Evaluating Swallowing Function in Patients with Critical Illness Polyneuropathy

Patricia Kritek, MD reviewing Ponfick M et al. Crit Care Med 2015 Feb.

Dysphagia was common but resolved within a few weeks in almost all patients.

Critical illness polyneuropathy (CIP) occurs often in patients admitted to intensive care units (ICUs). In addition to profound weakness, patients with CIP have respiratory failure and trouble with oral intake. Although dysphagia is a concern in these patients, the prevalence of dysphagia in CIP is unknown, and recovery of normal swallowing function has not been delineated. Investigators in Germany used serial fiberoptic endoscopy to evaluate swallowing function prospectively in 22 patients (mean age, 71) with CIP who were treated in a neurological rehabilitation ICU. All patients had undergone tracheostomy, and 73% were mechanically ventilated initially. Patients received an average of 300 minutes of physical, occupational, and speech and swallowing therapy on most days of the week. Endoscopic examinations were performed on days 3, 14, and 28 after ICU admission.

On initial examination, only two patients (9%) had normal swallowing function, and more patients had aspiration with saliva (45%) or liquids (78%) than with pureed food (18%). At 28 days after admission, all but one of the patients with dysphagia had recovered fully. Improvement in swallowing function was not associated with presence of a tracheostomy tube.

CITATIONS:

Ponfick M et al. Dysphagia — a common, transient symptom in critical illness polyneuropathy: A fiberoptic endoscopic evaluation of swallowing study. Crit Care Med 2015 Feb; 43:365.