(1466) Prevalence, Characteristics, and Recovery Patterns of Dysphagia in Critically Ill Adults

Sunday, February 23, 2025

11:00am – 12:00pm Eastern Time

Location: Connections Central - RST 10

First Author(s)

Cara Donohue, PhD, CCC-SLP (she/her/hers)

Vanderbilt University Medical Center
Nashville, Tennessee, USA

Co-Author(s)

KR

Kaitlynn Raye, B.A.

Graduate Student in Speech-Language Pathology
Vanderbilt University, United States
PP

Pratik Pandharipande, MD, FCCM

Professor of Anesthesiology and Surgery, Vice Chair Anesthesiology Faculty Affairs Office
Vanderbilt University Medical Center, and Center for Critical Illness, Brain Dysfunction, and Survivorship (CIBS)
Brentwood, Tennessee, United States
RD

Robert Dittus, MD, MPH,

Professor of Medicine, Director, Tennessee Geriatric Research of Education and Clinical Center
Vanderbilt University Medical Center, United States
E. Wesley Wesley Ely, MD, MPH, MCCM

Professor of Medicine
Vanderbilt University and Geriatric Research, Education and Clinical Center (GRECC) Service, Department of Veterans Affairs Medical Center
Nashville, Tennessee, United States

Introduction: Critically ill adults with post intensive care syndrome (PICS) are at high risk of developing dysphagia, or swallowing difficulties. Dysphagia recovery is crucial and can impact health outcomes and quality of life, yet little is known about prevalence or characteristics of dysphagia in adults with PICS. We conducted a systematic review to examine the prevalence, characteristics, and risk factors for dysphagia in adults with PICS in acute and post-acute settings.

Methods: This systematic review was registered on PROSPERO and used PRISMA guidelines. Five databases were searched from inception to September 2023 using search terms: dysphagia, deglutition disorders, swallowing disorders, sepsis, PICS, COVID-19. Two authors independently reviewed articles based on inclusion criteria: 1) adults ≥18 years, 2) diagnosis of COVID-19, sepsis, or PICS and dysphagia, 3) underwent clinical swallow evaluation, 4) in acute or post-acute setting. Two authors independently assessed levels of research evidence and risk of bias using The Oxford Centre for Evidence-based Medicine Levels of Evidence and the Modified Downs and Black Checklist and extracted demographics, study design, dysphagia assessment methods, outcomes, and co-morbidities.

Results: 2,738 unique articles were identified. Based on title and abstract, 2,639 articles were screened out. Of the 99 articles that underwent full-text review, 27 met inclusion. Dysphagia prevalence ranged from 17-100% and persisted in up to 23% of individuals six months post-discharge. When reviewing the highest quality research articles, prevalence of aspiration was 23-63% and up to 92% of aspiration cases were silent (no cough response to tracheal aspirate with high likelihood to be missed clinically).

Conclusions: Study design limitations, high risk of bias, and heterogeneity in methods/outcomes hindered the ability to conduct a meta-analysis and limit the ability to draw firm conclusions about dysphagia in critically ill adults. Yet, existing data reveals that dysphagia is highly prevalent and persists chronically in some critically ill adults following hospital discharge. Future research is needed to determine the true prevalence and impact of dysphagia on health outcomes and quality of life in critically ill adults during the acute and post-acute recovery phase.