TY - JOUR
T1 - The prevalence of post-extubation dysphagia in critically ill adults
T2 - an Australian data linkage study
AU - McIntyre, Melanie L.
AU - Chimunda, Timothy
AU - Murray, Joanne
AU - Lewis, Trent W.
AU - Doeltgen, Sebastian H.
PY - 2022/12/5
Y1 - 2022/12/5
N2 - Objective: To define the prevalence of dysphagia after endotracheal intubation in critically ill adult patients. Design: A retrospective observational data linkage cohort study using the Australian and New Zealand Intensive Care Society Adult Patient Database and a mandatory government statewide health care administration database. \Setting: Private and public intensive care units (ICUs) within Victoria, Australia. Participants: Adult patients who required endotracheal intubation for the purpose of mechanical ventilation within a Victorian ICU between July 2013 and June 2018. Main outcome measures: Presence of dysphagia, aspiration pneumonia, ICU length of stay, hospital length of stay, and cost per episode of care. Results: Endotracheal intubation in the ICU was required for 71 124 patient episodes across the study period. Dysphagia was coded in 7.3% (n = 5203) of those episodes. Patients with dysphagia required longer ICU (median, 154 [interquartile range (IQR), 78–259] v 53 [IQR, 27–107] hours; P < 0.001) and hospital admissions (median, 20 [IQR, 13–30] v 8 [IQR, 5–15] days; P < 0.001), were more likely to develop aspiration pneumonia (17.2% v 5.6%; odds ratio, 3.0; 95% CI, 2.8–3.2; P < 0.001), and the median health care expenditure increased by 93% per episode of care ($73 586 v $38 108; P < 0.001) compared with patients without dysphagia. Conclusions: Post-extubation dysphagia is associated with adverse patient and health care outcomes. Consideration should be given to strategies that support early identification of patients with dysphagia in the ICU to determine if these adverse outcomes can be reduced.
AB - Objective: To define the prevalence of dysphagia after endotracheal intubation in critically ill adult patients. Design: A retrospective observational data linkage cohort study using the Australian and New Zealand Intensive Care Society Adult Patient Database and a mandatory government statewide health care administration database. \Setting: Private and public intensive care units (ICUs) within Victoria, Australia. Participants: Adult patients who required endotracheal intubation for the purpose of mechanical ventilation within a Victorian ICU between July 2013 and June 2018. Main outcome measures: Presence of dysphagia, aspiration pneumonia, ICU length of stay, hospital length of stay, and cost per episode of care. Results: Endotracheal intubation in the ICU was required for 71 124 patient episodes across the study period. Dysphagia was coded in 7.3% (n = 5203) of those episodes. Patients with dysphagia required longer ICU (median, 154 [interquartile range (IQR), 78–259] v 53 [IQR, 27–107] hours; P < 0.001) and hospital admissions (median, 20 [IQR, 13–30] v 8 [IQR, 5–15] days; P < 0.001), were more likely to develop aspiration pneumonia (17.2% v 5.6%; odds ratio, 3.0; 95% CI, 2.8–3.2; P < 0.001), and the median health care expenditure increased by 93% per episode of care ($73 586 v $38 108; P < 0.001) compared with patients without dysphagia. Conclusions: Post-extubation dysphagia is associated with adverse patient and health care outcomes. Consideration should be given to strategies that support early identification of patients with dysphagia in the ICU to determine if these adverse outcomes can be reduced.
KW - post-extubation dysphagia
KW - endotracheal intubation
KW - critically ill patients
KW - swallowing dysfunction
KW - dysphagia
KW - intensive care unit (ICU)
UR - http://www.scopus.com/inward/record.url?scp=85143525671&partnerID=8YFLogxK
U2 - 10.51893/2022.4.OA5
DO - 10.51893/2022.4.OA5
M3 - Article
AN - SCOPUS:85143525671
SN - 1441-2772
VL - 24
SP - 352
EP - 359
JO - Critical Care and Resuscitation
JF - Critical Care and Resuscitation
IS - 4
ER -