Martínez de Lagrán Zurbano Itziar, Laguna Luisa Bordejé, Soria Constanza Viña, Guisasola Carlos Pollán, Marcos-Neira Pilar
Department of Intensive Care Medicine, Germans Trias i Pujol University Hospital, Badalona, Spain; Doctoral Programme in Surgery and Morphological Sciences of the Univ Autonoma of Barcelona, Passeig de la Vall D'hebrón 119-129, 08035 Barcelona, Spain.
Department of Intensive Care Medicine, Germans Trias i Pujol University Hospital, Badalona, Spain.
Clin Nutr ESPEN. 2023 Feb;53:214-223. doi: 10.1016/j.clnesp.2022.12.021. Epub 2022 Dec 23.
Aspiration and dysphagia are frequent in critically ill patients, and evidence of the validity of bedside screening tests is lacking. This study evaluated the modified Volume-Viscosity Swallow Test (mV-VST) as a screening tool for aspiration and dysphagia in intensive care unit patients.
An observational, prospective longitudinal cohort single-center study included patients older than 18 years old, on mechanical ventilation for at least 48 h, conscious and cooperative. Patients had been admitted in intensive care between March 2016 and August 2019 at a university hospital in Spain. Data from the mV-VST and the flexible endoscopic evaluation of swallowing (FEES) test in extubated and tracheostomized patients were collected; the ROC curve was obtained for each group, and the sensitivity (Se), specificity (Sp), positive (pPV) and negative (nPV) predictive values of mV-VST were calculated and compared with the FEES results. We calculated percentages and 95% confidence intervals (CI) for qualitative variables and means or medians for quantitative variables according to the Shapiro-Wilk test. A univariate analysis identified dysphagia risk factors in each group.
The study included 87 patients: 44 extubated and 43 tracheostomized with similar age, body mass index, Sequential Organ Failure Assessment, Charlson comorbidity index, type and reason for admission. Aspiration with FEES was significantly higher in extubated patients than in tracheostomized patients, 43.2% vs. 23.2%, respectively, p = 0.04. With the mV-VST, aspiration was detected in 54.5% of extubated patients and in 39.5% of tracheostomized patients. In the extubated group, the Se of mV-VST to detect aspiration was 89.5%, Sp was 72%, and nPV was 90%. In the tracheostomized group, Se was 100%, Sp was 78.8%, and nPV was 100%. The ROC curve showed that mV-VST similarly identifies aspiration in extubated and tracheostomized patients.
Dysphagia and aspiration are frequent amongst patients in intensive care after mechanical ventilation. The mV-VST is a valid screening tool to detect aspiration and dysphagia in extubated and tracheostomized patients.
在重症患者中，误吸和吞咽困难很常见，但缺乏床边筛查试验有效性的证据。本研究评估改良的容量 - 黏度吞咽试验（mV - VST）作为重症监护病房患者误吸和吞咽困难的筛查工具。
一项观察性、前瞻性纵向队列单中心研究纳入了年龄大于18岁、机械通气至少48小时、意识清醒且配合的患者。这些患者于2016年3月至2019年8月期间入住西班牙一家大学医院的重症监护病房。收集了拔管和气管切开患者的mV - VST数据以及吞咽功能的软性内镜评估（FEES）试验数据；为每组绘制ROC曲线，并计算mV - VST的敏感性（Se）、特异性（Sp）、阳性预测值（pPV）和阴性预测值（nPV），并与FEES结果进行比较。根据Shapiro - Wilk检验，我们计算了定性变量的百分比和95%置信区间（CI）以及定量变量的均值或中位数。单因素分析确定了每组中的吞咽困难危险因素。
该研究纳入了87例患者：44例拔管患者和43例气管切开患者，他们在年龄、体重指数、序贯器官衰竭评估、Charlson合并症指数、入院类型和原因方面相似。拔管患者中FEES检测到的误吸显著高于气管切开患者，分别为43.2%和23.2%，p = 0.04。使用mV - VST时，在54.5%的拔管患者和39.5%的气管切开患者中检测到误吸。在拔管组中，mV - VST检测误吸的Se为89.5%，Sp为72%，nPV为90%。在气管切开组中，Se为100%，Sp为78.8%，nPV为100%。ROC曲线显示，mV - VST在拔管和气管切开患者中同样能识别误吸。
机械通气后重症监护病房患者中吞咽困难和误吸很常见。mV - VST是检测拔管和气管切开患者误吸和吞咽困难的有效筛查工具。
