title: Post-extubation dysphagia is associated with longer hospitalization in survivors of critical illness with neurologic impairment.
abstract: BACKGROUND
  Critically ill patients can develop acute respiratory failure requiring endotracheal intubation. Swallowing dysfunction after liberation from mechanical ventilation, also known as post-extubation dysphagia, is common and deleterious among patients without neurologic disease. However, the risk factors associated with the development of post-extubation dysphagia and its effect on hospital lengthofstay in critically ill patients with neurologic disorders remains relatively unexplored.
  
  
  METHODS
  We conducted a retrospective, observational cohort study from 2008 to 2010 of patients with neurologic impairment who required mechanical ventilation and subsequently received a bedside swallow evaluation (BSE) by a speech-language pathologist.
  
  
  RESULTS
  A BSE was performed after mechanical ventilation in 25% (630/2,484) of all patients. In the 184 patients with neurologic impairment, post-extubation dysphagia was present in 93% (171/184), and was classified as mild, moderate, or severe in 34% (62/184), 26% (48/184), and 33% (61/184), respectively. In univariate analyses, statistically significant risk factors for moderate/severe dysphagia included longer durations of mechanical ventilation and the presence of a tracheostomy. In multivariate analysis, adjusting for age, tracheostomy, cerebrovascular disease, and severity of illness, mechanical ventilation for >7 days remained independently associated with moderate/severe dysphagia (adjusted odds ratio=4.48 (95%confidence interval=2.14 to 9.81), P<0.01). The presence of moderate/severe dysphagia was also significantly associated with prolonged hospital lengthofstay, discharge status, and surgical placement of feeding tubes. When adjusting for age, severity of illness, and tracheostomy, patients with moderate/severe dysphagia stayed in the hospital 4.32 days longer after their initial BSE than patients with none/mild dysphagia (95% confidence interval=3.04 to 5.60 days, P<0.01).
  
  
  CONCLUSIONS
  In a cohort of critically ill patients with neurologic impairment, longer duration of mechanical ventilation is independently associated with post-extubation dysphagia, and the development of post-extubation dysphagia is independently associated with a longer hospital length of stay after the initial BSE.
authors.forename: Madison
authors.initials: M
authors.lastname: Macht
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: King
authors.forename: Tim
authors.initials: T
authors.lastname: Wimbish
authors.forename: Brendan J
authors.initials: BJ
authors.lastname: Clark
authors.forename: Alexander B
authors.initials: AB
authors.lastname: Benson
authors.forename: Ellen L
authors.initials: EL
authors.lastname: Burnham
authors.forename: André
authors.initials: A
authors.lastname: Williams
authors.forename: Marc
authors.initials: M
authors.lastname: Moss
mesh_terms: D000328:Adult; D000368:Aged; D060666:Airway Extubation / Q000379:methods / Q000639:trends*; D015331:Cohort Studies; D016638:Critical Illness / Q000628:therapy*; D003680:Deglutition Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006760:Hospitalization / Q000639:trends; D006801:Humans; D007902:Length of Stay / Q000639:trends*; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000175:diagnosis* / Q000453:epidemiology; D012189:Retrospective Studies; D017741:Survivors; D015300:Ventilator Weaning / Q000379:methods / Q000639:trends