Risk factors for dysphagia after weaning from invasive mechanical ventilation and therapeutic effect of electrical stimulation.

2023 Fiscal Year Final Research Report

• Project/Area Number: 20K11240
• Research Category: Grant-in-Aid for Scientific Research (C)
• Allocation Type: Multi-year Fund
• Section: 一般
• Review Section: Basic Section 59010:Rehabilitation science-related
• Research Institution: Dokkyo Medical University
• Principal Investigator: Hasegawa Ryuichi 獨協医科大学, 医学部, 教授 (10301053)
• Co-Investigator(Kenkyū-buntansha): 大林 茂 埼玉医科大学, 医学部, 教授 (90318246)
• Project Period (FY): 2020-04-01 – 2024-03-31
• Keywords: 嚥下障害 / 人工呼吸 / 気管挿管 / 挿管期間 / FSS-ICU / FOIS

Outline of Final Research Achievements

First, a prospective observational study on the development of dysphagia after tracheal tube extubation was conducted at their own institution. The observation period was 10 months and 41 patients were enrolled. There were 20 (48.8%) cases of dysphagia immediately after extubation. On the other hand, immediately before discharge, most patients showed improvement in swallowing function, with 2 (5.7%) cases of dysphagia, except for 6 patients who died.
Next, the risk of post-extubation dysphagia was investigated: multivariate logistic regression analysis was performed in 80 patients and showed that 'physical function in the ICU' was significant with OR 1.141 (p=0.041, 95% CI 1.005-1.294) and 'duration of intubation' with OR 0.886 (p=0.006, 95% CI 0.812-0.966). OR 0.886 (p=0.006, 95%CI 0.812-0.966) and was significant. These results suggest that physical function during ICU admission and duration of intubation are associated with the development of post-extubation dysphagia.

Free Research Field

集中治療医学

Academic Significance and Societal Importance of the Research Achievements

抜管後嚥下障害の課題は高い発症率と予後の悪化にも関わらず、人工呼吸器離脱まで評価が行われず有効な予防策も無いことにある。つまり挿管期間が長いほど廃用が進行し、嚥下障害が完成してしまう。今回抜管後嚥下障害の発症率は高いものの、多くの症例は適切な介入により退院までに経口摂取可能となった。一方嚥下障害が残存する症例もあり、リスク因子として「挿管期間」や「ICUでの身体機能」が示されたことから、人工呼吸中にこれらを用いてハイリスク症例をスクリーニングできれば早期介入が可能になると考える。更にこの評価方法の信頼性・妥当性が確立されれば多くのICUで嚥下障害に対する早期介入を促す一助となるだろう。