Thomas Simone, Sauter Wolfgang, Starrost Ulrike, Pohl Marcus, Mehrholz Jan
a Private Europäische Medizinische Akademie der Klinik Bavaria in Kreischa , Wissenschaftliches Institut , Kreischa , Germany.
b Klinik Bavaria in Kreischa , Fach und Privatkrankenhaus , Kreischa , Germany.
Disabil Rehabil. 2018 Jun;40(13):1494-1500. doi: 10.1080/09638288.2017.1300341. Epub 2017 Mar 21.
Treatment in intensive care units (ICUs) often results in swallowing dysfunction. Recent longitudinal studies have described the recovery of critically ill people, but we are not aware of studies of the recovery of swallowing function in patients with ICU-acquired muscle weakness. This paper aims to describe the time course of regaining water swallowing function in patients with ICU-acquired weakness in the post-acute phase and to describe the risks of regaining water swallowing function and the risk factors involved.
This cohort study included patients with ICU-acquired muscle weakness in our post-acute department, who were unable to swallow. We monitored the process of regaining water swallowing function using the 3-ounce water swallowing test.
We included 108 patients with ICU-acquired muscle weakness. Water swallowing function was regained after a median of 12 days (interquartile range =17) from inclusion in the study and after a median of 59 days (interquartile range= 36) from the onset of the primary illness. Our multivariate Cox Proportional Hazard model yielded two main risk factors for regaining water swallowing function: the number of medical tubes such as catheters at admission to the post-acute department (adjusted hazard ratio [HR] = 1.282; 95% confidence interval [CI]: 1.099-1.495) and the time until weaning from the respirator in days (adjusted HR =1.02 per day; 95%CI: 0.998 to 1.008).
We describe a time course for regaining water swallowing function based on daily tests in the post-acute phase of critically ill patients. Risk factors associated with regaining water swallowing function in rehabilitation are the number of medical tubes and the duration of weaning from the respirator. Implications for rehabilitation Little guidance is available for the management of swallowing dysfunction in the rehabilitation of critically ill patients with intensive-care-units acquired muscle weakness. There is a time dependent pattern of recovery from swallowing dysfunction with daily water swallowing tests in the post-acute phase of critically ill patients. Daily water swallowing tests can be used to test swallowing dysfunction in the post-acute phase of critically ill patients The amount of medical tubes and the duration of weaning from respirator are associated risk factors for recovery of swallowing dysfunction.
重症监护病房（ICU）的治疗常常导致吞咽功能障碍。近期的纵向研究描述了危重症患者的康复情况，但我们尚未发现有关ICU获得性肌无力患者吞咽功能恢复的研究。本文旨在描述急性后期ICU获得性肌无力患者恢复吞咽水功能的时间进程，并描述恢复吞咽水功能的风险及相关危险因素。
这项队列研究纳入了我们急性后期科室中无法吞咽的ICU获得性肌无力患者。我们使用3盎司水吞咽测试来监测恢复吞咽水功能的过程。
我们纳入了108例ICU获得性肌无力患者。从纳入研究起，中位12天（四分位间距=17）后恢复了吞咽水功能，从原发性疾病发病起，中位59天（四分位间距=36）后恢复。我们的多变量Cox比例风险模型得出了恢复吞咽水功能的两个主要危险因素：急性后期科室入院时导管等医疗管的数量（调整后风险比[HR]=1.282；95%置信区间[CI]：1.099 - 1.495）以及脱机天数（调整后HR = 每天1.02；95%CI：0.998至1.008）。
我们基于对危重症患者急性后期的每日测试描述了恢复吞咽水功能的时间进程。康复中与恢复吞咽水功能相关的危险因素是医疗管数量和脱机持续时间。对康复的启示对于重症监护病房获得性肌无力的危重症患者康复中的吞咽功能障碍管理，几乎没有可用的指导。危重症患者急性后期通过每日水吞咽测试，吞咽功能障碍的恢复存在时间依赖性模式。每日水吞咽测试可用于检测危重症患者急性后期的吞咽功能障碍。医疗管数量和脱机持续时间是吞咽功能障碍恢复的相关危险因素。
