Background
Dysphagia in critical care is often multi-factorial. The pathogenesis of dysphagia may involve direct laryngeal trauma caused by endotracheal / tracheostomy tubes resulting in impairments in laryngeal closure, neuromyopathy resulting in weakness of oral, pharyngeal and laryngeal muscles and diminished laryngeal sensation secondary to prolonged endotracheal intubation. Consequences of dysphagia include delayed return to oral intake, pneumonia, poor quality of life, longer intensive care and hospital stays and is an independent predictor for 90-day mortality [1-6]. It remains an under-recognised but highly relevant clinical challenge that has longer term impact. In a multi-centre 5-year longitudinal study, symptoms were reported to persist beyond hospital discharge for > 6 months in 23% of patients [7].
We recently conducted a systematic review of interventions for oropharyngeal dysphagia in acute and critical care ( https://doi.org/10.1186/s13643-019-1196-0 ; review in the editorial process). Very few studies were conducted in critical care, but others are registered as ongoing indicating a rising trend. In general, we noted variability in reported outcomes and assessment tools used that emphasises the need for a core outcome set for dysphagia intervention studies in intensive care.
Aim
To establish a core outcome measurement set (COMS) for dysphagia interventions for adult patients treated in a critical care facility.
Objectives
1. To characterise selection and definition of outcomes used in existing trials of dysphagia interventions in critical care
2. To obtain consensus on a COMS for future trials of dysphagia interventions in critical care
Please contact Sallyanne Duncan on sduncan10@qub.ac.uk for a copy of the protocol.
References
1. Macht M, King CJ, Wimbish T, Clark BJ, Benson AB, Burnham, et al. Postextubation dysphagia is associated with longer hospitalization in survivors of critical illness with neurologic impairment. Critical Care 2013; 17: R119.
2. Solh A, Okada M, Bhat A, Pietrantoni C. Swallowing disorders post orotracheal intubation in the elderly. Intensive Care Medicine. 2003; 29: 1451–5.
3. Ponfick M, Linden R, Nowak DA. Dysphagia-a common, transient symptom in critical illness polyneuropathy: a fiberoptic endoscopic evaluation of swallowing study. Critical Care Medicine. 2015; 43(2): 365–72.
4. Kim MJ, Park YH, Park YS, Song YH. Associations between prolonged intubation and developing p2stextubation dysphagia and aspiration pneumonia in non-neurologic critically ill patients. Annals of Rehabilitation Medicine. 2015; 39:763–71.
5. Zielske J, Bohne S, Brunkhorst F, Axer H, Guntinas-Lichius O. Acute and long-term dysphagia in critically ill patients with severe sepsis: results of a prospective controlled observational study. European Archives Otorhinolaryngology 2014; 271(11): 3085–93.
6. Schefold JC, Berger D, Zurcher P, Lensch M, Perren A, Jakob SM, et al. Dysphagia in mechanically ventilated ICU patients (DYnAMICS): a prospective observational trial. Critical Care Medicine 2017; 45(12): 2061–9.
7. Brodsky MB, Huang M, Shanholtz C, Mendez-Tellez PA, Palmer JB, Colantuoni E, et al. Recovery from dysphagia symptoms after oral endotracheal intubation in acute respiratory distress syndrome survivors. A 5-year longitudinal study. Annals of American Thoracic Society 2017; 14: 376–83.
8. Duncan S, Mc Gaughey J, Fallis R, McAuley D.F., Walshe M and Blackwood B. Interventions for oropharyngeal dysphagia in acute and critical care: a protocol for a systematic review and meta-analysis. Systematic reviews 2019; 8:283 https://doi.org/10.1186/s13643-019-1196-0.
Sallyanne Duncan, PhD student, QUB.
Supervisory team:
Professor Bronagh Blackwood (PI) & Professor Danny McAuley,
Wellcome Wolfson Institute for Experimental Medicine,
School of Medicine, Dentistry and Biomedical Sciences,
Queen's University, Belfast.
Professor Margaret Walshe,
School of Clinical Speech and Language Studies,
Trinity College Dublin.
Disease Category: Other
Disease Name: Critical illness , Dysphagia
Age Range: 16 - 100
Sex: Either
Nature of Intervention: Any
- Clinical experts
- Researchers
- Service users
- COS for clinical trials or clinical research
- COS for practice
- Recommendations for outcome measures (measurement/how)
- Consensus conference
- Delphi process
- Focus group(s)
- Systematic review
1. Systematic review: Data on outcomes extracted in our recently completed systematic review will be collated. Outcome metrics will be reported and synthesised including the definition and detail of primary and secondary outcomes, measurement variables, analysis metrics, method of aggregation, and time-point of measurements.
2. Patient and stakeholder engagement forums: Establish views from patients, multidisciplinary clinicians and other relevant stakeholders on what they consider to be important outcomes for dysphagia interventions.
3. Delphi process: Having collated the findings from the previous methods we will undertake a Delphi study to establish a consensus on core outcomes considered to be a priority for future dysphagia intervention trials. Stakeholders will include international interdisciplinary expert clinicians, researchers, and patient representatives. Our Delphi process will take a two stage approach to gain agreement on (a) the COS and (b) the measures for the COS.
4. Consensus conference: if required, we will conduct a consensus conference to minimise unnecessary overlap on outcomes or gain expert clinical and statistical agreement on appropriate measures and metrics.