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European Archives of Oto-Rhino-Laryngology

, Volume 271, Issue 11, pp 3085–3093 | Cite as

Acute and long-term dysphagia in critically ill patients with severe sepsis: results of a prospective controlled observational study

  • Joerg Zielske
  • Silvia Bohne
  • Frank M. Brunkhorst
  • Hubertus Axer
  • Orlando Guntinas-LichiusEmail author
Miscellaneous

Abstract

Dysphagia is a major risk factor for morbidity and mortality in critically ill patients treated in intensive care units (ICUs). Structured otorhinolaryngological data on dysphagia in ICU survivors with severe sepsis are missing. In a prospective study, 30 ICU patients with severe sepsis and thirty without sepsis as control group were examined using bedside fiberoptic endoscopic evaluation of swallowing after 14 days in the ICU (T1) and 4 months after onset of critical illness (T2). Swallowing dysfunction was assessed using the Penetration–Aspiration Scale (PAS). The Functional Oral Intake Scale was applied to evaluate the diet needed. Primary endpoint was the burden of dysphagia defined as PAS score >5. At T1, 19 of 30 severe sepsis patients showed aspiration with a PAS score >5, compared to 7 of 30 in critically ill patients without severe sepsis (p = 0.002). Severe sepsis and tracheostomy were independent risk factors for severe dysphagia with aspiration (PAS > 5) at T1 (p = 0.042 and 0.006, respectively). 4-month mortality (T2) was 57 % in severe sepsis patients compared to 20 % in patients without severe sepsis (p = 0.006). At T2, more severe sepsis survivors were tracheostomy-dependent and needed more often tube or parenteral feeding (p = 0.014 and p = 0.040, respectively). Multivariate analysis revealed tracheostomy at T1 as independent risk factor for severe dysphagia at T2 (p = 0.030). Severe sepsis appears to be a relevant risk factor for long-term dysphagia. An otorhinolaryngological evaluation of dysphagia at ICU discharge is mandatory for survivors of severe critical illness to plan specific swallowing rehabilitation programs.

Keywords

Critically ill Intensive care Severe sepsis Dysphagia Swallowing Tracheostomy 

Notes

Acknowledgments

The study was supported by the Center of Sepsis Control & Care (CSCC), funded by the German Federal Ministry of Education and Research (BMBF; Grant No. 01 E0 1002); by the Paul Martini Sepsis Research Group, funded by the Thuringian Ministry of Education, Science and Culture (ProExcellence; Grant No. PE 108–2); the publically funded Thuringian Foundation for Technology, Innovation and Research (STIFT); and the German Sepsis Society (GSS). The authors have no financial interest to declare in relation to the content of this article.

Conflict of interest

The authors indicate that they have no conflict of interest.

Supplementary material

405_2014_3148_MOESM1_ESM.docx (42 kb)
Supplementary material 1 (DOCX 41 kb)

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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Joerg Zielske
    • 1
    • 2
  • Silvia Bohne
    • 1
  • Frank M. Brunkhorst
    • 2
    • 3
    • 4
  • Hubertus Axer
    • 2
    • 5
  • Orlando Guntinas-Lichius
    • 1
    Email author
  1. 1.Department of OtorhinolaryngologyJena University HospitalJenaGermany
  2. 2.Centre for Sepsis Control and Care (CSCC)Jena University HospitalJenaGermany
  3. 3.Department of Anesthesiology and Intensive Care MedicineJena University HospitalJenaGermany
  4. 4.Center of Clinical StudiesJena University HospitalJenaGermany
  5. 5.Hans Berger Department of NeurologyJena University HospitalJenaGermany

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