The prevalence of post-extubation dysphagia in critically ill adults: an Australian data linkage study

Melanie L McIntyre; Timothy Chimunda; Joanne Murray; Trent W Lewis; Sebastian H Doeltgen

doi:10.51893/2022.4.OA5

The prevalence of post-extubation dysphagia in critically ill adults: an Australian data linkage study

Crit Care Resusc. 2023 Oct 16;24(4):352-359. doi: 10.51893/2022.4.OA5. eCollection 2022 Dec 5.

Authors

Melanie L McIntyre^{1

2}, Timothy Chimunda^{3

4

5}, Joanne Murray¹, Trent W Lewis^{6

7}, Sebastian H Doeltgen¹

Affiliations

¹ Swallowing Neurorehabilitation Research Lab, Speech Pathology, Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia.
² Department of Speech Pathology, Bendigo Health, Bendigo, VIC, Australia.
³ Department of Critical Care, Northern Health, Epping, VIC, Australia.
⁴ University of Queensland, Brisbane, QLD, Australia.
⁵ University of Melbourne, Melbourne, VIC, Australia.
⁶ Medical Devices Research Institute, Flinders University, Adelaide, SA, Australia.
⁷ College of Science Engineering, Flinders University, Adelaide, SA, Australia.

Abstract

Objective: To define the prevalence of dysphagia after endotracheal intubation in critically ill adult patients. Design: A retrospective observational data linkage cohort study using the Australian and New Zealand Intensive Care Society Adult Patient Database and a mandatory government statewide health care administration database. Setting: Private and public intensive care units (ICUs) within Victoria, Australia. Participants: Adult patients who required endotracheal intubation for the purpose of mechanical ventilation within a Victorian ICU between July 2013 and June 2018. Main outcome measures: Presence of dysphagia, aspiration pneumonia, ICU length of stay, hospital length of stay, and cost per episode of care. Results: Endotracheal intubation in the ICU was required for 71 124 patient episodes across the study period. Dysphagia was coded in 7.3% (n = 5203) of those episodes. Patients with dysphagia required longer ICU (median, 154 [interquartile range (IQR), 78-259] v 53 [IQR, 27-107] hours; P < 0.001) and hospital admissions (median, 20 [IQR, 13-30] v 8 [IQR, 5-15] days; P < 0.001), were more likely to develop aspiration pneumonia (17.2% v 5.6%; odds ratio, 3.0; 95% CI, 2.8-3.2; P < 0.001), and the median health care expenditure increased by 93% per episode of care ($73 586 v $38 108; P < 0.001) compared with patients without dysphagia. Conclusions: Post-extubation dysphagia is associated with adverse patient and health care outcomes. Consideration should be given to strategies that support early identification of patients with dysphagia in the ICU to determine if these adverse outcomes can be reduced.