Weixia Yu, Limi Dan, Jianzheng Cai, Yuyu Wang, Qingling Wang, Yingying Zhang, Xin Wang
{"title":"接受气管插管的重症监护患者拔管后吞咽困难的发生率:系统回顾和荟萃分析。","authors":"Weixia Yu, Limi Dan, Jianzheng Cai, Yuyu Wang, Qingling Wang, Yingying Zhang, Xin Wang","doi":"10.1186/s40001-024-02024-x","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Post-extubation dysphagia (PED) emerges as a frequent complication following endotracheal intubation within the intensive care unit (ICU). PED has been strongly linked to adverse outcomes, including aspiration, pneumonia, malnutrition, heightened mortality rates, and prolonged hospitalization, resulting in escalated healthcare expenditures. Nevertheless, the reported incidence of PED varies substantially across the existing body of literature. Therefore, the principal objective of this review was to provide a comprehensive estimate of PED incidence in ICU patients undergoing orotracheal intubation.</p><p><strong>Methods: </strong>We searched Embase, PubMed, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Database, China Science, Technology Journal Database (VIP), and SinoMed databases from inception to August 2023. Two reviewers independently screened studies and extracted data. Subsequently, a random-effects model was employed for meta-statistical analysis utilizing the \"meta prop\" command within Stata SE version 15.0 to ascertain the incidence of PED. In addition, we performed subgroup analyses and meta-regression to elucidate potential sources of heterogeneity among the included studies.</p><p><strong>Results: </strong>Of 4144 studies, 30 studies were included in this review. The overall pooled incidence of PED was 36% (95% confidence interval [CI] 29-44%). Subgroup analyses unveiled that the pooled incidence of PED, stratified by assessment time (≤ 3 h, 4-6 h, ≤ 24 h, and ≤ 48 h), was as follows: 31.0% (95% CI 8.0-59.0%), 28% (95% CI 22.0-35.0%), 41% (95% CI 33.0-49.0%), and 49.0% (95% CI 34.0-63.0%), respectively. When sample size was 100 < N ≤ 300, the PED incidence was more close to the overall PED incidence. Meta-regression analysis highlighted that sample size, assessment time and mean intubation time constituted the source of heterogeneity among the included studies.</p><p><strong>Conclusion: </strong>The incidence of PED was high among ICU patients who underwent orotracheal intubation. ICU professionals should raise awareness about PED. In the meantime, it is important to develop guidelines or consensus on the most appropriate PED assessment time and assessment tools to accurately assess the incidence of PED.</p>","PeriodicalId":11949,"journal":{"name":"European Journal of Medical Research","volume":null,"pages":null},"PeriodicalIF":2.8000,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11365263/pdf/","citationCount":"0","resultStr":"{\"title\":\"Incidence of post-extubation dysphagia among critical care patients undergoing orotracheal intubation: a systematic review and meta-analysis.\",\"authors\":\"Weixia Yu, Limi Dan, Jianzheng Cai, Yuyu Wang, Qingling Wang, Yingying Zhang, Xin Wang\",\"doi\":\"10.1186/s40001-024-02024-x\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Post-extubation dysphagia (PED) emerges as a frequent complication following endotracheal intubation within the intensive care unit (ICU). PED has been strongly linked to adverse outcomes, including aspiration, pneumonia, malnutrition, heightened mortality rates, and prolonged hospitalization, resulting in escalated healthcare expenditures. Nevertheless, the reported incidence of PED varies substantially across the existing body of literature. Therefore, the principal objective of this review was to provide a comprehensive estimate of PED incidence in ICU patients undergoing orotracheal intubation.