postextubation dysphagia is persistent and associated with poor outcomes in survivors of critical illnesspostextubation吞咽困难是持久的和相关的结果差的重要疾病的幸存者.pdfVIP

Macht et al. Critical Care 2011, 15:R231 /content/15/5/R231 RESEARCH Open Access Postextubation dysphagia is persistent and associated with poor outcomes in survivors of critical illness 1* 2 1 1 1 3 Madison Macht , Tim Wimbish , Brendan J Clark , Alexander B Benson , Ellen L Burnham , André Williams and Marc Moss1 Abstract Introduction: Dysphagia is common among survivors of critical illness who required mechanical ventilation during treatment. The risk factors associated with the development of postextubation dysphagia, and the effects of dysphagia on patient outcomes, have been relatively unexplored. Methods: We conducted a retrospective, observational cohort study from 2008 to 2010 of all patients over 17 years of age admitted to a university hospital ICU who required mechanical ventilation and subsequently received a bedside swallow evaluation (BSE) by a speech pathologist. Results: A BSE was performed after mechanical ventilation in 25% (630 of 2,484) of all patients. After we excluded patients with stroke and/or neuromuscular disease, our study sample size was 446 patients. We found that dysphagia was present in 84% of patients (n = 374) and classified dysphagia as absent, mild, moderate or severe in 16% (n = 72), 44% (n = 195), 23% (n = 103) and 17% (n = 76), respectively. In univariate analyses, we found that statistically significant risk factors for severe dysphagia included long duration of mechanical ventilation and reintubation. In multivariate analysis, after adjusting for age, gender and severity of illness, we found that mechanical ventilation for more than seven days remained independently associated with moderate or severe dysphagia (adj