CHEST Guidelines-Post-Extubation-Dysphagia

Post-Extubation-Dysphagia_chest

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The article "Post-Extubation Dysphagia: The Truth Is Hard to Swallow" by Shannon M. Fernando, MD, and Andrew J. E. Seely, MD, PhD, discusses an often overlooked complication of mechanical ventilation in ICU patients—post-extubation dysphagia. This condition impairs a patient's ability to safely swallow, leading to a higher risk of aspiration, pneumonia, and prolonged hospital stays. The authors emphasize that although prevalent, post-extubation dysphagia is frequently undiagnosed, escalating morbidity and mortality rates.<br /><br />Two studies highlighted in the article, by Zuercher et al. and Moss et al., explore the factors associated with post-extubation dysphagia and propose screening methods to better diagnose this condition. Zuercher et al. found that pre-existing neurological disease, emergency admissions, long durations of mechanical ventilation, renal replacement therapy, and severe illness increase the risk for dysphagia post-extubation. They validated a simple "water swallow test" leading to early detection, although recognizing its limitations due to its lack of negative predictive value.<br /><br />Conversely, Moss et al. proposed a more formal bedside swallowing evaluation using speech-language pathologists, which, although initially less accurate, greatly improved with certain identified factors enhancing sensitivity and accuracy.<br /><br />Both studies underscore the importance of early detection and routine screening for post-extubation dysphagia, particularly after prolonged intubation or in severely ill patients. The authors note the lack of effective treatments, although swallow retraining and prevention of oral intake may help. They stress the urgent need for innovative interventions and improved therapies to manage and treat post-extubation dysphagia effectively. Enhanced screening and detection are critical to mitigate further harm and improve outcomes for critically ill patients.

Keywords

post-extubation dysphagia

mechanical ventilation

aspiration risk

pneumonia

ICU patients

swallowing evaluation

screening methods

neurological disease

speech-language pathologists

early detection