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Association between clinical risk factors and severity of dysphagia after extubation based on a videofluoroscopic swallowing study

Korean Journal of Internal Medicine 2020년 35권 1호 p.79 ~ 87
양원종 ( Yang Won-Jong ) - Kyungpook National University Chilgok Hospital Department of Rehabilitation Medicine

박은희 ( Park Eun-Hee ) - Kyungpook National University Chilgok Hospital Department of Rehabilitation Medicine
민유선 ( Min Yu-Sun ) - Kyungpook National University Chilgok Hospital Department of Rehabilitation Medicine
허재원 ( Huh Jae-Won ) - Kyungpook National University Hospital Department of Rehabilitation Medicine
김애령 ( Kim Ae-Ryoung ) - Kyungpook National University School of Medicine Department of Rehabilitation Medicine
오현민 ( Oh Hyun-Min ) - Kyungpook National University Hospital Department of Rehabilitation Medicine
남태우 ( Nam Tae-Woo ) - Kyungpook National University Chilgok Hospital Department of Rehabilitation Medicine
정태두 ( Jung Tae-Du ) - Kyungpook National University Chilgok Hospital Department of Rehabilitation Medicine

Abstract


Background/Aims: This study aimed to evaluate the correlation between clinical risk factors of post-extubation dysphagia (PED) and the severity of impaired pharyngeal swallowing function assessed via videofluoroscopic swallowing studies (VFSSs).

Methods: This study was a retrospective review of medical records. Of 116 patients who were admitted to the intensive care unit and underwent VFSS, 32 who had non-neurologic disorders and experienced prolonged intubation (for more than 48 hours) were diagnosed with PED. The severity of PED was evaluated by using a functional dysphagia scale (FDS) and a penetration aspiration scale (PAS), on the basis of VFSS.

Results: The Simplified Acute Physiology Score 3 and total FDS score were positively correlated (r = 0.40, p = 0.02). Intubation duration was positively correlated with total PAS and FDS scores (r = 0.62, p < 0.001; r = 0.65, p < 0.001, respectively). The amounts of residue in the valleculae (RV) and pyriform sinuses (RP) were associated with intubation duration (r = 0.58, p < 0.001; r = 0.57, p < 0.001, respectively). Multivariate regression analysis revealed that intubation duration was significantly associated with the total FDS score, RV and RP subscales of the FDS, and total PAS score.

Conclusions: The severity of impaired swallowing function, particularly the amount of residue in the pharyngeal recesses assessed via VFSS, was strongly associated with both severity of medical illness and intubation duration. Intubation duration could be a prognostic factor for assessing impaired swallowing function on the basis of VFSS.

키워드

Post-extubation dysphagia ; Videofluoroscopic swallowing study ; Intubation, intratracheal ; Deglutition disorders ; Extubation
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