Critical Care volume 29,
Article number: 244 (2025)
Abstract
Dysphagia (i.e. an impairment in swallowing function that
impacts on safety or efficiency) is present in many intensive care unit (ICU)
survivors, in particular following extubation (“post-extubation dysphagia”,
PED). Despite the fact that pathomechanisms leading to PED are currently
incompletely understood, local as well as central neurological and
neuromuscular dysfunctions may be key to development of PED. Data from
prospective large-scale clinical investigations with systematic screening
demonstrate that PED affects about one out of five (about 20%) of mixed
medical-surgical unplanned (emergency) ICU admissions. PED is associated with
an increased risk for aspiration, aspiration-induced pneumonia, malnutrition,
increased ICU resource use, decreased quality of life, prolonged ICU- and
hospital length of stay and increased overall morbidity and mortality. Data
demonstrate that PED is an independent predictor of 90-day mortality with
increased risk of death up to about one year after ICU admission. PED may be a
somewhat overlooked medical problem since in many ICUs, PED is currently not
routinely screened for in all patients at risk (i.e. all ICU
patients) following extubation. In this review, we update the available data on
PED with a focus on epidemiology, risk factors, potential aetiology and
treatment approaches, as well as clinical management on ICUs.
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