Dysphagia Post-Extubation Affects Long-Term Mortality in Mixed Adult ICU Patients—Data From a Large Prospective Observational Study With Systematic Dysphagia Screening

OBJECTIVES: Data on long-term effects of post-extubation dysphagia is lacking. We investigate mid- and long-term clinical outcomes in a large sample of ICU patients with systematic dysphagia screening. DESIGN: Outcome analysis with a follow-up of 6 years or death (whichever occurred earlier) of ICU patients from a prospective observational trial (Dysphagia in Mechanically Ventilated ICU Patients study) with systematic dysphagia screening. SETTING: ICU of a tertiary care academic center. PATIENTS: Nine-hundred thirty-three mixed medical-surgical ICU patients (median age, 66 yr; interquartile range [IQR], 54–74, Acute Physiology and Chronic Health Evaluation II score 19 [IQR, 14–24], 71% male). INTERVENTIONS: ICU patients were followed up for a mean follow-up period of 1,731 ± 772 days (4.7 ± 2.1 yr). Primary outcome measures were 180-day and 360-day all-cause mortality in ICU patients with versus without dysphagia. MEASUREMENTS AND MAIN RESULTS: Two-hundred seventy-three patients died (29.3%) during the observational interval (n = 76 lost to follow-up). In dysphagia screening positive versus negative ICU patients, mortality at 180 days was 16% versus 5.8% (excess mortality 10.2%), whereas mortality at 360 days was 25% versus 9.1% (excess mortality 15.9%). Adjustment for confounders in a Cox model revealed a significant association of dysphagia with all-cause mortality in a time-dependent manner. The risk of death in ICU patients with versus without post-extubation dysphagia declined from about 2.5 times higher to about equal risk for both groups over the first year (i.e. 1.03 yr) post-ICU admission (at 360 d: hazard ratio [HR], 1.03; 95% CI, 0.42–3.70). The mean mortality HR for the first year post-ICU admission was HR 2.09 (95% CI, 1.34–3.24; p = 0.0009). CONCLUSIONS: Long-term follow-up of a large cohort of medical-surgical adult ICU patients systematically screened for dysphagia showed that dysphagia is associated with increased hazards for death for up to 1 year after ICU admission. Our data underline effects of post-extubation dysphagia on long-term clinical outcomes in affected critically ill patients.

[1]  J. Schefold,et al.  Dysphagia in the intensive care unit: a (multidisciplinary) call to action , 2020, Intensive Care Medicine.

[2]  D. Needham,et al.  Post-extubation dysphagia: a problem needing multidisciplinary efforts , 2019, Intensive Care Medicine.

[3]  D. McAuley,et al.  Interventions for oropharyngeal dysphagia in acute and critical care: a protocol for a systematic review and meta-analysis , 2019, Systematic Reviews.

[4]  J. Schefold,et al.  Dysphagia in the intensive care unit in Switzerland (DICE) - results of a national survey on the current standard of care. , 2019, Swiss medical weekly.

[5]  J. Schefold,et al.  Dysphagia in the intensive care unit: epidemiology, mechanisms, and clinical management , 2019, Critical Care.

[6]  J. Schefold,et al.  Clinical Approaches to Assess Post-extubation Dysphagia (PED) in the Critically Ill , 2019, Dysphagia.

[7]  G. Citerio,et al.  Are intensive care physicians aware of dysphagia? The MADICU survey results , 2018, Intensive Care Medicine.

[8]  Jaakko Reinikainen,et al.  Time-varying covariates and coefficients in Cox regression models. , 2018, Annals of translational medicine.

[9]  J. Takala,et al.  Dysphagia in Mechanically Ventilated ICU Patients (DYnAMICS): A Prospective Observational Trial , 2017, Critical care medicine.

[10]  C. Bodine,et al.  ICU-Acquired Swallowing Disorders , 2013, Critical care medicine.

[11]  André A Williams,et al.  Postextubation dysphagia is persistent and associated with poor outcomes in survivors of critical illness , 2011, Critical care.

[12]  R. Martino,et al.  The incidence of dysphagia following endotracheal intubation: a systematic review. , 2010, Chest.

[13]  R. Martino,et al.  Incidence and impact of dysphagia in patients receiving prolonged endotracheal intubation after cardiac surgery. , 2009, Canadian journal of surgery. Journal canadien de chirurgie.

[14]  M. Kollef,et al.  Tracheobronchial aspiration of gastric contents in critically ill tube-fed patients: Frequency, outcomes, and risk factors , 2006, Critical care medicine.

[15]  P. Grambsch,et al.  Proportional hazards tests and diagnostics based on weighted residuals , 1994 .

[16]  M. Scott,et al.  Pulmonary aspiration in mechanically ventilated patients with tracheostomies. , 1994, Chest.

[17]  A. Dreher.  Modeling Survival Data Extending The Cox Model , 2016 .