Swallowing dysfunction after mechanical ventilation in trauma patients

Carlos V R Brown, Kelli Hejl, Amy D. Mandaville, Paul E. Chaney, Guy Stevenson, Charlotte Smith

Research output: Contribution to journalArticle

27 Scopus citations

Abstract

Background: Swallowing dysfunction can occur after mechanical ventilation, leading to complications such as aspiration and pneumonia. After mechanical ventilation, authors have recommended evaluating patients with contrast studies or endoscopy to identify patients at risk for swallowing dysfunction and aspiration. The purpose of the study was to determine if a bedside swallowing evaluation (BSE) can identify patients with swallowing dysfunction after mechanical ventilation. Methods: This is a 1-year (2008) prospective study of all adult trauma patients admitted to the intensive care unit requiring mechanical ventilation. Upon separation from mechanical, all patients received a BSE. The BSE used mental status, facial symmetry, swallow reflex, and oral ice chips and water to identify swallowing dysfunction. Patients who passed the BSE were advanced to oral intake per physician orders, whereas patients who failed the BSE were allowed nothing by mouth. Results: A total of 345 patients were included; 54 died before separation from mechanical ventilation and were excluded. The remaining 291 patients underwent BSE after separation from mechanical ventilation, with 143 (49%) passing and 148 (51%) failing. Patients who failed the BSE required mechanical ventilation longer than those who passed (14 ± 13 vs 5 ± 20 days, P = 001). In addition, only 23% of patients extubated within 72 hours failed the BSE, whereas 78% of those intubated more than 72 hours failed the BSE (P < .001). All patients who passed the BSE were discharged from the hospital without a clinical aspiration event. Independent risk factors for failure of BSE included tracheostomy, older age, prolonged mechanical ventilation, delirium tremens, traumatic brain injury, and spine fracture. Three (2%) patients who failed the BSE had a clinical aspiration event despite taking nothing by mouth. Conclusions: A simple BSE can be used to identify patients at risk for swallowing dysfunction after mechanical ventilation. More importantly, BSE can safely clear patients without swallowing dysfunction, avoiding costly and time-consuming contrast studies or endoscopic evaluation.

Original languageEnglish (US)
Pages (from-to)108.e9-108.e13
JournalJournal of Critical Care
Volume26
Issue number1
DOIs
StatePublished - Feb 2011

Keywords

  • Aspiration
  • Dysphagia
  • Mechanical ventilation
  • Swallowing

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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    Brown, C. V. R., Hejl, K., Mandaville, A. D., Chaney, P. E., Stevenson, G., & Smith, C. (2011). Swallowing dysfunction after mechanical ventilation in trauma patients. Journal of Critical Care, 26(1), 108.e9-108.e13. https://doi.org/10.1016/j.jcrc.2010.05.036