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Original Research: CRITICAL CARE MEDICINE |

Swallowing Dysfunction in Nonneurologic Critically Ill Patients Who Require Percutaneous Dilatational Tracheostomy

Carlos M. Romero, MD; Andrés Marambio, MD; Jorge Larrondo, MD; Katherine Walker, MD; María-Teresa Lira, RN; Eduardo Tobar, MD; Rodrigo Cornejo, MD; Mauricio Ruiz, MD
Author and Funding Information

From the Intensive Care Unit, Critical Care Unit (Drs Romero, Tobar, and Cornejo and Ms Lira), the Department of Surgery (Dr Marambio), the Faculty of Medicine (Dr Larrondo), the Department of Oto-Rhino-Laryngology (Dr Walker), and the Respiratory Disease Section (Dr Ruiz), Department of Internal Medicine, Clinical Hospital University of Chile, Santiago Norte, Chile.

Correspondence to: Carlos M. Romero, MD, Unidad de Pacientes Críticos, Departamento de Medicina, Hospital Clínico Universidad de Chile, Facultad de Medicina Universidad de Chile, Santos Dumont 999, Independencia, Santiago Norte, Chile; e-mail: caromero@redclinicauchile.cl


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(6):1278-1282. doi:10.1378/chest.09-2792
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Background:  The aim of this study was to determine the incidence of swallowing dysfunction in nonneurologic critically ill patients who require percutaneous dilatational tracheostomy (PDT) for prolonged mechanical ventilation (MV) and to compare the duration of the cannulation period and length of stay in the critical care unit (CCU) in patients with and without swallowing dysfunction.

Methods:  A total of 40 consecutive patients without neurologic disorders who require PDT for prolonged MV were included. Previous to the tracheostomy decannulation process, an otolaryngologist performed a fiberoptic endoscopic evaluation of swallowing (FEES). We used analysis of variance for the analysis; the results are presented as mean values ± SD.

Results:  Mean age was 62 ± 15 years. Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores were 21 ± 2 and 9 ± 1, respectively. Time of MV previous to PDT was 20 ± 11 days, total MV duration was 38 ± 16 days, and CCU stay was 63 ± 27 days. The incidence of swallowing dysfunction in this group of patients was 38% (15/40). No difference was found in the age or time period of MV previous to PDT between groups. The time period between FEES to tracheostomy decannulation process was 19 ± 11 days in patients with swallowing dysfunction vs 2 ± 4 days in those patients without dysfunction (P < .001). Patients who developed swallowing dysfunction stayed longer in the CCU (69 ± 23 vs 47 ± 19 days, P < .01).

Conclusions:  Nearly 40% of nonneurologic critically ill patients requiring PDT for prolonged MV presented swallowing dysfunction and experienced a significant delay in their tracheostomy decannulation process.


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