Endoscopic Assessment of Swallowing After Prolonged Intubation in the ICU Setting

Abstract

Objectives: The purpose of this study was to identify the frequency of swallowing dysfunction after extubation in a sample of patients with no preexisting dysphagia. Methods: Mechanically ventilated patients in the ICU with no prior history of dysphagia received a flexible endoscopic evaluation of swallowing (FEES) exam within 72 hours after extubation. The FEES was then analyzed for variables related to swallowing patterns and laryngeal pathology. Univariate analyses were performed to identify relationships between variables. Results: Fifty-nine patients were included in this study. After extubation, 21 (35.6%) penetrated and 13 (22.0%) aspirated. The mean days intubated was 9.4 ± 6.1. Various forms of laryngeal injury were associated with worse swallowing scores, and delayed onset of the swallow was a common finding in all patients post extubation. Of the 44 participants evaluated ≤24 hours post extubation, 56.8% penetrated/aspirated. Of the 15 patients evaluated >24 hours post extubation, 60.0% penetrated/aspirated. Conclusions: This study found a high frequency of dysphagia after prolonged intubation in patients with no preexisting dysphagia. Important variables leading to dysphagia are often overlooked, such as swallowing delay and laryngeal pathology. The timing of swallowing assessments did not reveal any difference in dysphagia frequency, suggesting that it might not be necessary to wait to perform dysphagia screens or evaluations.