Postextubation dysphagia in critically ill children: A prospective cohort study.

INTRODUCTION

Postextubation dysphagia (PED) is reported mainly in adults and is associated with poor outcomes. However, data on pediatric intensive care unit (PICU) patients are scarce. We aimed to assess the incidence, risk factors, and outcomes associated with PED in a PICU population.

METHODS

Between 2019 and 2021, we conducted a prospective, observational cohort study of patients aged 1 month to 15 years. Within 24 h after extubation, a speech-language pathologist routinely screened all consecutive patients receiving mechanical ventilation (>24 h) for dysphagia. A Functional Oral Intake Scale (FOIS) score of less than 6 indicated dysphagia.

RESULTS

A total of 161 patients were included, with a PED incidence of 69%. After adjusting for confounding variables, five variables were significantly associated with PED (odds ratio; 95% confidence interval): age <24 months (4.84; 1.5-15.60), neurological comorbidities (7.47; 1.36-40.96), iatrogenic withdrawal syndrome (5.52; 1.31-23.14), use of neuromuscular blocking agents (4.19; 1.18-14.82), and duration of intubation >72 h (3.22; 1.08-9.64). Dysphagia was significantly associated with longer PICU and hospital stays and a longer delay to oral feeding than patients without PED, 14 versus 7.5 days, 21 versus 15 days, and 6 versus 1 day, respectively. Ten participants (9%) failed to resume total oral intake at hospital discharge.

CONCLUSIONS

These findings indicate that PED is highly prevalent in children and associated with adverse patient outcomes. Identifying a core of risk factors might improve prompt recognition of patients at risk for PED and implement preventive approaches and early interventions.