CHEST Guidelines-Risk-Factors-for-Postextubation-Dysphagia-in-the-P

Risk-Factors-for-Postextubation-Dysphagia-in-the-P

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In the correspondence to the editor concerning the use of tocilizumab in COVID-19 patients, Fiore Mastroianni highlights concerns about administering IL-6 inhibitors like tocilizumab for COVID-19 treatment. He references a case report by Radbel et al. that describes adverse outcomes from such treatment and advises caution due to the hypothesis that inflammation drives severe COVID-19 outcomes. Mastroianni argues that while high IL-6 levels are linked with poor outcomes in some diseases, this has not been definitively established for COVID-19, and IL-6 may actually protect against viral infections. Hence, tocilizumab should only be used in clinical trials with careful consideration to avoid potential harm. He also critiques the proliferation of unreviewed studies, advocating for well-controlled clinical trials over small, uncontrolled ones.<br /><br />The second part addresses Jianping Chen and Jun Qian’s critique of a study assessing risk factors for postextubation dysphagia in ICU patients after mechanical ventilation. They argue that dysphagia should be analyzed considering competing risks like mortality, as patients who die before extubation cannot develop dysphagia, potentially skewing risk factor analysis. They also mention issues with immortal time bias, where the duration before dysphagia becomes apparent could affect study outcomes, particularly when time-based comparisons are made during mechanical ventilation.<br /><br />Authors responding to Chen and Qian clarify that their study did not focus on survival or mortality impacts of dysphagia but rather on identifying risk factors for developing dysphagia post extubation. They acknowledge limitations such as potentially underestimated dysphagia incidence but assert their focus was on patients who survived long enough for dysphagia assessment. Despite the concerns over methodology, the study relied on a large dataset from the DYnAMICS study to identify key risk factors like neurologic disease and extended mechanical ventilation duration.

Keywords

tocilizumab

COVID-19

IL-6 inhibitors

inflammation

clinical trials

postextubation dysphagia

mechanical ventilation

risk factors

immortal time bias

neurologic disease