The incidence of dysphagia following endotracheal intubation: a systematic review

Hospitalized patients are often at increased risk for oropharyngeal dysphagia following prolonged endotracheal intubation. Although reported incidence can be high, it varies widely. We conducted a systematic review to determine: (1) the incidence of dysphagia following endotracheal intubation, (2) the association between dysphagia and intubation time, and (3) patient characteristics associated with dysphagia. Fourteen electronic databases were searched, using keywords dysphagia, deglutition disorders, and intubation, along with manual searching of journals and grey literature. Two reviewers, blinded to each other, selected and reviewed articles at all stages according to our inclusion criteria: adult participants who underwent intubation and clinical assessment for dysphagia. Exclusion criteria were case series (n < 10), dysphagia determined by patient report, patients with tracheostomies, esophageal dysphagia, and/or diagnoses known to cause dysphagia. Critical appraisal used the Cochrane risk of bias assessment and Grading of Recommendations, Assessment, Development and Evaluation tools. A total of 1,489 citations were identified, of which 288 articles were reviewed and 14 met inclusion criteria. The studies were heterogeneous in design, swallowing assessment, and study outcome; therefore, we present findings descriptively. Dysphagia frequency ranged from 3% to 62% and intubation duration from 124.8 to 346.6 mean hours. The highest dysphagia frequencies (62%, 56%, and 51%) occurred following prolonged intubation and included patients across all diagnostic subtypes. All studies were limited by design and risk of bias. Overall quality of the evidence was very low. This review highlights the poor available evidence for dysphagia following intubation and hence the need for high-quality prospective trials.