Swallowing Neurorehabilitation Research Lab, Speech Pathology, Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia.
Department of Speech Pathology, Bendigo Health, Bendigo, Victoria, Australia.
Laryngoscope. 2022 Feb;132(2):364-374. doi: 10.1002/lary.29311. Epub 2020 Dec 15.
OBJECTIVES/HYPOTHESIS: To identify, describe, and where possible meaningfully synthesize the reported risk factors for postextubation dysphagia (PED) in critically ill patients.
Systematic review and meta-analysis.
A systematic search of peer-reviewed and grey literature was conducted in common scientific databases to identify previously evaluated risk factors of PED. Data extraction and risk of bias assessment used a double-blind approach. Random effects models were used for the meta-analyses. Meta-analyses were conducted where sufficient study numbers allowed after accounting for statistical and clinical heterogeneity.
Twenty-five studies were included, which investigated a total of 150 potential risk factors. Of these, 63 risk factors were previously identified by at least one study each as significantly increasing the risk of PED. After accounting for clinical and statistical heterogeneity, only two risk factors were suitable for meta-analysis, gender, and duration of intubation. In separate meta-analyses, neither gender (RR 1.00 [0.71, 1.43], I = 0%) nor duration of intubation (RR 1.54 [-0.40, 3.49], I = 0%) were significant predictors of PED.
A large number of risk factors for PED have been reported in the literature. However, significant variability in swallowing assessment methods, patient populations, timing of assessment, and duration of intubation prevented meaningful meta-analyses for the majority of these risk factors. Where meta-analysis was possible, gender and duration of intubation were not identified as risk factors for PED. We discuss future directions in clinical and research contexts. Laryngoscope, 132:364-374, 2022.
目的/假设：确定、描述并在可能的情况下综合分析重症患者拔管后吞咽困难（PED）的报告风险因素。
系统回顾和荟萃分析。
在常见的科学数据库中进行了同行评审和灰色文献的系统搜索，以确定 PED 的先前评估风险因素。使用双盲方法进行数据提取和偏倚风险评估。在考虑到统计和临床异质性后，如果有足够的研究数量，使用随机效应模型进行荟萃分析。
共纳入 25 项研究，共调查了 150 个潜在的风险因素。其中，有 63 个风险因素被至少一项研究确定为显著增加 PED 风险。在考虑到临床和统计异质性后，只有两个风险因素适合荟萃分析，即性别和插管时间。在单独的荟萃分析中，性别（RR 1.00 [0.71, 1.43]，I ² = 0%）和插管时间（RR 1.54 [-0.40, 3.49]，I ² = 0%）均不是 PED 的显著预测因素。
文献中报道了大量 PED 的风险因素。然而，吞咽评估方法、患者人群、评估时间和插管时间的显著差异，使得对大多数这些风险因素进行有意义的荟萃分析变得不可能。在可能进行荟萃分析的情况下，性别和插管时间都未被确定为 PED 的风险因素。我们讨论了在临床和研究背景下的未来方向。喉镜，132:364-374，2022 年。
