title: Nurse-performed screening for postextubation dysphagia: a retrospective cohort study in critically ill medical patients.
abstract: BACKGROUND
  Swallowing difficulties are common, and dysphagia occurs frequently in intensive care unit (ICU) patients after extubation. Yet, no guidelines on postextubation swallowing assessment exist. We aimed to investigate the safety and effectiveness of nurse-performed screening (NPS) for postextubation dysphagia in the medical ICU.
  
  
  METHODS
  We conducted a retrospective cohort study of mechanically ventilated patients who were extubated in a 20-bed medical ICU. Phase I (no NPS, October 2012 to January 2014) and phase II (NPS, February 2014 to July 2015) were compared. In phase II, extubated patients received NPS up to three times on consecutive days; patients who failed were referred to speech-language pathologists. Outcomes analyzed included oral feeding at ICU discharge, reintubation, ICU readmission, postextubation pneumonia, ICU and/or hospital mortality, and ICU and/or hospital length of stay (LOS). Subgroup analysis was done for patients extubated after >72 h of mechanical ventilation, as the latter may predispose patients to postextubation dysphagia. Multivariable adjustments for Acute Physiology and Chronic Health Evaluation (APACHE) II score and comorbidities were done because of baseline differences between the phases.
  
  
  RESULTS
  A total of 468 patients were studied (281 in phase I, 187 in phase II). Patients in phase II had higher APACHE II scores than those in phase I (27.2 ± 8.2 vs. 25.4 ± 8.2; P = 0.018). Despite this, patients in phase II showed a 111 % increase in (the odds of) oral feeding at ICU discharge and a 59 % decrease in postextubation pneumonia (multivariate P values 0.001 and 0.006, respectively). In the subgroup analysis, NPS was associated with a 127 % increase in oral feeding at ICU discharge, an 80 % decrease in postextubation pneumonia, and a 25 % decrease in hospital LOS (multivariate P values 0.021, 0.004, and 0.009, respectively). No other outcome differences were found.
  
  
  CONCLUSIONS
  NPS for dysphagia is safe and may be superior to no screening with respect to several patient-centered outcomes.
authors.affiliation: Division of Respiratory & Critical Care Medicine, University Medicine Cluster, National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 10, Singapore, 119228, Singapore. kay_choong_see@nuhs.edu.sg.|Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. kay_choong_see@nuhs.edu.sg.
authors.forename: Kay Choong
authors.initials: KC
authors.lastname: See
authors.affiliation: Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
authors.forename: Si Yu
authors.initials: SY
authors.lastname: Peng
authors.affiliation: Division of Respiratory & Critical Care Medicine, University Medicine Cluster, National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 10, Singapore, 119228, Singapore.|Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
authors.forename: Jason
authors.initials: J
authors.lastname: Phua
authors.affiliation: Department of Nursing, National University Hospital, Singapore, Singapore.
authors.forename: Chew Lai
authors.initials: CL
authors.lastname: Sum
authors.affiliation: Department of Rehabilitation, National University Hospital, Singapore, Singapore.
authors.forename: Johncy
authors.initials: J
authors.lastname: Concepcion
mesh_terms: D018806:APACHE; D000328:Adult; D000368:Aged; D060666:Airway Extubation / Q000009:adverse effects*; D015331:Cohort Studies; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness / Q000628:therapy*; D003680:Deglutition Disorders / Q000175:diagnosis* / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D024802:Nurse's Role; D012121:Respiration, Artificial / Q000009:adverse effects; D012189:Retrospective Studies; D015300:Ventilator Weaning / Q000009:adverse effects
keywords: Airway extubation; Deglutition disorders; Intensive care unit; Intubation; Pneumonia