared to a younger cohort.


This was a prospective, interventional, clinical study set in a medical intensive care unit in a university-affiliated hospital.


The study involved 42 consecutive elderly patients (≥65 years old) and 42 controls (<65 years) matched for severity of illness requiring endotracheal intubation for more than 48 h.


A fiberoptic endoscopic evaluation of swallowing (FEES) was performed within 48 h post-extubation and on days 5, 9, and 14 for those with evidence of aspiration.


Swallowing dysfunction was assessed by the detection of test material below the true vocal cords. Aspiration was documented in 52% of the elderly and 36% of the control group (P=0.2). No significant difference in the co-morbidity index and the length of mechanical ventilation was found between aspirators and non-aspirators. None of the control group had swallowing deficits after 2 weeks, while 13% of the elderly participants showed persistent impairment in the swallowing reflex. By multivariate analysis, the preadmission functional status was the only determinant of a slowly resolving swallowing deficit (hazard ratio 1.68; 95% confidence interval 1.26–3.97). No post-extubation aspiration pneumonia was identified in either group.


Critically ill elderly patients exhibit delayed resolution of swallowing impairment post extubation. FEES should be considered for those with impaired preadmission functional status.


Elderly Swallowing Endotracheal intubation Aspiration Pneumonia 


  1. 1.
    de Larminat V, Montravers P, Dureuil B, Desmonts JM (1995) Alteration in swallowing reflex after extubation in intensive care unit patients. Crit Care Med 23:486–490PubMedGoogle Scholar
  2. 2.
    Leder SB, Cohn SM, Moller BA (1998) Fiberoptic endoscopic documentation of the high incidence of aspiration following extubation in critically ill trauma patients. Dysphagia 13:208–212PubMedGoogle Scholar
  3. 3.
    Tolep K, Getch CL, Criner GJ (1996) Swallowing dysfunction in patients receiving prolonged mechanical ventilation. Chest 109:167–172PubMedGoogle Scholar
  4. 4.
    Barquist E, Brown M, Cohn S, Lundy D, Jackowski J (2001) Postextubation fiberoptic endoscopic evaluation of swallowing after prolonged endotracheal intubation: a randomized prospective trial. Crit Care Med 29:1710–1713PubMedGoogle Scholar
  5. 5.
    Leder SB, Ross DA (2000) Investigation of the causal relationship between tracheotomy and aspiration in the acute care setting. Laryngoscope 110:641–644PubMedGoogle Scholar
  6. 6.
    Langmore SE, Schatz MA, Olsen N (1988) Fiberoptic endoscopic examination of swallowing safety: a new procedure. Dysphagia 2:216–219PubMedGoogle Scholar
  7. 7.
    Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW (1963) Studies of illness in the aged: the index of ADL, a standardized measure of biological and psychosocial function. JAMA 185:914–919Google Scholar
  8. 8.
    Charlson ME, Pompie P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chron Dis 40:373–383Google Scholar
  9. 9.
    Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) APACHE II: a severity of disease classification system. Crit Care Med 13:818–829PubMedGoogle Scholar
  10. 10.
    Whited RE (1984) A prospective study of laryngotracheal sequelae in long-term intubation. Laryngoscope 94:367–377PubMedGoogle Scholar
  11. 11.
    Colice GL, Stukel TA, Dain B (1992) Resolution of laryngeal injury following translaryngeal intubation. Am Rev Respir Dis 145:361–364PubMedGoogle Scholar
  12. 12.
    Horner J, Massey EW, Riski JE, Lathrop DL, Chase KN (1988) Aspiration following stroke: clinical correlates and outcome. Neurology 38:1359–1362PubMedGoogle Scholar
  13. 13.
    Walton J (1985) The parkinsonian syndrome. In: Walton J (ed) Brain's diseases of the nervous system. Oxford University Press, London, pp 325–328Google Scholar
  14. 14.
    Ajemian M, Nirmul G, Anderson MT, et al (2001) Routine fiberoptic endoscopic evaluation of swallowing following prolonged intubation: implications for management. Arch Surg 136:434–437PubMedGoogle Scholar
  15. 15.
    Stauffer JL, Olson DE, Petty TL (1981) Complications and consequences of endotracheal intubation and tracheotomy. Am J Med 70:65–76Google Scholar
  16. 16.
    Bishop MJ, Hibbard AJ, Fink BR (1985) Laryngeal injury in a dog model of prolonged endotracheal intubation. Anaesthesiology 62:770–773Google Scholar
  17. 17.
    Doty RW, Bosma TF (1956) An electromyographic analysis of reflex deglutition. J Neurophysiol 19:44–47Google Scholar

Copyright information

© Springer-Verlag 2003

Authors and Affiliations

  • Ali El Solh
    • 1
  • Mifue Okada
    • 1
  • Abid Bhat
    • 1
  • Celestino Pietrantoni
    • 1
  1. 1.Division of Pulmonary. Critical Care and Sleep MedicineUniversity of Buffalo School of Medicine and Biomedical Sciences, Erie County Medical CenterBuffaloUSA

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