Factors associated with swallowing assessment after oral endotracheal intubation and mechanical ventilation for acute lung injury.
BACKGROUND
Endotracheal intubation is associated with postextubation swallowing dysfunction, but no guidelines exist for postextubation swallowing assessments.


OBJECTIVE
We evaluated the prevalence, patient demographic and clinical factors, and intensive care unit (ICU) and hospital organizational factors associated with swallowing assessment after oral endotracheal intubation and mechanical ventilation in patients with acute lung injury (ALI).


METHODS
We performed a secondary analysis of a prospective cohort study in which investigators evaluated 178 eligible patients with ALI who were mechanically ventilated via oral endotracheal tube. The patients were recruited from 13 ICUs at four teaching hospitals in Baltimore, Maryland. Patient demographic and clinical factors, types of ICU, and hospital study sites were evaluated for their association with completion of a swallowing assessment both in the ICU and after the ICU stay before hospital discharge. Factors significantly associated with a swallow assessment were evaluated in a multivariable logistic regression model.


RESULTS
Before hospital discharge, 79 (44%) patients completed a swallowing assessment, among whom 59 (75%) had their assessments initiated in ICU and 20 (25%) had their assessments initiated on the hospital ward. Female sex (odds ratio [OR] = 2.01; 95% confidence interval [95% CI] = 1.03-3.97), orotracheal intubation duration (OR = 1.13 per day; 95% CI = 1.05-1.22), and hospital study site (Site 3: OR = 2.41; 95% CI = 1.00-5.78) were independently associated with swallowing assessment. Although Site 3 had a twofold increase in swallowing assessments in the ICU, there was no significant difference between hospitals in the frequency of swallowing assessments completed after ICU discharge (P = 0.287) or in the proportion of patients who failed a swallowing assessment conducted in the ICU (P = 0.468) or on the ward (P = 0.746).


CONCLUSIONS
In this multisite prospective study, female sex, intubation duration, and hospital site were associated with postextubation swallowing assessment. These results demonstrate variability in practice patterns between institutions and highlight the need to determine the appropriate timing and indications for swallowing assessment and to more fully understand swallowing dysfunction after intubation.
1 Department of Physical Medicine and Rehabilitation.
Martin B
MB
Brodsky
Marlís
M
González-Fernández
Pedro A
PA
Mendez-Tellez
Carl
C
Shanholtz
Jeffrey B
JB
Palmer
Dale M
DM
Needham
D055371:Acute Lung Injury / Q000628:therapy*; D000328:Adult; D015142:Baltimore / Q000453:epidemiology; D003679:Deglutition / Q000502:physiology*; D003680:Deglutition Disorders / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007362:Intensive Care Units; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D009055:Mouth; D016017:Odds Ratio; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000379:methods*; D012307:Risk Factors; D013997:Time Factors
acute lung injury; deglutition; deglutition disorders; intubation; referral and consultation