Background: Swallowing difficulties are common, and dysphagia occurs frequently in intensive care unit (ICU)\npatients after extubation. Yet, no guidelines on postextubation swallowing assessment exist. We aimed to\ninvestigate the safety and effectiveness of nurse-performed screening (NPS) for postextubation dysphagia in\nthe medical ICU.\nMethods: We conducted a retrospective cohort study of mechanically ventilated patients who were extubated in a\n20-bed medical ICU. Phase I (no NPS, October 2012 to January 2014) and phase II (NPS, February 2014 to July 2015)\nwere compared. In phase II, extubated patients received NPS up to three times on consecutive days; patients who\nfailed were referred to speech-language pathologists. Outcomes analyzed included oral feeding at ICU discharge,\nreintubation, ICU readmission, postextubation pneumonia, ICU and/or hospital mortality, and ICU and/or hospital\nlength of stay (LOS). Subgroup analysis was done for patients extubated after >72 h of mechanical ventilation, as the\nlatter may predispose patients to postextubation dysphagia. Multivariable adjustments for Acute Physiology and Chronic\nHealth Evaluation (APACHE) II score and comorbidities were done because of baseline differences between the phases.\nResults: A total of 468 patients were studied (281 in phase I, 187 in phase II). Patients in phase II had higher APACHE II\nscores than those in phase I (27.2 �± 8.2 vs. 25.4 �± 8.2; P = 0.018). Despite this, patients in phase II showed a\n111 % increase in (the odds of) oral feeding at ICU discharge and a 59 % decrease in postextubation pneumonia\n(multivariate P values 0.001 and 0.006, respectively). In the subgroup analysis, NPS was associated with a 127 %\nincrease in oral feeding at ICU discharge, an 80 % decrease in postextubation pneumonia, and a 25 % decrease in\nhospital LOS (multivariate P values 0.021, 0.004, and 0.009, respectively). No other outcome differences were found.\nConclusions: NPS for dysphagia is safe and may be superior to no screening with respect to several patient-centered\noutcomes.
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