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Postextubation dysphagia in critically ill children: A prospective cohort study

Paulo S L da Silva1, Maria E Reis2, Thais S M Fonseca3

  • 1Pediatric Intensive Care Unit, Diadema State Hospital, São Paulo, São Paulo, Brazil.

Pediatric Pulmonology
|October 13, 2022
PubMed

Insights

Postextubation dysphagia (PED) affects 69% of pediatric intensive care unit (PICU) patients, leading to longer hospital stays. Key risk factors include young age, neurological issues, and prolonged ventilation, highlighting the need for early intervention.

Area of Science:

  • Pediatric critical care medicine
  • Swallowing disorders
  • Mechanical ventilation outcomes

Background:

  • Postextubation dysphagia (PED) is a known complication in adults, but data in pediatric intensive care unit (PICU) populations are limited.
  • PED is associated with significant negative patient outcomes.

Purpose of the Study:

  • To determine the incidence, risk factors, and outcomes of PED in a pediatric intensive care unit (PICU).

Main Methods:

  • A prospective, observational cohort study was conducted from 2019-2021.
  • 161 pediatric patients (1 month to 15 years) receiving mechanical ventilation for over 24 hours were screened for dysphagia within 24 hours of extubation using the Functional Oral Intake Scale (FOIS).
  • Dysphagia was defined as an FOIS score less than 6.

Main Results:

  • The incidence of PED was 69% in the studied pediatric population.
  • Significant risk factors for PED included age under 24 months, neurological comorbidities, iatrogenic withdrawal syndrome, use of neuromuscular blocking agents, and duration of intubation exceeding 72 hours.
  • PED was associated with significantly longer PICU stays (14 vs 7.5 days), hospital stays (21 vs 15 days), and delayed oral feeding (6 vs 1 day).
  • 9% of patients with PED did not achieve total oral intake by hospital discharge.

Conclusions:

  • Postextubation dysphagia (PED) is highly prevalent in children admitted to the PICU.
  • Identifying specific risk factors can aid in the early detection and management of PED.
  • Prompt recognition and intervention strategies are crucial for improving outcomes in pediatric patients with dysphagia postextubation.
Abstract

Keywords:
childrendysphagiaextubationmechanical ventilationpediatric intensive care unitswallowing

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