Authors (including presenting author) :
Yip CY (1), Wong KR (1), Lai PCK (2), Ngai CWW(2), Chan WM (2)
Affiliation :
(1) Speech Therapy Department, Queen Mary Hospital (2) Department of Adult Intensive Care Unit, Queen Mary Hospital
Introduction :
Dysphagia has been investigated in different literature following prolonged endotracheal intubation. Prolong intubation >48 hours has been suggested to contribute to an increased risk of pulmonary aspiration after extubation. A systematic review documented that the incidence of post-extubation dysphagia occurs in 41% of critically ill adults. Evaluation involving instrumental assessment is important to identify post extubation dysphagia with possible silent aspiration. A New service pathway involving QMH ICU implemented since 2023 aims to identify patients with prolong intubation for early ST initial assessment and FEES assessment.
Objectives :
With implementation of this new service pathway for patients with prolonged intubation in ICU, this study aims to 1) evaluate the time to resume oral feeding 2) Percentage of patients resume oral feeding during ICU stay 3) Identify incidence of silent aspiration in patients with prolonged intubation 4) Correlation between duration of intubation and incidence of aspiration.
Methodology :
This study was undertaken retrospectively investigating patients in the period of January 2023- December 2024. Inclusion criteria included 1) Patients intubated for >= 48 hours and were successfully extubated, 2) Patients failed initial bedside swallowing assessment with Functional Oral Intake Scale (FOIS)
Result & Outcome :
In 2022, 51.4% of patients were able to resume oral feeding upon discharged from QMH; 29.7 % of patients were able to resume oral feeding during ICU stay and the mean time to commence oral feeding was 19.4 days. After implementing the new pathway in 2023-2024, 69.6% of patients were able to resume oral feeding upon discharged from QMH. The result revealed a significant difference between the initial FOIS post extubation and FOIS upon discharge (P=0.02); Nearly half of patients were able to resume full oral feeding during ICU stay and the mean time to commence oral feeding was 15.8 days. Among the 69 patients identified in 2023-2024, mean duration of intubation was 128.9 hours for aspirators and 104.8 hours for non aspirators (P = 0.23). Further analysis demonstrated an incidence of silent aspiration of 42.4% among all patients.
The new pathway with early FEES assessment demonstrated clinical significance on early resumption of oral feeding during ICU stay and enhanced timely swallowing rehabilitation planning for patients in ICU. It also effectively identified silent aspiration in prolong intubated patients which can reduce risk of pulmonary complications and prolong ICU stay.
