Dysphagia Following Extubation

Dysphagia following extubation is a commonly occurring issue for critically ill adult patients (Brodsky et al., 2018; McIntyre et al., 2021; Schefold et al., 2017; Zuercher et al., 2020). Post-extubation dysphagia refers to swallowing issues that occur at the oral or pharyngeal stages of swallowing in patients who are critically ill who have undergone endotracheal intubation (McIntyre et al., 2023). Post-extubation dysphagia is correlated with increased health care costs, prolonged enteral feeding, increased risk for the development of pneumonia, and a predictor of all-cause mortality (Macht et al., 2013; McInytre et al., 2022; Park et al., 2017; Schefold et al., 2017).

The causes of dysphagia following extubation are thought to be multifactorial and may include trauma to the oral cavity, pharynx, or larynx, intensive care unit (ICU)-acquired weakness, altered sensation, changes in respiratory swallow patterns, and alterations in cognition (Brodsky et al., 2020; Goldsmith, 2000; Macht et al., 2013; Zuercher et al., 2019).

Currently, the identification and diagnosis processes for dysphagia following extubation are not standardized but may occur following a clinical swallow evaluation, a flexible endoscopic evaluation of swallowing (FEES) or a modified barium swallow study (MBSS) (McIntyre et al., 2023). Recommendations for the timing of swallow evaluations vary. Some studies recommend evaluating swallow function immediately following extubation, while others recommend waiting to complete an evaluation between 1-5 days (Burgess et al., 1979; de Larminat et al., 1995; Padovani  et al., 2010; Skoretz et al., 2010). Risk factors for dysphagia following extubation may include age, comorbidities, laryngeal pathologies, duration of tracheal intubation, APACHE II, duration of oral endotracheal intubation, and tracheostomy (Brodsky et al., 2020; Hou et al., 2023; Zuercher et al., 2019).

Each person should be assessed on an individual basis to determine the appropriateness of completing a swallowing evaluation – delaying an assessment may be warranted depending on the individual’s respiratory and cognitive function (Dobak & Kelly, 2020).

To learn more about dysphagia following extubation, check out the references cited in this post.

Intubation in emergent situation.