Medical Doctor, Department of Critical Care Medicine, Saiseikai Yokohama-shi Tobu Hospital, Yokohama-shi, Kanagawa, Japan.
Speech-Language Pathologists, Department of Rehabilitation, Saiseikai Yokohama-shi Tobu Hospital, Yokohama-shi, Kanagawa, Japan.
Nurs Crit Care. 2019 Mar;24(2):70-75. doi: 10.1111/nicc.12359. Epub 2018 Jul 3.
Post-extubation dysphagia reportedly occurs in 3%-60% of patients and is independently associated with poor patient outcomes.
The aim of this study was to investigate the frequency of post-extubation dysphagia, as diagnosed using our novel nurse-performed swallowing screening protocol, and to evaluate patient outcomes, including the frequency of discharge home, the length of the intensive care unit and hospital stays, the frequency of hospital-acquired pneumonia and death in the intensive care unit and hospital.
This was a prospective cohort study.
This study was conducted in a mixed intensive care unit in a critical care hospital in Japan. Between October 2016 and September 2017, the swallowing functions of 216 patients were assessed using our novel screening protocol. To investigate the correlation between dysphagia and patient outcomes, we compared a dysphagia group with a no dysphagia group.
Twenty-five patients (11·6%) were diagnosed with dysphagia. The frequency of discharge home, which was the primary outcome, was significantly lower in the patients with dysphagia (60% versus 87·4%, P = 0·002). Dysphagia was also correlated with longer hospital stay and higher mortality. A binomial logistic regression analysis, including the variables of dysphagia, Acute Physiology and Chronic Health Evaluation II score and duration of ventilator use, showed that dysphagia was an independent risk factor for a lower incidence of discharge home.
Among patients admitted to a mixed intensive care unit, post-extubation dysphagia was correlated with a poor prognosis.
The current study emphasizes the poor prognosis of patients with dysphagia after extubation. Dysphagia developed in more than 1 in 10 patients post-extubation; therefore, monitoring for a swallowing disorder is crucial in daily nursing in the intensive care unit.
据报道，拔管后吞咽困难在 3%-60%的患者中发生，且与患者预后不良独立相关。
本研究旨在调查使用我们新的护士执行的吞咽筛查方案诊断的拔管后吞咽困难的频率，并评估患者预后，包括出院回家的频率、重症监护病房和住院的时间、医院获得性肺炎的频率以及重症监护病房和医院的死亡率。
这是一项前瞻性队列研究。
本研究在日本一家重症监护医院的混合重症监护病房进行。在 2016 年 10 月至 2017 年 9 月期间，使用我们新的筛查方案评估了 216 例患者的吞咽功能。为了研究吞咽困难与患者预后的相关性，我们比较了吞咽困难组和无吞咽困难组。
25 例（11.6%）患者被诊断为吞咽困难。出院回家的频率是主要结局，吞咽困难患者的出院回家频率明显较低（60%对 87.4%，P=0.002）。吞咽困难还与住院时间延长和死亡率升高相关。包括吞咽困难、急性生理学和慢性健康评估 II 评分以及呼吸机使用时间等变量的二项逻辑回归分析显示，吞咽困难是出院回家发生率较低的独立危险因素。
在混合重症监护病房住院的患者中，拔管后吞咽困难与预后不良相关。
本研究强调了拔管后吞咽困难患者的不良预后。在拔管后，超过 10%的患者出现吞咽困难，因此，在重症监护病房的日常护理中监测吞咽障碍至关重要。
