A pragmatic approach to identifying postextubation dysphagia in critically ill surgical patients using the water swallow test

Abstract

Postextubation dysphagia (PED) is a frequent complication in critically ill patients, associated with aspiration pneumonia, reintubation, and increased mortality. However, its reported incidence varies widely (3–62%) due to differences in patient populations and assessment methods. This study aimed to determine the incidence of postextubation dysphagia (PED) using the Water Swallow Test (WST) and to identify associated risk factors in surgical ICU patients. This prospective interventional study enrolled adult surgical ICU patients who were intubated for more than 12 h and subsequently extubated. The WST was performed 3–6 h after extubation. Patients who failed the WST underwent bedside Fiberoptic Endoscopic Evaluation of Swallowing (FEES) to confirm dysphagia. We collected and analyzed associated risk factors, including age, comorbidities, endotracheal tube size, duration and difficulty of intubation, history of reintubation, admission diagnosis, and laboratory parameters. A total of 123 patients were included. Ten patients failed the WST, but FEES confirmed PED in eight, yielding an incidence of 6.5%. The median age was 63.6 years in the non-dysphagia group and 73 years in the dysphagia group. Patients with PED had a significantly longer median duration of intubation (144 vs. 36 h, p < 0.05). History of reintubation was more frequent in patients with PED (37.5%) than in non-dysphagia patients (8.7%, p = 0.040). Univariate analysis identified several factors associated with PED. Specifically, significant risk factors included history of reintubation [OR 6.30 (95% CI 1.31–30.33), p = 0.022], increased days on vasopressor support [OR 1.53 (95% CI 1.18–1.99), p = 0.001], elevated blood urea nitrogen (BUN) levels [OR 1.03 (95% CI 1.01–1.06), p = 0.020], and prolonged intubation [OR 1.01 (95% CI 1.01–1.02), p = 0.001]. The Water Swallowing Test (WST) is a practical screening tool for Postextubation Dysphagia (PED) but may miss silent aspiration. Therefore, despite WST results, careful monitoring during oral intake is essential for high-risk patients to prevent pulmonary complications. Thai Clinical Trials Registry. Trial no. TCTR20211023003. Retrospectively registered on October 23, 2021.