PURPOSE: To evaluate risk factors associated with non-recovery of normal swallowing following prolonged endotracheal intubation.
METHODS: Chart review of twenty-seven patients from a previous study (total of 48 patients) from our institution who developed swallowing dysfunction (diagnosed by Fiberoptic Endoscopic Evaluation of Swallowing study) following prolonged endotracheal intubation was done. Seventeen of these patients recovered their swallowing function (recoverers) and the remaining ten never recovered their swallowing function (non-recoverers) and required alternate forms of nutrition such as percutaneous endoscopic gastrostomy tubes or jejunal feeding tubes. Clinical variables evaluated included age, severity of illness (APACHE II scores), albumin levels, length of intubation, and associated comorbidities. The mean age of each group as well as the average length of intubation, albumin levels and mean Apache II scores were computed and compared. Statistical analysis was done using the student t-test and Fisher’s exact.
RESULTS: The mean age of the group of patients who recovered their swallowing function was 68.6 years compared to 71.2 years (p=0.6478). The average length of intubation for the recoverers was 7.75 days while that of the non-recoverers was 10.4 days (p=0.2768). The mean Apache II scores for the recoveres was 20 compared to 26 in the other group (p=0.0190). An Apache II score greater than 26 was predictive of non-recovery of swallowing function (p=0.0005), with a sensitivity of 78% and specificity of 94%. The mean albumin levels were 2.9g/dl for recoverers and 2.5g/dl for non-recoverers (p=0.4507). There were no significant differences in preexisting comorbidities between the two groups.
CONCLUSION: Severity of illness is a significant risk factor for non-recovery of swallowing function in patients who develop swallowing dysfunction following prolonged intubation. An Apache II score greater than 26 was highly predictive of non-recovery of swallowing function.
CLINICAL IMPLICATIONS: For patients who develop swallowing dysfunction following prolonged intubation, those with higher APACHE II Scores are more likely not to recover swallowing function.Alternate routes of feeding such as Percutaneous Endoscopic Gastrostomy tubes, Jejunal feeding tubes should be considered sooner rather than later.
DISCLOSURE: Jonathan Laryea, None.