Post-extubation dysphagia in the ICU-a narrative review: epidemiology, mechanisms and clinical management (Update...

Dysphagia (i.e. an impairment in swallowing function that impacts on safety or efficiency) is present in many intensive care unit (ICU) survivors, in particular following extubation ("post-extubation dysphagia", PED). Despite the fact that pathomechanisms leading to PED are currently incompletely understood, local as well as central neurological and neuromuscular dysfunctions may be key to development of PED. Data from prospective large-scale clinical investigations with systematic screening demonstrate that PED affects about one out of five (about 20%) of mixed medical-surgical unplanned (emergency) ICU admissions. PED is associated with an increased risk for aspiration, aspiration-induced pneumonia, malnutrition, increased ICU resource use, decreased quality of life, prolonged ICU- and hospital length of stay and increased overall morbidity and mortality. Data demonstrate that PED is an independent predictor of 90-day mortality with increased risk of death up to about one year after ICU admission. PED may be a somewhat overlooked medical problem since in many ICUs, PED is currently not routinely screened for in all patients at risk (i.e. all ICU patients) following extubation. In this review, we update the available data on PED with a focus on epidemiology, risk factors, potential aetiology and treatment approaches, as well as clinical management on ICUs.