Chest
Volume 137, Issue 6, June 2010, Pages 1278-1282
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ORIGINAL RESEARCH
CRITICAL CARE MEDICINE
Swallowing Dysfunction in Nonneurologic Critically Ill Patients Who Require Percutaneous Dilatational Tracheostomy

https://doi.org/10.1378/chest.09-2792Get rights and content

Background

The aim of this study was to determine the incidence of swallowing dysfunction in nonneurologic critically ill patients who require percutaneous dilatational tracheostomy (PDT) for prolonged mechanical ventilation (MV) and to compare the duration of the cannulation period and length of stay in the critical care unit (CCU) in patients with and without swallowing dysfunction.

Methods

A total of 40 consecutive patients without neurologic disorders who require PDT for prolonged MV were included. Previous to the tracheostomy decannulation process, an otolaryngologist performed a fiberoptic endoscopic evaluation of swallowing (FEES). We used analysis of variance for the analysis; the results are presented as mean values ± SD.

Results

Mean age was 62 ± 15 years. Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores were 21 ± 2 and 9 ± 1, respectively. Time of MV previous to PDT was 20 ± 11 days, total MV duration was 38 ± 16 days, and CCU stay was 63 ± 27 days. The incidence of swallowing dysfunction in this group of patients was 38% (15/40). No difference was found in the age or time period of MV previous to PDT between groups. The time period between FEES to tracheostomy decannulation process was 19 ± 11 days in patients with swallowing dysfunction vs 2 ± 4 days in those patients without dysfunction (P < .001). Patients who developed swallowing dysfunction stayed longer in the CCU (69 ± 23 vs 47 ± 19 days, P < .01).

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.

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

References (27)

  • SB Leder et al.

    Fiberoptic endoscopic documentation of the high incidence of aspiration following extubation in critically ill trauma patients

    Dysphagia

    (1998)
  • E Barquist et al.

    Postextubation fiberoptic endoscopic evaluation of swallowing after prolonged endotracheal intubation: a randomized, prospective trial

    Crit Care Med

    (2001)
  • MS Ajemian et al.

    Routine fiberoptic endoscopic evaluation of swallowing following prolonged intubation: implications for management

    Arch Surg

    (2001)
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