Dysphagia Following Extubation Part 1

When it comes to patients that are intubated, there are a lot of factors to consider.

What is their current diagnosis, why are they intubated, how long were they intubated?   Was intubation traumatic?   Have they self-extubated?

There is a lot of discussion over the timing of the evaluation.   Traditionally, it has been thought that there needs to be a period of 24 hours following extubation to allow for recovery.

This series of posts will break down what the evidence tells us regarding post extubation dysphagia.

When:

Marvin, Thibeault and Ehlenbach looked at when we should evaluate a patient’s swallow following extubation.   Typically swallowing evaluations are completed 24 hours after extubation.

This study looked at 49 patients using Flexible Endoscopic Evaluation of Swallowing (FEES).   All patients had been intubated for more than 48 hours.  None of the patients had premorbid dysphagia or diagnoses that could indicate dysphagia.

26 patients were female and the mean age was 56.

At 2-4 hours following extubation, 69% of patients were able to safely swallow at least 1 texture.

At 24 hours following extubation, there was a decrease in Penetration/Aspiration Scale scores with 79% of patients showed improvement in airway protection.

“These findings suggest that although patients may be safe to begin a modified diet soon after extubation, delaying evaluation until 24-h post-extubation may allow for a less restricted diet.”

Extubation of Critically Ill Trauma Patients

Leder, Cohn and Moller examined the incidence of aspiration following extubation of critically ill trauma patients.

The study looked at 11 males and 9 females ages 18-72 with intubation time of 2-45 days.

Aspiration was noted n 9/20 (45%) of patients.   4/9 (44% of aspirators) were silent aspirators or 20% of all patients).

8/9 patients that aspirated resumed an oral diet 2-10 days following extubation.   A low Glasgow Coma Score increased the risk of aspiration.

“It was concluded that trauma patients after orotracheal intubation and prolonged mechanical ventilation have an increased risk of aspiration.  An objective assessment of dysphagia to identify aspiration may reduce the likelihood of pulmonary complications after extubation.”

References:

Leder, S., Cohn, S. & Moller, B. Fiberoptic Endoscopic Documentation of the High Incidence of Aspiration following Extubation in Critically Ill Trauma Patients. Dysphagia 13, 208–212 (1998). https://doi.org/10.1007/PL00009573

Marvin, S., Thibeault, S. & Ehlenbach, W.J. Post-extubation Dysphagia: Does Timing of Evaluation Matter?. Dysphagia 34, 210–219 (2019). https://doi.org/10.1007/s00455-018-9926-3

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