by Takashi Hongo, Ryohei Yamamoto, Keibun Liu, Takahiko
Yaguchi, Hisashi Dote, Ryusuke Saito, Tomoyuki Masuyama, Kosuke Nakatsuka,
Shinichi Watanabe, Takahiro Kanaya, Tomoya Yamaguchi, Tetsuya Yumoto, Hiromichi
Naito and Atsunori Nakao
Critical Care volume 26,
Published: 08 April 2022
Background
Post-extubation dysphagia (PED) is recognized as a common
complication in the intensive care unit (ICU). Speech and language therapy
(SLT) can potentially help improve PED; however, the impact of the timing of
SLT initiation on persistent PED has not been well investigated. This study
aimed to examine the timing of SLT initiation and its effect on patient
outcomes after extubation in the ICU.
Methods
We conducted this multicenter, retrospective, cohort study,
collecting data from eight ICUs in Japan. Patients aged ≥ 20 years with
orotracheal intubation and mechanical ventilation for longer than 48 h,
and those who received SLT due to PED, defined as patients with modified water
swallowing test scores of 3 or lower, were included. The primary outcome was
dysphagia at hospital discharge, defined as functional oral intake scale score < 5
or death after extubation. Secondary outcomes included dysphagia or death at
the seventh, 14th, or 28th day after extubation, aspiration pneumonia, and
in-hospital mortality. Associations between the timing of SLT initiation and
outcomes were determined using multivariable logistic regression.
Results
A total of 272 patients were included. Of them, 82 (30.1%)
patients exhibited dysphagia or death at hospital discharge, and their time
spans from extubation to SLT initiation were 1.0 days. The primary outcome
revealed that every day of delay in SLT initiation post-extubation was
associated with dysphagia or death at hospital discharge (adjusted odds ratio
(AOR), 1.09; 95% CI, 1.02–1.18). Similarly, secondary outcomes showed
associations between this per day delay in SLT initiation and dysphagia or
death at the seventh day (AOR, 1.28; 95% CI, 1.05–1.55), 14th day (AOR, 1.34;
95% CI, 1.13–1.58), or 28th day (AOR, 1.21; 95% CI, 1.07–1.36) after extubation
and occurrence of aspiration pneumonia (AOR, 1.09; 95% CI, 1.02–1.17), while
per day delay in post-extubation SLT initiation did not affect in-hospital
mortality (AOR, 1.04; 95% CI, 0.97–1.12).
Conclusions
Delayed initiation of SLT in PED patients was associated
with persistent dysphagia or death. Early initiation of SLT may prevent this
complication post-extubation. A randomized controlled study is needed to
validate these results.
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