Post-extubation Dysphagia: Does Timing of Evaluation Matter?
Swallowing evaluations are often delayed at least 24 h following extubation with the assumption that swallow function improves over time. The purpose of this prospective cohort study was to determine if dysphagia, as measured by aspiration and need for diet modification, declines over the first 24-h post-extubation, whereby providing evidence-based evaluation guidelines for this population. Forty-nine patients completed FEES at 2–4 h post-extubation and 24–26 h post-extubation. We compared Penetration–Aspiration Scale scores and diet recommendation between time points. Multivariable logistic regression models were created to investigate associations between age, reason for admission, reason for intubation, and a history of COPD and outcomes of aspiration or silent aspiration at either FEES exam. Sixty-nine percent of participants safely swallowed at least one texture without aspiration at 2–4 h post-extubation. Within participants, there was a significant decrease in penetration/aspiration at 24 h and 79% showed improvement in airway protection on at least one bolus type, suggesting an improvement in swallow function over the first day following extubation. These findings suggest that although patients may be safe to begin a modified diet soon after extubation, delaying evaluation until 24-h post-extubation may allow for a less restricted diet.
KeywordsDeglutition Deglutition disorders Dysphagia ICU Intubation Endotracheal tube
The authors would like to acknowledge Glen Leverson, PhD, for his assistance with statistical analysis.
Compliance with Ethical Standards
Conflict of interest
All authors declare that they have no conflicts of interest.
All procedures performed were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the University of Wisconsin Institutional Review Board.
Informed consent was obtained from all participants or their surrogate prior to participating in this research study.
- 21.Holland G, Jayasekeran V, Pendleton N, Horan M, Jones M, Hamdy S. Prevalence and symptom profiling of oropharyngeal dysphagia in a community dwelling of an elderly population: a self-reporting questionnaire survey. Dis Esophagus. 2011;24:476–80. https://doi.org/10.1111/j.1442-2050.2011.01182.x.CrossRefPubMedGoogle Scholar
- 25.Centre N, Mars TR, Bartholomew S, Physics RM, Hospital F, Accepted UK, et al. Pharyngeal residue across the lifespan: a first look at what’s normal 2008;348–51.Google Scholar
- 26.Rodrigues M, Macri B, Marques JM, Santos RS, Furkim AM, Melek I, et al. Clinical and fiberoptic endoscopic assessment of swallowing in patients with chronic obstructive pulmonary disease. Int Arch Otorhinolaryngol. 2013;17:274–8. https://doi.org/10.7162/S1809-97772013000300007.CrossRefGoogle Scholar
- 28.Jaber S, Amraoui J, Lefrant J, Arich C, Cohendy R, Landreau L, et al. Clinical practice and risk factors for immediate complications of endotracheal intubation in the intensive care unit: a prospective, multiple-center study. Crit Care Med. 2006;34:2355–61. https://doi.org/10.1097/01.CCM.0000233879.58720.87.CrossRefPubMedGoogle Scholar