(1245) Assessment of Post-Extubation Dysphagia in Surgical ICU Patients

Introduction: The incidence of dysphagia in the ICU is as high as 62%, often seen following endotracheal intubation. Post-extubation dysphagia has a significant impact including malnutrition and aspiration, increasing the risk for pneumonia, reintubation, prolonged hospitalization and mortality. Several studies suggest increased risk factors such as age, duration of intubation and presence of tracheostomy. Prior to this study, referral to Speech Language Pathology (SLP) in the SICU at Hartford Hospital occurred after failure of a bedside swallow or at the discretion of the provider. The goal of this study is to implement a screening tool for early detection of post-extubation dysphagia.

Methods: The screening was implemented on January 16, 2021. This included SLP consultation if one or more of the following are present (intubated >48 hours and older than age 65, history of known dysphagia and/or aspiration, presence of tracheostomy or altered airway and order for strict head of bed flat) and if two or more of the following are present (difficulty with managing secretions or frequent suctioning, weak voice and cough, poor mental status and non-invasive ventilation). Pre-implementation data was collected from September 1, 2020 to January 15, 2021 and post-implementation data was collected from March 1, 2021 to June 30, 2021. Data collection from chart review included age, duration of intubation, time to SLP consultation, diet recommendation after initial evaluation and on discharge.

Results: The average number of extubations per month were similar in pre- and post-implementation time period (35.4 vs 35.5). The rate of SLP consultations per extubation increased expectedly after implementation (8.5% vs. 43.0%). The incidence of post-extubation dysphagia, defined as patients recommended NPO or modified diets, also increased (7.9% vs. 38.0%). The incidence of persistent post-extubation dysphagia, defined as patients recommended NPO or modified diets at discharge, was higher (5.1% vs. 19.7%).

Conclusions: A new screening tool has been developed to detect post-extubation dysphagia. Data reveals that the new screening tool increases the number of SLP consultations but also proportionally increases the detection of post-extubation dysphagia, which has significant clinical implications in the SICU patient population.