Ann Rehabil Med.  2015 Oct;39(5):763-771. 10.5535/arm.2015.39.5.763.

Associations Between Prolonged Intubation and Developing Post-extubation Dysphagia and Aspiration Pneumonia in Non-neurologic Critically Ill Patients

• Kim MJ
• Park YH
• Park YS
• Song YH

• KMID: 2148207
• DOI: http://doi.org/10.5535/arm.2015.39.5.763

Abstract

OBJECTIVE
To identify the associations between the duration of endotracheal intubation and developing post-extubational supraglottic and infraglottic aspiration (PEA) and subsequent aspiration pneumonia.
METHODS
This was a retrospective observational study from January 2009 to November 2014 of all adult patients who had non-neurologic critical illness, required endotracheal intubation and were referred for videofluoroscopic swallowing study. Demographic information, intensive care unit (ICU) admission diagnosis, severity of critical illness, duration of endotracheal intubation, length of stay in ICU, presence of PEA and severity of dysphagia were reviewed.
RESULTS
Seventy-four patients were enrolled and their PEA frequency was 59%. Patients with PEA had significantly longer endotracheal intubation durations than did those without (median [interquartile range]: 15 [9-21] vs. 10 [6-15] days; p=0.02). In multivariate logistic regression analysis, the endotracheal intubation duration was significantly associated with PEA (odds ratio, 1.09; 95% confidence interval [CI], 1.01-1.18; p=0.04). Spearman correlation analysis of intubation duration and dysphagia severity showed a positive linear association (r=0.282, p=0.02). The areas under the receiver operating characteristic curves (AUCs) of endotracheal intubation duration for developing PEA and aspiration pneumonia were 0.665 (95% CI, 0.542-0.788; p=0.02) and 0.727 (95% CI, 0.614-0.840; p=0.001), respectively.
CONCLUSION
In non-neurologic critically ill patients, the duration of endotracheal intubation was independently associated with PEA development. Additionally, the duration was positively correlated with dysphagia severity and may be helpful for identifying patients who require a swallowing evaluation after extubation.

Keyword

Intratracheal intubation; Deglutition disorders; Aspiration pneumonia; Critical illness; Fluoroscopy

MeSH Terms

Adult
Critical Illness*
Deglutition
Deglutition Disorders*
Diagnosis
Fluoroscopy
Humans
Intensive Care Units
Intubation*
Intubation, Intratracheal
Length of Stay
Logistic Models
Observational Study
Peas
Pneumonia, Aspiration*
Retrospective Studies
ROC Curve

Figure

• 

  Fig. 1 ROC curves of endotracheal intubation duration for developing post-extubational aspiration (A) and aspiration pneumonia (B) in non-neurologic critically ill patients. The optimal cut-off values (dots on the curves) for duration, which were calculated as Sensitivity + Specificity - 1, were 12.5 days for post-extubational aspiration (AUC, 0.665; 95% confidential interval, 0.542-0.788; p=0.016; sensitivity 63.6%, specificity 73.3%) and 8.5 days for aspiration pneumonia (AUC, 0.727; 95% confidential interval, 0.614-0.840; p=0.001; sensitivity 100%, specificity 47.8%). ROC, receiver operating characteristic; AUC, area under the ROC curve.

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