Abstract
Background
Post-extubation dysphagia has been associated with adverse health outcomes. To assist
service planning and process development for early identification, an understanding
of the number of patients affected is required. However, significant variation exists
in the reported incidence which ranges from 3% to 62%.
Objectives
The objective of this study was to (i) conduct a meta-analysis on the incidence of
dysphagia after endotracheal intubation in adult critically ill patients and (ii)
describe the extent of heterogeneity within peer-reviewed articles and grey literature
on the incidence of dysphagia after endotracheal intubation.
Data sources
Databases CINAHL, Cochrane Library, Embase, MEDLINE, PubMed, SpeechBITE, and Google
Scholar were systematically searched for studies published before October 2019.
Review methods
Data extraction occurred in a double-blind manner for studies meeting the inclusion
criteria. Risk of bias was determined using critical appraisal tools relevant to the
individual study design. The overall quality of the synthesised results was described
using the Grading of Recommendations Assessment, Development and Evaluation methodology.
Raw data were transformed using Freeman–Tukey arcsine square root methodology. A random-effects
model was utilised owing to heterogeneity between studies.
Results
Of 3564 identified studies, 38 met the criteria for inclusion in the final review.
A total of 5798 patient events were analysed, with 1957 dysphagic episodes identified.
The combined weighted incidence of post-extubation dysphagia was 41% (95% confidence
interval, 0.33–0.50). Of the patients with dysphagia, 36% aspirated silently (n = 155,
95% confidence interval, 0.22–0.50). Subgroup meta-regression analysis was unable
to explain the heterogeneity across studies when accounting for the method of participant
recruitment, method of dysphagia assessment, median duration of intubation, timing
of dysphagia assessment, or patient population.
Conclusion
Dysphagia after endotracheal intubation is common and occurs in 41% of critically
ill adults. Given the prevalence of dysphagia and high rates of silent aspiration
in this population, further prospective research should focus on systematic and sensitive
early identification methods.
Keywords
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Article info
Publication history
Published online: July 29, 2020
Accepted:
May 19,
2020
Received in revised form:
May 10,
2020
Received:
December 22,
2019
Footnotes
☆Prospero registration number CRD42018117131, available from https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42018117131
Identification
Copyright
© 2020 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.
