P0477 - Postextubation dysphagia: incidence, risk factors and outcomes

Purpose: Postextubation dysphagia (PED) in children is poorly investigated and yet, is commonly observed in the pediatric intensive care unit (PICU) setting. We aimed to assess the incidence, risk factors and the impact of PED occurrence in patient’s outcomes.

Methods: We performed a prospective, observational study in an 8-bed pediatric intensive care unit (PICU) of a tertiary hospital from January 1, 2018, through December 31, 2019. We included all patients admitted in our PICU aging between 1 month and 15 years, requiring endotracheal intubation for at least 24 hours and with a Glasgow Coma Scale score ≥ 14 points. Patients were excluded if they had a tracheostomy tube in place, an existing neurologic comorbidity, a history of oropharyngeal dysphagia, or had undergone head or neck surgical procedures. All patients underwent a bedside clinical swallowing evaluation, using the pediatric FOIS (Functional Oral Intake Scale) which was adapted by Dodrill from the tool for adults. This bedside assessment was performed by a certified speech language pathologist within 48 hours of extubation. For the univariate analysis, we used the Mann-Whitney test, Chi-square test and the Fisher exact test as appropriate. A p value < 0.05 was considered statistically significant and was the criterion for variable inclusion in the logistic regression model.

Results: PED was identified in 64 (58%) of the 110 patients. The univariate analysis showed that age, respiratory disease at admission, presence of complex chronic condition (comorbidities), length of intubation, time on continuous infusion of sedative drugs and occurrence of iatrogenic withdrawal syndrome (IWS) were significantly different between patients who had PED and those who did not (Table 1). The logistic regression showed that age ≤ 6 months (odds ratio 14.08), time of intubation > 3 days (odds ratio 8.76) and occurrence of IWS (odds ratio 14.9) were associated with PED (Table 2). Furthermore, patients with PED had a greater time elapsed from extubation to initiate oral intake (p=0.000), greater time to wean off feeding tube (p=0.000), longer PICU stay (p=0.0002) and longer hospital stay (p=0.002) (Table 1).

Conclusion: The incidence of PED is high (58%) among PICU patients. Younger age (≤ 6 months), longer duration of intubation and IWS were strongly associated with occurrence of PED. Also, PED can significantly impact on patient outcomes which may result in both increased length of PICU and hospital stay.