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The Incidence of Dysphagia Following Endotracheal Intubation: A Systematic Review

Stacey A. Skoretz, MSc; Heather L. Flowers, MEd, MHSc; Rosemary Martino, MA, PhD
Author and Funding Information

From the Department of Speech-language Pathology (Ms Skoretz and Drs Martino and Flowers), University of Toronto; and the Toronto Western Research Institute, University Health Network (Dr Martino), Toronto, Canada.

Correspondence to: Stacey Skoretz, MSc, University of Toronto, 160-500 University Ave, Toronto, Ontario, M5G 1V7 Canada; e-mail: stacey.skoretz@utoronto.ca


Parts of this work were presented at the 2009 Dysphagia Research Society Annual Meeting, New Orleans, LA, and the 2008 annual American Speech Language and Hearing Association Convention, Chicago, IL.

Funding/Support: Ms Skoretz and Dr Flowers were supported by Ontario Graduate Scholarships and the University of Toronto Open Fellowships. Dr Martino was supported by a Canadian Institutes of Health Research New Investigator Fellowship Award in Aging.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;137(3):665-673. doi:10.1378/chest.09-1823
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Hospitalized patients are often at increased risk for oropharyngeal dysphagia following prolonged endotracheal intubation. Although reported incidence can be high, it varies widely. We conducted a systematic review to determine: (1) the incidence of dysphagia following endotracheal intubation, (2) the association between dysphagia and intubation time, and (3) patient characteristics associated with dysphagia. Fourteen electronic databases were searched, using keywords dysphagia, deglutition disorders, and intubation, along with manual searching of journals and grey literature. Two reviewers, blinded to each other, selected and reviewed articles at all stages according to our inclusion criteria: adult participants who underwent intubation and clinical assessment for dysphagia. Exclusion criteria were case series (n < 10), dysphagia determined by patient report, patients with tracheostomies, esophageal dysphagia, and/or diagnoses known to cause dysphagia. Critical appraisal used the Cochrane risk of bias assessment and Grading of Recommendations, Assessment, Development and Evaluation tools. A total of 1,489 citations were identified, of which 288 articles were reviewed and 14 met inclusion criteria. The studies were heterogeneous in design, swallowing assessment, and study outcome; therefore, we present findings descriptively. Dysphagia frequency ranged from 3% to 62% and intubation duration from 124.8 to 346.6 mean hours. The highest dysphagia frequencies (62%, 56%, and 51%) occurred following prolonged intubation and included patients across all diagnostic subtypes. All studies were limited by design and risk of bias. Overall quality of the evidence was very low. This review highlights the poor available evidence for dysphagia following intubation and hence the need for high-quality prospective trials.

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