Predictive factors for oropharyngeal dysphagia after prolonged orotracheal intubation

Publication date: Available online 13 September 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Ana Carolina Martins de Oliveira, Amélia Augusta de Lima Friche, Marina Silva Salomão, Graziela Chamarelli Bougo, Laélia Cristina Caseiro Vicente
IntroductionLesions in the oral cavity, pharynx and larynx due to endotracheal intubation can cause a reduction in the local motility and sensitivity and impair the swallowing process, resulting in oropharyngeal dysphagia.ObjectiveTo verify the predictive factors for the development of oropharyngeal dysphagia and the risk of aspiration in patients with prolonged orotracheal intubation admitted to an intensive care unit.MethodsThis is an observational, analytical, cross-sectional and retrospective data collection study of 181 electronic medical records of patients submitted to prolonged orotracheal intubation. Data on age; gender; underlying disease; associated comorbidities; time and reason for orotracheal intubation; Glasgow scale on the day of the speech-language-audiology assessment; comprehension; vocal quality; presence and severity of dysphagia; risk of bronchoaspiration; and the suggested oral route were collected. The data were analyzed through logistic regression. The level of significance was set at 5%, with a 95% Confidence Interval.ResultsThe prevalence of dysphagia in this study was 35.9% and the risk of aspiration was 24.9%. As the age increased, the altered vocal quality and the degree of voice impairment increased the risk of the presence in dysphagia by 5-; 45.4- and 6.7-fold, respectively, and of aspiration by 6-; 36.4- and 4.8-fold. The increase in the time of orotracheal intubation increased the risk of aspiration by 5.5-fold.ConclusionPatients submitted to prolonged intubation who have risk factors associated with dysphagia and aspiration should be submitted to an early speech-language/audiology assessment and receive appropriate and timely treatment. The recognition of these predictive factors by the entire multidisciplinary team can minimize the possibility of clinical complications inherent to the risk of dysphagia and aspiration in extubated patients.



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