Department of Nursing, the First Affiliated Hospital of Soochow University, Suzhou, 215006, China.
Eur J Med Res. 2024 Aug 31;29(1):444. doi: 10.1186/s40001-024-02024-x.
Post-extubation dysphagia (PED) emerges as a frequent complication following endotracheal intubation within the intensive care unit (ICU). PED has been strongly linked to adverse outcomes, including aspiration, pneumonia, malnutrition, heightened mortality rates, and prolonged hospitalization, resulting in escalated healthcare expenditures. Nevertheless, the reported incidence of PED varies substantially across the existing body of literature. Therefore, the principal objective of this review was to provide a comprehensive estimate of PED incidence in ICU patients undergoing orotracheal intubation.
We searched Embase, PubMed, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Database, China Science, Technology Journal Database (VIP), and SinoMed databases from inception to August 2023. Two reviewers independently screened studies and extracted data. Subsequently, a random-effects model was employed for meta-statistical analysis utilizing the "meta prop" command within Stata SE version 15.0 to ascertain the incidence of PED. In addition, we performed subgroup analyses and meta-regression to elucidate potential sources of heterogeneity among the included studies.
Of 4144 studies, 30 studies were included in this review. The overall pooled incidence of PED was 36% (95% confidence interval [CI] 29-44%). Subgroup analyses unveiled that the pooled incidence of PED, stratified by assessment time (≤ 3 h, 4-6 h, ≤ 24 h, and ≤ 48 h), was as follows: 31.0% (95% CI 8.0-59.0%), 28% (95% CI 22.0-35.0%), 41% (95% CI 33.0-49.0%), and 49.0% (95% CI 34.0-63.0%), respectively. When sample size was 100 < N ≤ 300, the PED incidence was more close to the overall PED incidence. Meta-regression analysis highlighted that sample size, assessment time and mean intubation time constituted the source of heterogeneity among the included studies.
The incidence of PED was high among ICU patients who underwent orotracheal intubation. ICU professionals should raise awareness about PED. In the meantime, it is important to develop guidelines or consensus on the most appropriate PED assessment time and assessment tools to accurately assess the incidence of PED.
经气管插管在重症监护病房（ICU）后，拔管后吞咽困难（PED）成为一种常见的并发症。PED 与不良后果密切相关，包括吸入、肺炎、营养不良、死亡率升高和住院时间延长，从而导致医疗保健支出增加。然而，现有的文献中报告的 PED 发生率差异很大。因此，本综述的主要目的是提供 ICU 经口气管插管患者 PED 发生率的综合估计。
我们检索了 Embase、PubMed、Web of Science、Cochrane 图书馆、中国国家知识基础设施（CNKI）、万方数据库、中国科学技术期刊数据库（VIP）和中国生物医学文献数据库（SinoMed），检索时间从建库到 2023 年 8 月。两名审查员独立筛选研究并提取数据。随后，使用 Stata SE 版本 15.0 中的“meta prop”命令进行随机效应模型荟萃分析，以确定 PED 的发生率。此外，我们进行了亚组分析和荟萃回归，以阐明纳入研究之间异质性的潜在来源。
在 4144 篇研究中，有 30 篇研究纳入了本综述。PED 的总体合并发生率为 36%（95%置信区间 29-44%）。亚组分析显示，根据评估时间（≤3 h、4-6 h、≤24 h 和≤48 h）分层的 PED 合并发生率如下：31.0%（95%置信区间 8.0-59.0%）、28%（95%置信区间 22.0-35.0%）、41%（95%置信区间 33.0-49.0%）和 49.0%（95%置信区间 34.0-63.0%）。当样本量为 100<N≤300 时，PED 的发生率更接近总体 PED 发生率。荟萃回归分析表明，样本量、评估时间和平均插管时间是纳入研究异质性的来源。
经口气管插管的 ICU 患者 PED 发生率较高。ICU 专业人员应提高对 PED 的认识。同时，制定关于 PED 最佳评估时间和评估工具的指南或共识，以准确评估 PED 的发生率非常重要。
