Clinical Question

What is the incidence and what are the predictors of oropharyngeal dysphagia in extubated patients?

Critically Appraised Topic

The incidence and predictors of post-extubation dysphagia are difficult to clearly determine from the available evidence, due to broad patient populations and heterogeneous study designs. However a number of themes were noted in the literature reviewed. In a descriptive systematic review for the period 1949-May 2009 (Skoretz 2010) reported the incidence of dysphagia post-extubation as varying from 3-63%. However, the articles included in this review were all rated as low level evidence with heterogeneous patient groups. No consistent themes could be identified in terms of patient factors that predicted the presence of dysphagia. Higher quality evidence has been published since the systematic review was completed. In a search of the literature (May 2009- May 2015) 4 studies of level 3.3 evidence (as per NHRMC) were found, critiqued and included (Skoretz 2014, Bordon 2011, Macht 2011, Macht 2013). Skoretz (2014, n=909) reported an incidence of 67.5% in a cardiac population, Bordon (2011, n=150) reported 41% in a trauma population. Macht (2011, n=630), reported an incidence of 84% in a general ICU population and Macht (2013, n=184) 93% in a neurologically impaired population. The studies included suggest that predictors of dysphagia are; a longer duration of intubation (Skoretz 2014, Bordon 2011, Macht 2011, and Macht 2013) and increasing age (Skoretz 2014, Bordon 2011). PDF Format.

Critically Appraised Papers

Bordon et al (2011) Swallowing dysfunction after prolonged intubation: analysis of risk factors in trauma patients; The American Journal of Surgery Volume 202, No 6

Macht, M., Wimbish, T., Clark, B.J., Benson, A.B., Burnham, E.L., Williams. A., & Moss, M. Postextubation dysphagia is persistent and associated with poor outcomes in survivors of critical illness. Journal of Critical Care. 2011. 15:R231.

Post extubation dysphagia is associated with longer hospitalisation in survivors of critical illness with neurologic impairment. Machtm M et al. Critical Care (17); R119 (2013)

Skoretz, Stacey A. Flowers, Heather L, Martino, Rosemary. The incidence of dysphagia following endotracheal intubation: A systematic review. 2010; 137 (3): 665-673.

Skoretz, S., Yau, T., Ivanov, J., Granton, J. & Martino, R. (2014). Dysphagia and Associated Risk Factors Following Extubation in Cardiovascular Surgical Patients. Dysphagia. 29: 647–654.