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Post-extubation dysphagia: a problem needing multidisciplinary efforts

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  1. Szmuk P, Ezri T, Evron S, Roth Y, Katz J (2008) A brief history of tracheostomy and tracheal intubation, from the Bronze Age to the Space Age. Intensive Care Med 34(2):222–228

    Article  Google Scholar 

  2. Slutsky AS (2015) History of mechanical ventilation. From Vesalius to ventilator-induced lung injury. Am J Respir Crit Care Med 191(10):1106–1115

    Article  Google Scholar 

  3. Skoretz SA, Flowers HL, Martino R (2010) The incidence of dysphagia following endotracheal intubation: a systematic review. Chest 137(3):665–673

    Article  Google Scholar 

  4. Macht M, Wimbish T, Clark BJ et al (2011) Postextubation dysphagia is persistent and associated with poor outcomes in survivors of critical illness. Crit Care 15(5):R231

    Article  Google Scholar 

  5. Marvin S, Thibeault S, Ehlenbach WJ (2019) Post-extubation dysphagia: does timing of evaluation matter? Dysphagia 34(2):210–219

    Article  Google Scholar 

  6. Shifrin RY, Choplin RH (1996) Aspiration in patients in critical care units. Radiol Clin North Am 34(1):83–96

    CAS  PubMed  Google Scholar 

  7. Macht M, Wimbish T, Clark BJ et al (2012) Diagnosis and treatment of post-extubation dysphagia: results from a national survey. J Crit Care 27(6):578–586

    Article  Google Scholar 

  8. Brodsky MB, Gonzalez-Fernandez M, Mendez-Tellez PA, Shanholtz C, Palmer JB, Needham DM (2014) Factors associated with swallowing assessment after oral endotracheal intubation and mechanical ventilation for acute lung injury. Ann Am Thorac Soc 11(10):1545–1552

    Article  Google Scholar 

  9. Latronico N, Herridge M, Hopkins RO et al (2017) The ICM research agenda on intensive care unit-acquired weakness. Intensive Care Med 43(9):1270–1281

    Article  Google Scholar 

  10. Macht M, Wimbish T, Bodine C, Moss M (2013) ICU-acquired swallowing disorders. Crit Care Med 41(10):2396–2405

    Article  Google Scholar 

  11. Brodsky MB, Gellar JE, Dinglas VD et al (2014) Duration of oral endotracheal intubation is associated with dysphagia symptoms in acute lung injury patients. J Crit Care 29(4):574–579

    Article  Google Scholar 

  12. Brodsky MB, Levy MJ, Jedlanek E et al (2018) Laryngeal injury and upper airway symptoms after oral endotracheal intubation with mechanical ventilation during critical care: a systematic review. Crit Care Med 46(12):2010–2017

    Article  Google Scholar 

  13. Miller AJ (1982) Deglutition. Physiol Rev 62(1):129–184

    CAS  Article  Google Scholar 

  14. Martin-Harris B, Brodsky MB, Michel Y, Ford CL, Walters B, Heffner J (2005) Breathing and swallowing dynamics across the adult lifespan. Archiv Otolaryngol Head Neck Surg 131(9):762–770

    Article  Google Scholar 

  15. Brodsky MB, De I, Chilukuri K, Huang M, Palmer JB, Needham DM (2018) Coordination of pharyngeal and laryngeal swallowing events during single liquid swallows after oral endotracheal intubation for patients with acute respiratory distress syndrome. Dysphagia 33(6):768–777

    Article  Google Scholar 

  16. Hårdemark Cedborg AI, Sundman E, Boden K et al (2015) Effects of morphine and midazolam on pharyngeal function, airway protection, and coordination of breathing and swallowing in healthy adults. Anesthesiology 122(6):1253–1267

    Article  Google Scholar 

  17. Camargo FP, Ono J, Park M, Caruso P, Carvalho CR (2010) An evaluation of respiration and swallowing interaction after orotracheal intubation. Clinics (Sao Paulo) 65(9):919–922

    Article  Google Scholar 

  18. 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(3):486–490

    Article  Google Scholar 

  19. Leder SB, Suiter DM (2014) The Yale Swallow protocol: an evidence-based approach to decision making. Springer, Switzerland

    Book  Google Scholar 

  20. Leder SB, Warner HL, Suiter DM et al (2019) Evaluation of swallow function post-extubation: is it necessary to wait 24 hours? Ann Otol Rhinol Laryngol. 128(7):619–624

    Article  Google Scholar 

  21. Johnson KL (2018) Validation of a postextubation dysphagia screening tool for patients after prolonged endotracheal intubation. Am J Crit Care 27(2):89–96

    Article  Google Scholar 

  22. Suiter DM, Leder SB (2008) Clinical utility of the 3-ounce water swallow test. Dysphagia 23(3):244–250

    Article  Google Scholar 

  23. Giraldo-Cadavid LF, Leal-Leano LR, Leon-Basantes GA et al (2017) Accuracy of endoscopic and videofluoroscopic evaluations of swallowing for oropharyngeal dysphagia. Laryngoscope 127(9):2002–2010

    Article  Google Scholar 

  24. Aviv JE, Kaplan ST, Thomson JE, Spitzer J, Diamond B, Close LG (2000) The safety of flexible endoscopic evaluation of swallowing with sensory testing (FEESST): an analysis of 500 consecutive evaluations. Dysphagia 15(1):39–44

    CAS  Article  Google Scholar 

  25. Hafner G, Neuhuber A, Hirtenfelder S, Schmedler B, Eckel HE (2008) Fiberoptic endoscopic evaluation of swallowing in intensive care unit patients. Eur Arch Otorhinolaryngol 265(4):441–446

    Article  Google Scholar 

  26. Patel DA, Krishnaswami S, Steger E et al (2018) Economic and survival burden of dysphagia among inpatients in the United States. Dis Esophagus 31(1):1–7

    Article  Google Scholar 

  27. Donovan AL, Aldrich JM, Gross AK et al (2018) Interprofessional care and teamwork in the ICU. Crit Care Med 46(6):980–990

    Article  Google Scholar 

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This manuscript was supported in part by the National Institutes of Health/National Institute of Nursing Research (R01NR017433, Brodsky, Pandian, Needham).

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Correspondence to Martin B. Brodsky.

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Brodsky, M.B., Pandian, V. & Needham, D.M. Post-extubation dysphagia: a problem needing multidisciplinary efforts. Intensive Care Med 46, 93–96 (2020).

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