1Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Denver, Aurora, CO. 2Rehabilitation Therapy, University of Colorado Hospital, Aurora, CO. 3Assistive Technology Partners, Department of Physical Medicine and Rehabilitation, University of Colorado Denver, Aurora, CO.
Crit Care Med. 2013 Oct;41(10):2396-405. doi: 10.1097/CCM.0b013e31829caf33.
Patients hospitalized in the ICU can frequently develop swallowing disorders, resulting in an inability to effectively transfer food, liquids, and pills from their mouth to stomach. The complications of these disorders can be devastating, including aspiration, reintubation, pneumonia, and a prolonged hospital length of stay. As a result, critical care practitioners should understand the optimal diagnostic strategies, proposed mechanisms, and downstream complications of these ICU-acquired swallowing disorders.
Database searches and a review of the relevant medical literature.
A significant portion of the estimated 400,000 patients who annually develop acute respiratory failure, require endotracheal intubation, and survive to be extubated are determined to have dysfunctional swallowing. This group of swallowing disorders has multiple etiologies, including local effects of endotracheal tubes, neuromuscular weakness, and an altered sensorium. The diagnosis of dysfunctional swallowing is usually made by a speech-language pathologist using a bedside swallowing evaluation. Major complications of swallowing disorders in hospitalized patients include aspiration, reintubation, pneumonia, and increased hospitalization. The national yearly cost of swallowing disorders in hospitalized patients is estimated to be over $500 million. Treatment modalities focus on changing the consistency of food, changing mealtime position, and/or placing feeding tubes to prevent aspiration.
Swallowing disorders are costly and clinically important in a large population of ICU patients. The development of effective screening strategies and national diagnostic standards will enable further studies aimed at understanding the precise mechanisms for these disorders. Further research should also concentrate on identifying modifiable risk factors and developing novel treatments aimed at reducing the significant burden of swallowing dysfunction in critical illness survivors.
入住 ICU 的患者可能经常会出现吞咽障碍，从而无法有效地将食物、液体和药丸从口腔输送到胃部。这些障碍的并发症可能是毁灭性的，包括吸入、重新插管、肺炎和住院时间延长。因此，重症监护医生应该了解这些 ICU 获得性吞咽障碍的最佳诊断策略、提出的机制和下游并发症。
数据库搜索和对相关医学文献的回顾。
每年估计有 40 万因急性呼吸衰竭需要气管插管且存活至拔管的患者中，有相当一部分存在吞咽功能障碍。这组吞咽障碍有多种病因，包括气管插管的局部影响、神经肌肉无力和感觉改变。吞咽障碍的诊断通常由言语病理学家使用床边吞咽评估来做出。住院患者吞咽障碍的主要并发症包括吸入、重新插管、肺炎和住院时间延长。住院患者吞咽障碍的全国年费用估计超过 5 亿美元。治疗方法侧重于改变食物的稠度、改变进餐时的体位和/或放置喂养管以防止吸入。
吞咽障碍在 ICU 患者这一大众人群中既昂贵又具有重要的临床意义。制定有效的筛选策略和国家诊断标准将使进一步的研究能够了解这些障碍的确切机制。进一步的研究还应集中于确定可改变的危险因素，并开发旨在减少危重病幸存者吞咽功能障碍的显著负担的新疗法。
