Perspective on dysphagia screening, assessment methods, and protocols in intensive care units: an opinion article
Journal
Frontiers in human neuroscience
Date Issued
April 9, 2024
Author(s)
DOI
10.3389/fnhum.2024.1375408
Abstract
Intensive care unit (ICU) admission and related prolonged intubation has been
identified as a substantial risk factor for the development of swallowing problems (aka
dysphagia) (Perren et al., 2019; Spronk et al., 2022; Royals et al., 2023). Indeed, postextubation dysphagia (PED) has a documented prevalence rate of 93% (Macht et al.,
2013) and has been linked to adverse health outcomes and risks, including aspirationrelated pneumonia (Barker et al., 2022; Freeman-Sanderson et al., 2023; Royals et al.,
2023), malnutrition (Barker et al., 2022; Royals et al., 2023), dehydration (Royals et al.,
2023), re-intubation (Muñoz-Garach et al., 2023; Royals et al., 2023), prolonged mechanical
ventilation (MV) and length of ICU/hospital stay (Barker et al., 2022; Muñoz-Garach
et al., 2023; Royals et al., 2023; Clayton et al., 2024). Additionally, it contributes to delayed
recovery (Royals et al., 2023), reduced quality of life (QoL), and higher short-term (28
days) and mid-term (90 days) mortality rates (Perren et al., 2019; Muñoz-Garach et al.,
2023; Clayton et al., 2024).
Despite being prevalent and clinically significant in the ICU, PED remains underrecognized due to minimal routine screening (Zurbano et al., 2023) and a lack of
comprehensive assessment guidelines (Likar et al., 2024). Fewer than thirty percent of
surveyed ICU practitioners employ dysphagia protocols, while less than 20% of nurses
undergo formal dysphagia training regarding the screening of patients for suspected PED
(Freeman-Sanderson et al., 2023). But dysphagia screening and thereafter assessment is
particularly crucial for its early identification, management, prevention and mitigation of
complications, optimization of nutritional support and ultimately enhancement of patient
overall health outcomes (Freeman-Sanderson et al., 2023; Mpouzika et al., 2023; Troll et al.,
2023; Zurbano et al., 2023).
identified as a substantial risk factor for the development of swallowing problems (aka
dysphagia) (Perren et al., 2019; Spronk et al., 2022; Royals et al., 2023). Indeed, postextubation dysphagia (PED) has a documented prevalence rate of 93% (Macht et al.,
2013) and has been linked to adverse health outcomes and risks, including aspirationrelated pneumonia (Barker et al., 2022; Freeman-Sanderson et al., 2023; Royals et al.,
2023), malnutrition (Barker et al., 2022; Royals et al., 2023), dehydration (Royals et al.,
2023), re-intubation (Muñoz-Garach et al., 2023; Royals et al., 2023), prolonged mechanical
ventilation (MV) and length of ICU/hospital stay (Barker et al., 2022; Muñoz-Garach
et al., 2023; Royals et al., 2023; Clayton et al., 2024). Additionally, it contributes to delayed
recovery (Royals et al., 2023), reduced quality of life (QoL), and higher short-term (28
days) and mid-term (90 days) mortality rates (Perren et al., 2019; Muñoz-Garach et al.,
2023; Clayton et al., 2024).
Despite being prevalent and clinically significant in the ICU, PED remains underrecognized due to minimal routine screening (Zurbano et al., 2023) and a lack of
comprehensive assessment guidelines (Likar et al., 2024). Fewer than thirty percent of
surveyed ICU practitioners employ dysphagia protocols, while less than 20% of nurses
undergo formal dysphagia training regarding the screening of patients for suspected PED
(Freeman-Sanderson et al., 2023). But dysphagia screening and thereafter assessment is
particularly crucial for its early identification, management, prevention and mitigation of
complications, optimization of nutritional support and ultimately enhancement of patient
overall health outcomes (Freeman-Sanderson et al., 2023; Mpouzika et al., 2023; Troll et al.,
2023; Zurbano et al., 2023).
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