Chest
ORIGINAL RESEARCHCRITICAL CARE MEDICINESwallowing Dysfunction in Nonneurologic Critically Ill Patients Who Require Percutaneous Dilatational Tracheostomy
Section snippets
Materials and Methods
This was a prospective observational study performed in the Clinical Hospital University of Chile, a 600-bed tertiary and teaching facility, with a 55-bed medical-surgical CCU. The CCU consists of an ICU (12 beds) and an intermediate care unit (43 beds). The study was approved by the institutional ethics review board. Written informed consent was obtained from each patient's next of kin.
All the nonneurologic critically ill patients admitted to the ICU between July 2006 and June 2008 who
Results
During the 24 months of the study, 82 patients underwent a PDT because of prolonged MV. Twenty patients were excluded because of acute brain pathology and three because of neuromuscular disease as the cause of translaryngeal intubation. Two patients were younger than 18 years of age, and two patients had history of dysphagia before the translaryngeal intubation. Additionally, three patients were transferred to another hospital before the FEES could be performed, 10 patients died before
Discussion
Several authors using different techniques for assessment of swallowing in tracheostomized patients have reported an incidence of aspiration of 30% to 70%.10, 14, 15, 16, 17, 18 However, despite the known high incidence of swallowing dysfunction in patients with neurologic disorders,19, 20, 21 these patients were not analyzed separately in previously published studies. To our knowledge, this constitutes the first study to establish, in an acute setting, the incidence of swallowing dysfunction
Conclusions
Nearly 40% of nonneurologic critically ill patients requiring PDT for prolonged MV presented swallowing dysfunction and experienced a significant delay in their tracheostomy decannulation process. Based on these findings we suggest performing FEES routinely before decannulation or initiating oral feeding in this group of patients.
Acknowledgments
Author contributions: Dr Romero: contributed to conception, design, analysis, and interpretation of data, and drafting, review, and final approval of the manuscript.
Dr Marambio: contributed to acquisition and analysis of data, and review and final approval of the manuscript.
Dr Larrondo: contributed to acquisition and analysis of data, and review and final approval of the manuscript.
Dr Walker: contributed to conception of the study, acquisition of data, and review and final approval of the
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