Understanding Dysphagia in the ICU: Assessment and Impact
Dysphagia, the difficulty in swallowing, is a common issue in the ICU, affecting a significant percentage of intubated patients. It increases mortality, risk of pneumonia, malnutrition, and prolongs hospital stays. Assessment methods like bedside evaluation and FEES are crucial in managing dysphagia post-extubation. Research highlights the importance of early detection and management to improve patient outcomes.
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Dysphagia in the ICU Dysphagia in the ICU
Definition of dysphagia: Dysphagia is the inability to safely transfer food and liquid from the oral cavity to the oesophagus (Macht 2011). Occurrence in the ICU: from 3% to 62% of those patients who have been intubated (Zuercher 2019)
Dysphagia increases mortality by 9.2% (NCEPOD 2014) Increases risk of aspiration pneumonia Increased likelihood of malnutrition Prolongs ICU stay Prolongs hospital stay Still present on discharge in 60% of cases Increased morbidity and mortality
How dysphagia is assessed on the ICU Bedside swallowing assessment: Flexible Endoscopic Evaluation of Swallowing (FEES):
Are we good at this? A cohort of 135 ICU patients over a 12 month period who were eligible to receive a bedside swallowing assessment following extubation.
Some reading material (exciting)! Patrick Vuercher, Celine Moret, Rainer Dziewas, Joerg Schefold, Dysphagia in the intensive care unit: epidemiology, mechanisms and clinical management , Critical Care 23, Article 103, 2019. Madison Macht, Christopher King, Tim Wimbish, Brenden Clark, Alexander Benson, Ellen Burnham, Andre Williams, Marc Moss, Post-extubation dysphagia is associated with longer hospitalization in survivors of critical illness with neurological impairment , Critical Care 17, Article R119, 2013. Min Jung Kim, Yun Hee Park, Young Sook Park, You Hong Song, Associations Between Prolonged Intubation and Developing Post-extubation Dysphagia and Aspiration Pneumonia in Non-neurologic Critically Ill Patients , Annals of Rehabilitation Medicine, October 2015, 39(5), 763-771. Jens Schroder, Jorg Glahn, Rainer Dziewas, ICU-Related Dysphagia , ICU Management and Practise, v.15(3), 2015. Royal College of Speech and Language Therapists, Dysphagia Overview, https://www.rcslt.org/speech-and-language-therapy/clinical-information/dysphagia, 2019, accessed 21/11/2019. Karen Johnson, Laurie Speirs, Anne Mitchell, Heather Przbyl, Diane Anderson, Brenda Manos, Amy T. Schaenzer, Keri Winchester, Validation of a Postextubation Dysphagia Screening Tool for Patients After Prolonged Endotrachial Intubation , American Journal of Critical Care, March 2018 V.27(2).
