Post-extubation dysphagia in intensive care: The role of the otorhinolaryngologist

Post-extubation dysphagia (PED) is a frequent and underestimated complication in intensive care, with increased risk of morbidity and mortality. The role of the otorhinolaryngologist in management is not well defined.

A systematic literature review was conducted following the 2020 PRISMA guidelines. It focused on studies of adult patients assessed in intensive care for swallowing disorder after extubation. Study data comprised population, means and timing of assessment and criteria for ENT involvement. Risk of bias was assessed qualitatively using the STROBE, MINORS and AMSTAR guidelines.

Forty-one studies published between 2001 and 2024 were selected. Prevalence of PED ranged from 7% to 80%, exceeding 30% in two-thirds of the studies. Risk factors comprised advanced age, >5-7days' intubation, high severity score, endotracheal tube≥8mm, nasogastric catheter, laryngeal lesion, acquired muscle weakness, and no oral intake at 72hours. Methods varied: 34% of studies used instrumental assessment (FEES, VFSS) and the others used clinical tests (FOIS, FILS). ENT involvement was reported in only 27% of studies, on the following criteria: persistent voice abnormality, ineffective coughing, no oral feeding by day 3, failure on clinical tests, and radiologic suspicion of inhalation.

PED has significant prognostic impact, but is variably assessed. The ENT physician can play a key role, but intervention needs to be targeted. Based on the present findings, we propose a decision support algorithm combining simple clinical criteria and tests. Multicenter prospective studies are needed to validate the algorithm and assess its clinical and organizational contribution.