Evaluation and classification of post-extubation dysphagia in critically ill patients.

ABSTRACT Objective: to identify factors associated with dysphagia in patients undergoing prolonged orotracheal intubation (pOTI) and the post-extubation consequences. Methods: 150 patients undergoing pOTI participated in the study, evaluated according to the deglutition functional level (American Speech Language - Hearing Association National Outcome Measurement System - ASHA NOMS), severity determination (The Simplified Acute Physiology Score - SOFA) and submitted to collection of variables age, mortality, days of orotracheal intubation, number of sessions to introduce oral diet, and days to hospital discharge. We grouped patients according to ASHA classification: 1 (levels 1 and 2), 2 (levels 3, 4 and 5) and 3 (levels 6 and 7). Results: the variables associated with impaired deglutition functionality were age (p<0.001), mortality (p<0.003), OTI days (p=0.001), number of sessions to introduce oral diet (p<0.001) and days to hospital discharge (p=0.018). Multiple comparisons indicated significant difference between ASHA1 and ASHA2 groups in relation to ASHA3 group. ASHA1 and ASHA2 groups had a lower SOFA score when compared with the ASHA3 group (p=0.004). Only 20% of ASHA1 patients and 32% of ASHA2 patients presented safe deglutition levels before discharge. Conclusion: factors associated with dysphagia in patients submitted to pOTI were age over 55 years and orotracheal intubation time (greater in the cases with worse deglutition functionality). The post-extubation consequences were increased mortality and length of hospital stay in the presence of dysphagia.

摘要 目的：明确接受长期经口气管插管（prolonged orotracheal intubation, pOTI）患者的吞咽障碍（dysphagia）相关影响因素及拔管后并发症。方法：本研究纳入150例行pOTI的患者，采用吞咽功能水平评估工具——美国言语语言听力协会国家结局测量系统（American Speech Language-Hearing Association National Outcome Measurement System, ASHA NOMS）、病情严重程度评估方法——简化急性生理学评分（SOFA）进行评估，并收集患者的年龄、病死率、经口气管插管天数、开始口服饮食所需的治疗疗程数、住院天数等变量。根据ASHA分级对患者进行分组：1组（分级1、2）、2组（分级3、4、5）、3组（分级6、7）。结果：与吞咽功能受损相关的变量包括年龄（p<0.001）、病死率（p<0.003）、经口气管插管天数（p=0.001）、开始口服饮食所需的治疗疗程数（p<0.001）及住院天数（p=0.018）。多重比较结果显示，ASHA1组、ASHA2组与ASHA3组间存在显著差异；ASHA1组与ASHA2组的SOFA评分均低于ASHA3组（p=0.004）。仅20%的ASHA1组患者及32%的ASHA2组患者在出院前达到安全吞咽水平。结论：接受pOTI的患者发生吞咽障碍的相关影响因素为年龄≥55岁及经口气管插管时长（插管时长越长，吞咽功能越差）；合并吞咽障碍的患者拔管后并发症表现为病死率升高及住院时长延长。