Post-extubation dysphagia in trauma patients: it's hard to swallow.

BACKGROUND

There is a significant incidence of unrecognized postextubation dysphagia in trauma patients. The purpose of this study was to evaluate the incidence, ascertain the risk factors, and identify patients with postextubation dysphagia who will require clinical swallow evaluation.

METHODS

A prospective observational study was performed on 270 trauma patients. Bedside clinical swallow evaluation was done within 24 hours of extubation. Logistic regression analysis was used to adjust for confounding variables.

RESULTS

The incidence of oropharyngeal dysphagia (OD) in our study was 42%. Ventilator days was the strongest independent risk factor for OD (3.6 vs 8.0, P < .001). The odds ratio showed a 25% risk for OD for each additional ventilator day. Silent aspiration was found in 37% of patients with OD.

CONCLUSIONS

Trauma patients requiring mechanical ventilation for ≥2 days are at increased risk for dysphagia and should undergo routine swallow evaluations after extubation.