Swallowing dysfunction after prolonged intubation: analysis of risk factors in trauma patients
| Autor: | Vafa Ghaemmaghami, Ara Feinstein, Jason L. Sperry, Ravia Bokhari, Anthony Bordon, David Testa |
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| Rok vydání: | 2011 |
| Předmět: |
Adult
Male medicine.medical_specialty Population Pilot Projects law.invention Injury Severity Score Risk Factors law Internal medicine mental disorders Intubation Intratracheal Odds Ratio medicine Humans education Retrospective Studies education.field_of_study business.industry Incidence musculoskeletal neural and ocular physiology Glasgow Coma Scale Retrospective cohort study General Medicine Odds ratio Prognosis Intensive care unit United States Confidence interval Deglutition Surgery Survival Rate nervous system Cohort Wounds and Injuries Female Deglutition Disorders business Follow-Up Studies |
| Zdroj: | The American Journal of Surgery. 202:679-683 |
| ISSN: | 0002-9610 |
| Popis: | Background The clinical significance of post-extubation swallowing dysfunction (PSD) is profound, resulting in both increased morbidity and mortality. Specific risk factors have not been described in an injured patient cohort. The purpose of this pilot study was to elucidate independent factors that predict PSD in this population. Methods A retrospective cohort analysis was performed on 150 consecutive trauma patients intubated for more than 48 hours. Assessment of swallowing function after extubation was performed by a simple bedside speech pathology evaluation. Patients then were divided into 2 groups: those with and those without PSD. Backwards stepwise logistic regression analysis then was used to determine independent predictors of PSD after controlling for important injury characteristics and patient demographics. Results The incidence of PSD in our study cohort was 41%. Patients with PSD, although older than non-PSD patients (48 vs 37.5 y; P = .001), were similar with respect to admission Glasgow coma score (GCS) and injury severity score. Regression analysis revealed that age older than 55 years (odds ratio, 2.60; P = .037; 95% confidence interval, 1.1–6.4) and ventilator days (odds ratio, 1.14; P = .001; 95% confidence interval, 1.1–1.2) were significant independent risk factors for PSD. Interpretation of these odds ratios revealed that those patients older than age 55 had more than a 2.5-fold greater risk of PSD. The risk increased by 14% for every day a patient required intubation. There was no significant association between PSD and injury severity score, GCS, presence of medical comorbidities, or development of nosocomial pneumonia. Conclusions PSD is a common occurrence in trauma patients. Age older than 55 years and ventilator days are independent risk factors for PSD. Injury severity, altered GCS upon arrival, comorbidities, and nosocomial pneumonia were not independent risk factors for PSD in our cohort. These results suggest that older patients with extended intensive care unit stays and ventilator requirements may benefit from early swallowing evaluation. |
| Databáze: | OpenAIRE |
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