気管内挿管後の嚥下障害の割合

今日は、気管内挿管後の嚥下障害の割合の系統的レビュー論文を紹介します。

Stacey A. Skoretz, et al: The Incidence of Dysphagia Following　Endotracheal Intubation: A Systematic Review. Chest 2010;137;665-673

14論文のレビューですが、論文間の違いが大きいためメタ分析は行っていません。結論としては気管内挿管後の嚥下障害の割合は、3～62％とばらつきが大きいです。平均挿管時間は124.8時間（約5日）～346.6時間（約14日）でした。嚥下障害の発生割合が50％以上と高い論文では、挿管時間が長かったです。

ただし、すべての研究デザインの質はとても低く、気管内挿管後の嚥下障害の割合に関する質の高いエビデンスは存在しないとまとめています。個人的印象では3％ではあまりに低く、62％は多すぎるという感じがします。いずれにしてもすべての気管内挿管後の患者に嚥下障害を疑い、何らかのスクリーニングテストなどで評価することは必要です。

Abstract
Hospitalized patients are often at increased risk for oropharyngeal dysphagia following prolonged endotracheal intubation. Although reported incidence can be high, it varies widely. We conducted a systematic review to determine: (1) the incidence of dysphagia following endotracheal intubation, (2) the association between dysphagia and intubation time, and (3) patient characteristics associated with dysphagia. Fourteen electronic databases were searched, using keywords dysphagia , deglutition disorders , and intubation , along with manual searching of journals and grey literature. Two reviewers, blinded to each other, selected and reviewed articles at all stages according to our inclusion criteria: adult participants who underwent intubation and clinical assessment for dysphagia. Exclusion criteria were case series (n , 10), dysphagia determined by patient report, patients with tracheostomies, esophageal dysphagia, and/or　diagnoses　known to cause dysphagia. Critical appraisal used the Cochrane risk of bias assessment and Grading of Recommendations, Assessment, Development and Evaluation tools.

A total of 1,489 citations were identifi ed, of which 288 articles were reviewed and 14 met inclusion criteria. The studies were heterogeneous in design, swallowing assessment, and study outcome; therefore, we present fi ndings descriptively. Dysphagia frequency ranged from 3% to 62% and intubation duration from 124.8 to 346.6 mean hours. The highest dysphagia frequencies (62%, 56%, and 51%) occurred following prolonged intubation and included patients across all diagnostic subtypes. All studies were limited by design and risk of bias. Overall quality of the evidence was very low. This review highlights the poor available evidence for dysphagia following intubation and hence the need for high-quality prospective trials.