ID | 63424 |
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Hongo, Takashi
Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
Yamamoto, Ryohei
Department of Healthcare Epidemiology, School of Public Health, Graduate School of Medicine, Kyoto University
Liu, Keibun
Critical Care Research Group, Faculty of Medicine, University of Queensland, The Prince Charles Hospital
Yaguchi, Takahiko
Department of Intensive Care Medicine, Kameda Medical Center
Dote, Hisashi
Department of Emergency and Critical Care Medicine, Seirei Hamamatsu General Hospital
Saito, Ryusuke
Department of Emergency and Critical Care Medicine, Seirei Hamamatsu General Hospital
Masuyama, Tomoyuki
Department of Emergency, Misato Kenwa Hospital
Nakatsuka, Kosuke
Department of Anesthesiology, Okayama Rosai Hospital
Watanabe, Shinichi
Department of Rehabilitation, Nagoya Medical Center, NHO
Kanaya, Takahiro
Department of Rehabilitation, Hokkaido Medical Center, NHO
Yamaguchi, Tomoya
Division of Critical Care Medicine, Nara Prefecture General Medical Center
Yumoto, Tetsuya
Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
ORCID
Kaken ID
publons
Naito, Hiromichi
Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
ORCID
Kaken ID
publons
Nakao, Atsunori
Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
Kaken ID
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Abstract | Background Post-extubation dysphagia (PED) is recognized as a common complication in the intensive care unit (ICU). Speech and language therapy (SLT) can potentially help improve PED; however, the impact of the timing of SLT initiation on persistent PED has not been well investigated. This study aimed to examine the timing of SLT initiation and its effect on patient outcomes after extubation in the ICU. Methods We conducted this multicenter, retrospective, cohort study, collecting data from eight ICUs in Japan. Patients aged >= 20 years with orotracheal intubation and mechanical ventilation for longer than 48 h, and those who received SLT due to PED, defined as patients with modified water swallowing test scores of 3 or lower, were included. The primary outcome was dysphagia at hospital discharge, defined as functional oral intake scale score < 5 or death after extubation. Secondary outcomes included dysphagia or death at the seventh, 14th, or 28th day after extubation, aspiration pneumonia, and in-hospital mortality. Associations between the timing of SLT initiation and outcomes were determined using multivariable logistic regression. Results A total of 272 patients were included. Of them, 82 (30.1%) patients exhibited dysphagia or death at hospital discharge, and their time spans from extubation to SLT initiation were 1.0 days. The primary outcome revealed that every day of delay in SLT initiation post-extubation was associated with dysphagia or death at hospital discharge (adjusted odds ratio (AOR), 1.09; 95% CI, 1.02-1.18). Similarly, secondary outcomes showed associations between this per day delay in SLT initiation and dysphagia or death at the seventh day (AOR, 1.28; 95% CI, 1.05-1.55), 14th day (AOR, 1.34; 95% CI, 1.13-1.58), or 28th day (AOR, 1.21; 95% CI, 1.07-1.36) after extubation and occurrence of aspiration pneumonia (AOR, 1.09; 95% CI, 1.02-1.17), while per day delay in post-extubation SLT initiation did not affect in-hospital mortality (AOR, 1.04; 95% CI, 0.97-1.12). Conclusions Delayed initiation of SLT in PED patients was associated with persistent dysphagia or death. Early initiation of SLT may prevent this complication post-extubation. A randomized controlled study is needed to validate these results.
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Keywords | Post-extubation dysphagia
Speech and language therapy
Intensive care
Dysphagia
Aspiration pneumonia
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Published Date | 2022-04-08
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Publication Title |
Critical Care
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Volume | volume26
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Issue | issue1
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Publisher | BMC
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Start Page | 98
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ISSN | 1364-8535
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Content Type |
Journal Article
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language |
English
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OAI-PMH Set |
岡山大学
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Copyright Holders | © The Author(s) 2022.
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File Version | publisher
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Related Url | isVersionOf https://doi.org/10.1186/s13054-022-03974-6
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License | http://creativecommons.org/licenses/by/4.0/
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