Lin Chung-Wei, Chiang Ting-Yi, Chen Wen-Ching, Chiu Li-Wen, Su Yung-Chung, Lin Hsin-Ching, Chang Chun-Tuan
Department of Education, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
Department of General Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
Otolaryngol Head Neck Surg. 2023 May;168(5):935-943. doi: 10.1002/ohn.168. Epub 2023 Feb 26.
To investigate the incidence rate of postextubation dysphagia (PED) in patients with COVID-19, as well as relative factors potentially influencing the clinical course of dysphagia.
Six databases including PubMed, MEDLINE, Embase, ScienceDirect, the Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science were searched with no restriction on the language.
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Data were extracted and cross-examined among 3 of the authors. The random-effects model was adopted for the statistical synthesis. The percentage and 95% confidence interval (CI) were adopted as the effect measurements of the PED incidence rate. Subgroup analyses, sensitivity analyses, and metaregression were also performed to identify the heterogeneity among the studies.
A total of 594 patients were enrolled and analyzed from the 10 eligible studies. The weighted incidence of PED in patients with COVID-19 was 66.5% (95% CI: 49.7%-79.9%). Age was the potential factor influencing the incidence rate after heterogeneity was adjusted by the metaregression analysis.
Compared to the current evidence reporting only 41% of the non-COVID patients experienced PED, our study further disclosed that a higher 66.5% of COVID-19 patients suffered from PED, which deserves global physicians' attention. With the association between COVID-19 and dysphagia having been more clearly understood, future clinicians are suggested to identify intubated patients' risk factors earlier to strengthen PED care programs in the era of COVID-19.
调查新型冠状病毒肺炎（COVID-19）患者拔管后吞咽困难（PED）的发生率，以及可能影响吞咽困难临床病程的相关因素。
检索了六个数据库，包括PubMed、MEDLINE、Embase、ScienceDirect、Cochrane对照试验中央注册库（CENTRAL）和Web of Science，对语言无限制。
遵循系统评价和Meta分析的首选报告项目（PRISMA）指南。由三位作者提取并交叉核对数据。采用随机效应模型进行统计合成。采用百分比和95%置信区间（CI）作为PED发生率的效应量。还进行了亚组分析、敏感性分析和Meta回归分析，以识别研究之间的异质性。
从10项符合条件的研究中，共纳入并分析了594例患者。COVID-19患者中PED的加权发生率为66.5%（95%CI：49.7%-79.9%）。经Meta回归分析调整异质性后，年龄是影响发生率的潜在因素。
与目前仅报道41%的非COVID患者发生PED的证据相比，我们的研究进一步揭示，高达66.5%的COVID-19患者患有PED，这值得全球医生关注。随着对COVID-19与吞咽困难之间关联的更清晰理解，建议未来的临床医生更早识别插管患者的危险因素，以加强COVID-19时代的PED护理计划。
