Korean J Otorhinolaryngol-Head Neck Surg.  2024 Jul;67(7):394-400. 10.3342/kjorl-hns.2024.00115.

Post-Extubated Dysphagia in Intensive Care Unit Patients Based on Flexible Endoscopic Evaluation of Swallowing Examination and Its Affecting Factors

• Sari I
• Tamin S
• Rachmawati EZK
• Hutauruk SM
• Fardizza F
• Aditianingsih D
• Prihartono J

• KMID: 2558026
• DOI: http://doi.org/10.3342/kjorl-hns.2024.00115

Abstract

Background and Objectives
Post-extubation dysphagia (PED) is a condition characterized by swallowing difficulty following the removal of breathing tube. Untreated dysphagia leads to increased morbidity and mortality; however, no study has been conducted on the proportion of PED at RSUPN Dr. Cipto Mangunkusumo (RSCM), using flexible endoscopic evaluation of swallowing (FEES), or on the factors that contribute to its occurrence.
Subjects and Method
Anamnesis and medical record review were conducted on post-extubation patients in the RSCM intensive care unit (ICU) meeting inclusion criteria. Research subjects underwent maximum phonation time (MPT) examination thrice. FEES examination was carried out twice, with 24 hours of post-extubation on all subjects and 72 hours of postextubation on those with PED on initial FEES examination.
Results
The study involved 33 subjects who met the inclusion criteria. The proportion of mild to severe PED determined by FEES 24 hours after extubation was 66.7%, and those exhibiting laryngeal injury was 87.9%. The bivariate analysis revealed a significant correlation between the number of comorbidities, intubation duration, laryngeal injury severity, and MPT value with the incidence of PED in the RSCM ICU. Moreover, the multivariate analysis showed that the duration of intubation exceeding 24 hours had a statistically significant association with the incidence of PED (p=0.003; OR 15.30; 95% CI 2.46-95.19).
Conclusion
The proportion of mild to severe dysphagia in post-extubation patients in the RSCM ICU is quite high. Intubation duration exceeding 24 hours and having more than one comorbidity significantly contribute to the increased risk of dysphagia in post-extubated patients in the RSCM ICU.

Keyword

Endoscopy; Deglutition disorders; Intensive care unit; Laryngeal disease