Factors Contributing to Post Extubation Dysphagia in Critically Ill Patients

Abstract

Critically care nurses play an important role to investigate and early detect suspected complications from the intubation process such as post-extubation dysphagia. Post-extubation dysphagia has negative consequences which can be classified into physiological such as malnutrition and/or dehydration, chocking, chest infection and aspiration pneumonia, in addition to psychological, and economic consequences as post-extubation dysphagia could increase the consumption of supplies, human resources, workload and the overall cost of care. There are many factors that contribute to the development of post-extubation dysphagia, which include: physiological changes related factors; age, pathological related factors; initial diagnosis and comorbidies and therapeutic related factors; presence of tracheal and gastric tube, in addition to some medications that may lead to dysphagia. Objective: Identify factors contributing to post-extubation dysphagia in critically ill patients. Setting: This study was conducted in the General Medical ICUs namely; Casualty unit (unit I), (unit III) and Continuous Renal Replacement Therapy at the Alexandria Main University Hospital (AMUH). In addition to Almoassat General ICU. Subjects: A convenience sample of 50 adult intubated critically ill patients. Tools: Two tools were used for data collection: "Factors Contributing to Post-extubation Dysphagia Assessment" and "Gugging Swallowing Screen". Results: The differences between the studied patients according to the occurrence of post-extubation dysphagia at first 6hrs compared to after 12hrs and after 24 hrs was statistically significant (p=<0.001). The duration of mechanical ventilation was the only significant risk factor to post-extubation dysphagia after 24hrs according to the binary logistic regression analysis. Conclusion: All the studied patients developed post-extubation dysphagia by the first 6 hrs of extubation. The severity of post-extubation dysphagia varied between mild, moderate and severe. Critically ill patients were highly susceptible for exposure of multiple iatrogenic factors which can contribute to post-extubation dysphagia during ICU stay. The only significant risk factor to post-extubation dysphagia after 24hrs was the duration of mechanical ventilation. Recommendations: Critical care nurses should be continuously monitor the intubated critically ill patients who are risky to develop post extubation dysphagia, and continuous in-serve training programs for CCNs in the ICUs.