Independent Risk Factors for Prolonged Tube Feeding After Endotracheal Intubation and Ventilation

Abstract

Purpose

Postextubation dysphagia (PED) can lead to prolonged tube feeding, but risk factors associated with prolonged tube feeding in this population are largely unknown. The purpose of this study was to identify factors independently associated with prolonged tube feeding in adult inpatients who required intubation and mechanical ventilation.

Materials and Methods

Retrospective observational cohort study in a dataset of 1.3 million inpatients. Extubated adults without preventilation dysphagia or tube feeding who underwent instrumental swallowing assessment were included. To characterize factors independently associated with prolonged tube feeding, we compiled a set of potential factors, completed factor selection using a random forest algorithm, and performed logistic regression.

Results

In total, 206 of 987 (20.9%) patients had prolonged tube feeding. The regression model produced an area under the curve of 0.79. Factors with the greatest influence on prolonged tube feeding included dysphagia with thickened liquids, dysphagia with soft/solid foods, preadmission weight loss, number of intubations, admission for neurologic disorder, and hospital of admission.

Conclusions

Several factors predicted prolonged tube feeding after extubation. The strongest were some, but not all, aspects of swallowing function and clinical practice pattern variability. Clinical decision-making should consider bolus-specific data from instrumental swallowing evaluation rather than binary presence or absence of dysphagia.

Keywords

postextubation dysphagia tube-feeding swallowing

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References

McIntyre

Doeltgen

Dalton

Koppa

Chimunda

. Post-extubation dysphagia incidence in critically ill patients: A systematic review and meta-analysis. Aust Crit Care. 2021;34(1):67-75. https://doi.org/10.1016/j.aucc.2020.05.008

Macht

Wimbish

Clark

, et al. Postextubation dysphagia is persistent and associated with poor outcomes in survivors of critical illness. Crit Care. 2011;15(5):R231. https://doi.org/10.1186/cc10472

Kim

Park

Song

. Associations between prolonged intubation and developing post-extubation dysphagia and aspiration pneumonia in non-neurologic critically ill patients. Ann Rehabil Med. 2015;39(5):763-771. https://doi.org/10.5535/arm.2015.39.5.763

Lee

Hsu

Liang

, et al. The efficacy and safety of tube feeding in advanced dementia patients: A systemic review and meta-analysis study. J Am Med Dir Assoc. 2021;22(2):357-363. https://doi.org/10.1016/j.jamda.2020.06.035

Ueshima

Shimizu

Maeda

, et al. Nutritional management in adult patients with dysphagia: Position paper from Japanese working group on integrated nutrition for dysphagic people. J Am Med Dir Assoc. 2022;23(10):1676-1682. https://doi.org/10.1016/j.jamda.2022.07.009

Macht

Wimbish

Clark

, et al. Diagnosis and treatment of post-extubation dysphagia: Results from a national survey. J Crit Care. 2012;27(6):578-586. https://doi.org/10.1016/j.jcrc.2012.07.016

Rosenbek

Robbins

Roecker

PDEB

Coyle

Wood

. A penetration-aspiration scale. Dysphagia. 1996;11(2):93-98.

Speiser

Miller

Tooze

. A comparison of random forest Variable selection methods for classification prediction modeling. Expert Syst Appl. 2019;134:93-101. https://doi.org/10.1016/j.eswa.2019.05.028

Genuer

Poggi

J-M

Tuleau-Malot

. Variable selection using random forests. Pattern Recognit Lett. 2010;31(14):2225-2236. https://doi.org/10.1016/j.patrec.2010.03.014

10.

McIntyre

Chimunda

Koppa

Dalton

Reinders

Doeltgen

. Risk factors for postextubation dysphagia: A systematic review and meta-analysis. Laryngoscope. 2022;132(2):364-374. https://doi.org/10.1002/lary.29311

11.

Elixhauser

Steiner

Harris

Coffey

. Comorbidity measures for use with administrative data. Med Care. 1998;36(1):8-27.

12.

Veterans Health Administration National Drug File (VANDF) Source Information n.d. https://www.nlm.nih.gov/research/umls/rxnorm/sourcereleasedocs/vandf.html (accessed March 30, 2023).

13.

Morris

White

Royston

. Tuning multiple imputation by predictive mean matching and local residual draws. BMC Med Res Methodol. 2014;14(1):75. https://doi.org/10.1186/1471-2288-14-75

14.

van Buuren

. Package “mice” 2022.

15.

Kwok

Davis

Cagle

Sue

Kaups

. Post-extubation dysphagia in trauma patients: It’s hard to swallow. Am J Surg. 2013;206(6):924-928. https://doi.org/10.1016/j.amjsurg.2013.08.010

16.

Slingerland-Boot

van der Heijden

Schouten

, et al. Prospective observational cohort study of reached protein and energy targets in general wards during the post-intensive care period: The PROSPECT-I study. Clin Nutr. 2022;41(10):2124-2134. https://doi.org/10.1016/j.clnu.2022.07.031

17.

Zhang

, et al. Predictors of complete oral feeding resumption after feeding tube placement in patients with stroke and dysphagia: A systematic review. J Clin Nurs 2023;32(11-12): 2533-2546.https://doi.org/10.1111/jocn.16404

18.

Siao

Tseng

Wang

, et al. Predicting feeding-tube dependence in patients following endotracheal extubation: A two-item swallowing screen. BMC Pulm Med. 2021;21(1):1-8. https://doi.org/10.1186/s12890-021-01771-5

19.

Malandraki

Markaki

Georgopoulos

Psychogios

and SN. Postextubation dysphagia in critical patients: A first report from the largest step-down intensive care unit in Greece Georgia. Am J Speech Lang Pathol. 2016;25(2):150-160. https://doi.org/10.1044/2015

20.

Skoretz

Yau

Ivanov

Granton

Martino

. Dysphagia and associated risk factors following extubation in cardiovascular surgical patients. Dysphagia. 2014;29(6):647-654. https://doi.org/10.1007/s00455-014-9555-4

21.

Suiter

. Dysphagia screening: Challenges and controversies. Perspect ASHA Spec Interest Groups. 2018;3(13):82-88. https://doi.org/10.1044/persp3.SIG13.82

22.

Brodsky

Levy

Jedlanek

, et al. Laryngeal injury and upper airway symptoms after oral endotracheal intubation with mechanical ventilation during critical care: A systematic review*. Crit Care Med. 2018;46(12):2010-2017. https://doi.org/10.1097/CCM.0000000000003368

23.

Newman

Vilardell

Clavé

Speyer

. Effect of bolus viscosity on the safety and efficacy of swallowing and the kinematics of the swallow response in patients with oropharyngeal dysphagia: White paper by the European society for swallowing disorders (ESSD). Dysphagia. 2016;31(2):232-249. https://doi.org/10.1007/s00455-016-9696-8

24.

González-Fernández

Gardyn

Wyckoff

PKS

Palmer

. Validation of ICD-9 code 787.2 for identification of individuals with dysphagia from administrative databases. Dysphagia. 2009;24(4):398-402. https://doi.org/10.1007/s00455-009-9216-1

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