Systemic Factors Associated With Severe Dysphagia 28 Days After Extubation in ICU Patients With Post-extubation Dysphagia

Objectives To identify clinical and respiratory factors associated with severe dysphagia at 28 days after extubation, defined as a Food Intake Level Scale (FILS) score of 1-3 with continued dependence on enteral nutrition, among critically ill patients with post-extubation dysphagia (PED). Methods We retrospectively reviewed intensive care unit (ICU) patients with PED who had been able to eat orally before admission and subsequently received swallowing rehabilitation by speech-language pathologists at a single center between April 2021 and September 2023. Patients with a FILS score of 1-3 at 28 days after extubation who still required enteral nutrition were classified as having severe dysphagia. Patients were classified into a severe dysphagia group (FILS score 1-3; n = 16) and a non-severe dysphagia group (FILS score 4-10; n = 39). We examined factors related to severe dysphagia using univariable and multivariable analyses. Results Respiratory rate at the initial post-extubation swallowing assessment was higher in the severe dysphagia group than in the non-severe dysphagia group, whereas other vital signs and laboratory findings were similar. In multivariable analysis, respiratory rate (odds ratio (OR): 1.72; 95% confidence interval (CI): 1.31-2.68; P < 0.0001) and the duration of intubation (OR: 1.21; 95% CI: 1.00-1.52; P = 0.0497) were independently associated with severe dysphagia at 28 days after extubation. Conclusions Higher respiratory rate at the initial swallowing assessment and longer duration of intubation were independently associated with severe dysphagia 28 days after extubation in ICU patients with PED. These findings may help clinicians identify patients at risk of prolonged dysphagia after extubation.