title: Recovery from Dysphagia Symptoms after Oral Endotracheal Intubation in Acute Respiratory Distress Syndrome Survivors. A 5-Year Longitudinal Study.
abstract: BACKGROUND
  Nearly 60% of patients who are intubated in intensive care units (ICUs) experience dysphagia after extubation, and approximately 50% of them aspirate. Little is known about dysphagia recovery time after patients are discharged from the hospital.
  
  
  OBJECTIVE
  To determine factors associated with recovery from dysphagia symptoms after hospital discharge for acute respiratory distress syndrome (ARDS) survivors who received oral intubation with mechanical ventilation.
  
  
  METHODS
  This is a prospective, 5-year longitudinal cohort study involving 13 ICUs at four teaching hospitals in Baltimore, Maryland. The Sydney Swallowing Questionnaire (SSQ), a 17-item visual analog scale (range, 0-1,700), was used to quantify patient-perceived dysphagia symptoms at hospital discharge, and at 3, 6, 12, 24, 36, 48, and 60 months after ARDS. An SSQ score greater than or equal to 200 was used to indicate clinically important dysphagia symptoms at the time of hospital discharge. Recovery was defined as an SSQ score less than 200, with a decrease from hospital discharge greater than or equal to 119, the reliable change index for SSQ score. Fine and Gray proportional subdistribution hazards regression analysis was used to evaluate patient and ICU variables associated with time to recovery accounting for the competing risk of death.
  
  
  RESULTS
  Thirty-seven (32%) of 115 patients had an SSQ score greater than or equal to 200 at hospital discharge; 3 died before recovery. All 34 remaining survivors recovered from dysphagia symptoms by 5-year follow-up, 7 (23%) after 6 months. ICU length of stay was independently associated with time to recovery, with a hazard ratio (95% confidence interval) of 0.96 (0.93-1.00) per day.
  
  
  CONCLUSIONS
  One-third of orally intubated ARDS survivors have dysphagia symptoms that persist beyond hospital discharge. Patients with a longer ICU length of stay have slower recovery from dysphagia symptoms and should be carefully considered for swallowing assessment to help prevent complications related to dysphagia.
authors.affiliation: 1 Department of Physical Medicine and Rehabilitation.|2 Outcomes After Critical Illness and Surgery (OACIS) Research Group.
authors.forename: Martin B
authors.identifier: http://orcid.org/0000-0002-3645-2944
authors.initials: MB
authors.lastname: Brodsky
authors.affiliation: 2 Outcomes After Critical Illness and Surgery (OACIS) Research Group.|3 Division of Pulmonary and Critical Care Medicine.
authors.forename: Minxuan
authors.identifier: http://orcid.org/0000-0001-5551-586X
authors.initials: M
authors.lastname: Huang
authors.affiliation: 4 Division of Pulmonary and Critical Care Medicine, University of Maryland, Baltimore, Maryland.
authors.forename: Carl
authors.identifier: http://orcid.org/0000-0003-3938-178X
authors.initials: C
authors.lastname: Shanholtz
authors.affiliation: 2 Outcomes After Critical Illness and Surgery (OACIS) Research Group.|5 Department of Anesthesiology and Critical Care Medicine.
authors.forename: Pedro A
authors.identifier: http://orcid.org/0000-0002-1085-4427
authors.initials: PA
authors.lastname: Mendez-Tellez
authors.affiliation: 1 Department of Physical Medicine and Rehabilitation.|6 Department of Otolaryngology-Head and Neck Surgery.|7 Center for Functional Anatomy and Evolution, and.
authors.forename: Jeffrey B
authors.identifier: http://orcid.org/0000-0003-2491-9559
authors.initials: JB
authors.lastname: Palmer
authors.affiliation: 2 Outcomes After Critical Illness and Surgery (OACIS) Research Group.|8 Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; and.
authors.forename: Elizabeth
authors.identifier: http://orcid.org/0000-0002-0091-9434
authors.initials: E
authors.lastname: Colantuoni
authors.affiliation: 1 Department of Physical Medicine and Rehabilitation.|2 Outcomes After Critical Illness and Surgery (OACIS) Research Group.|3 Division of Pulmonary and Critical Care Medicine.
authors.forename: Dale M
authors.initials: DM
authors.lastname: Needham
mesh_terms: D000328:Adult; D015142:Baltimore; D003680:Deglutition Disorders / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010351:Patient Discharge; D011446:Prospective Studies; D012044:Regression Analysis; D012121:Respiration, Artificial / Q000009:adverse effects*; D012128:Respiratory Distress Syndrome / Q000150:complications* / Q000628:therapy; D012307:Risk Factors; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D017741:Survivors / Q000706:statistics & numerical data; D013997:Time Factors
keywords: acute respiratory distress syndrome; deglutition; deglutition disorders; intubation; recovery of function