To Feed or Not to Feed: Dysphagia Screening Post-Extubation

Dysphagia is a potential complication of mechanical ventilation for patients in critical care units. Patients at highest risk are those with greater than 48 hours of intubation. The risk of postextubation dysphagia (PED) increases 25 percent after one day of intubation and doubles to 50 percent after just two days of intubation. Current practice for PED requires evaluation by a speech and language pathologist, which may result in patients being kept NPO 24-48 hours. Patients with PED are at risk for dehydration, malnutrition, aspiration of oral secretions and aspiration pneumonia. The consequences of PED include poor patient outcomes, increased length of ICU stay and additional costs totaling more than $500 million. Johnson and Speirs will present information on the value of PED screening of patients with prolonged intubation by nurses who are present with the patient 24 hours/day, seven days a week. Enhancing a nurse’s skill in identifying dysphagia would benefit critically ill patients, with timely evaluation and initiation of feeding helping to maintain adequate nutrition. The presenters will describe how nurses are already successfully performing dysphagia screening for post-stroke patients, medical patients in acute care and critically ill thermal burn patients using valid and reliable screening tools, as well as the potential for expanding this screening to patients with prolonged intubation.