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ICU-Acquired Swallowing Disorders

Macht, Madison MD1; Wimbish, Tim MS, CCC-SLP2; Bodine, Cathy PhD, CCC-SLP3; Moss, Marc MD1

doi: 10.1097/CCM.0b013e31829caf33
Concise Definitive Review

Objectives: Patients hospitalized in the ICU can frequently develop swallowing disorders, resulting in an inability to effectively transfer food, liquids, and pills from their mouth to stomach. The complications of these disorders can be devastating, including aspiration, reintubation, pneumonia, and a prolonged hospital length of stay. As a result, critical care practitioners should understand the optimal diagnostic strategies, proposed mechanisms, and downstream complications of these ICU-acquired swallowing disorders.

Data Sources: Database searches and a review of the relevant medical literature.

Data Synthesis: A significant portion of the estimated 400,000 patients who annually develop acute respiratory failure, require endotracheal intubation, and survive to be extubated are determined to have dysfunctional swallowing. This group of swallowing disorders has multiple etiologies, including local effects of endotracheal tubes, neuromuscular weakness, and an altered sensorium. The diagnosis of dysfunctional swallowing is usually made by a speech-language pathologist using a bedside swallowing evaluation. Major complications of swallowing disorders in hospitalized patients include aspiration, reintubation, pneumonia, and increased hospitalization. The national yearly cost of swallowing disorders in hospitalized patients is estimated to be over $500 million. Treatment modalities focus on changing the consistency of food, changing mealtime position, and/or placing feeding tubes to prevent aspiration.

Conclusions: Swallowing disorders are costly and clinically important in a large population of ICU patients. The development of effective screening strategies and national diagnostic standards will enable further studies aimed at understanding the precise mechanisms for these disorders. Further research should also concentrate on identifying modifiable risk factors and developing novel treatments aimed at reducing the significant burden of swallowing dysfunction in critical illness survivors.

1Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Denver, Aurora, CO.

2Rehabilitation Therapy, University of Colorado Hospital, Aurora, CO.

3Assistive Technology Partners, Department of Physical Medicine and Rehabilitation, University of Colorado Denver, Aurora, CO.

Dr. Moss’s institution received grant support from the National Institutes of Health (NIH) (K24 HL089223). He received support for travel and funding for article research from NIH. He is employed by the University of Colorado Denver. The remaining authors have disclosed that they do not have any potential conflicts of interest.

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© 2013 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins