Disordered swallowing associated with prolonged oral endotracheal intubation in critical illness

There is increasing interest in complications of critical illness, which may play a major role in lengthening the duration of hospitalization [1]. Between 42 and 60% of critically ill patients have disordered swallowing (dysphagia) following extubation, with duration of endotracheal intubation recognized as a risk factor [2]. Endotracheal intubation of more than 6 days has been associated with an increased incidence and severity of dysphagia [3]. Much of the current data on post-extubation dysphagia are inferred from subjective assessments of pulmonary aspiration (radiography/nasoendoscopy), and mechanistic swallow information is lacking. High-resolution pharyngeal manometry, a catheter-based assessment, provides objective biomechanical data and quantifies bolus movement and muscle contraction/relaxation along the pharynx during swallowing (Fig. 1a, b) [4, 5]. We utilized this test in critically ill patients to determine the impact of the duration of endotracheal intubation on swallowing biomechanics. We hypothesized that high-resolution pharyngeal manometry would demonstrate objectively measurable disordered swallowing in critically ill patients, and that this would be exacerbated by endotracheal intubation.