| Objective:1.To discover the occurrence of persistent swallowing disorder in patients after tracheal intubation in the ICU and to analyze the factors affecting it.2.To describe the duration of dysphagia in patients after tracheal intubation in the ICU and to explore the factors influencing it.Methods:In this study,the prospective study method in descriptive research was used,and patients with swallowing disorders after tracheal intubation who met the nadir criteria in a comprehensive ICU of a tertiary hospital in Shanghai from February 2022 to January 2023 were selected as study subjects using convenience sampling.And the patients were assessed for the first time using the Standardized Swallowing Assessment(SSA)within 24 to 48 hours of successful extubation.Patients were considered to have swallowing disorder if their first SSA score was over 18 points.In general,clinical and intubation-related data were collected and reassessed daily at 14:00～15:00 until the patient’s swallowing disorder assessment was negative,i.e.,SSA score was 18 or the patient was discharged from the hospital.The data were statistically analyzed using SPSS27.0.Firstly,the factors influencing the occurrence of persistent dysphagia three days after extubation were screened by univariate analysis,and then multifactorial analysis was performed using logistic regression.Secondly,by applying Kaplan-Meier method to plot the recovery time curve of swallowing function and Log-rank test for univariate analysis and Cox multifactor analysis to explore the factors influencing the duration of swallowing disorder after extubation.Results:1.From February 2022 to January 2023,a total of 335 patients undergoing mechanical ventilation with tracheal intubation during ICU stay were evaluated for swallowing function,and 85 patients with swallowing disorders were screened,and the incidence of swallowing disorders after extubation was 25.4%and persistent swallowing disorders was 35.3%in this study.Logistic regression analysis showed that age(OR=1.101,95%CI:1.000-1.211),presence of gastric tube before extubation(OR=0.007,95%CI:0.000-0.548)and first SSA score(OR=9.006,95%CI:2.13438.011)had a significant effect on the incidence of persistent the difference in the incidence of swallowing disorders was statistically significant(P<0.05).2.A total of 85 patients were followed up in this study and all returned to normal swallowing disorders at the follow-up cut-off time(before discharge),with a recovery rate of 100%.The duration of swallowing disorder ranged from 24 to 312 hours,with a median value of 72 hours and a mean duration of swallowing disorder of(83.08±59.24)hours.Cox regression analysis showed that the first SSA score after extubation(RR=0.672,95%CI:0.556-0.812)was independent risk factor for the duration of swallowing disorder after extubation(P<0.05).Conclusions:1.The incidence of persistent dysphagia after ICU extubation in this study was 35.3%,and the incidence of persistent dysphagia was associated with age,presence of gastric tube before extubation,and first SSA score.The risk of persistent dysphagia increased by 1.101 times for each 1-year increase in age and by 9.006 times for each 1-point increase in the first SSA score after extubation,and the risk of persistent dysphagia increased by 0.007 times for those with nasal feeding tubes compared to those without nasal feeding tubes before extubation.Clinical staff should pay attention to the continuous assessment of swallowing function after extubation in this patient population in order to implement timely interventions to improve patient prognosis.2.The average duration of swallowing disorder in ICU tracheal intubated patients was(83.088±59.24)hours,and the duration was correlated with the first SSA score after extubation,and every 1-point decrease in the first SSA score after extubation would shorten the duration of swallowing disorder by 0.672 times.Clinical staff should focus on the assessment of swallowing function after extubation and take timely interventions for patients with higher first assessment scores to shorten the duration of swallowing disorder,reduce hospital costs,and rationalize the use of hospital resources. |
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