</p><p><strong>Methods: </strong>We searched Embase, PubMed, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Database, China Science, Technology Journal Database (VIP), and SinoMed databases from inception to August 2023. Two reviewers independently screened studies and extracted data. Subsequently, a random-effects model was employed for meta-statistical analysis utilizing the \\\"meta prop\\\" command within Stata SE version 15.0 to ascertain the incidence of PED. In addition, we performed subgroup analyses and meta-regression to elucidate potential sources of heterogeneity among the included studies.</p><p><strong>Results: </strong>Of 4144 studies, 30 studies were included in this review. The overall pooled incidence of PED was 36% (95% confidence interval [CI] 29-44%). Subgroup analyses unveiled that the pooled incidence of PED, stratified by assessment time (≤ 3 h, 4-6 h, ≤ 24 h, and ≤ 48 h), was as follows: 31.0% (95% CI 8.0-59.0%), 28% (95% CI 22.0-35.0%), 41% (95% CI 33.0-49.0%), and 49.0% (95% CI 34.0-63.0%), respectively. When sample size was 100 < N ≤ 300, the PED incidence was more close to the overall PED incidence. Meta-regression analysis highlighted that sample size, assessment time and mean intubation time constituted the source of heterogeneity among the included studies.</p><p><strong>Conclusion: </strong>The incidence of PED was high among ICU patients who underwent orotracheal intubation. ICU professionals should raise awareness about PED. In the meantime, it is important to develop guidelines or consensus on the most appropriate PED assessment time and assessment tools to accurately assess the incidence of PED.</p>\",\"PeriodicalId\":11949,\"journal\":{\"name\":\"European Journal of Medical Research\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":2.8000,\"publicationDate\":\"2024-08-31\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11365263/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"European Journal of Medical Research\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1186/s40001-024-02024-x\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"MEDICINE, RESEARCH & EXPERIMENTAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Journal of Medical Research","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s40001-024-02024-x","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"MEDICINE, RESEARCH & EXPERIMENTAL","Score":null,"Total":0}
引用次数: 0
摘要
背景:拔管后吞咽困难(PED)是重症监护病房(ICU)内气管插管后经常出现的并发症。PED 与不良后果密切相关,包括吸入、肺炎、营养不良、死亡率升高和住院时间延长,导致医疗支出增加。然而,现有文献中关于 PED 发生率的报道差异很大。因此,本综述的主要目的是全面估计接受气管插管的 ICU 患者的 PED 发生率:方法:我们检索了Embase、PubMed、Web of Science、Cochrane Library、中国国家知识基础设施(CNKI)、万方数据库、中国科技期刊数据库(VIP)和SinoMed数据库(从开始到2023年8月)。两名审稿人独立筛选研究并提取数据。随后,我们利用Stata SE 15.0版中的 "meta prop "命令,采用随机效应模型进行元统计分析,以确定PED的发病率。此外,我们还进行了亚组分析和元回归,以阐明纳入研究中潜在的异质性来源:在 4144 项研究中,有 30 项研究被纳入了本综述。PED的总发病率为36%(95%置信区间[CI] 29-44%)。亚组分析显示,按评估时间(≤ 3 小时、4-6 小时、≤ 24 小时和≤ 48 小时)分层,PED 的汇总发生率如下:分别为 31.0% (95% CI 8.0-59.0%)、28% (95% CI 22.0-35.0%)、41% (95% CI 33.0-49.0%)和 49.0% (95% CI 34.0-63.0%)。当样本量为 100 个时在接受气管插管的 ICU 患者中,PED 的发生率很高。ICU 专业人员应提高对 PED 的认识。同时,就最合适的 PED 评估时间和评估工具制定指南或达成共识以准确评估 PED 的发生率非常重要。
Incidence of post-extubation dysphagia among critical care patients undergoing orotracheal intubation: a systematic review and meta-analysis.
Background: Post-extubation dysphagia (PED) emerges as a frequent complication following endotracheal intubation within the intensive care unit (ICU). PED has been strongly linked to adverse outcomes, including aspiration, pneumonia, malnutrition, heightened mortality rates, and prolonged hospitalization, resulting in escalated healthcare expenditures. Nevertheless, the reported incidence of PED varies substantially across the existing body of literature. Therefore, the principal objective of this review was to provide a comprehensive estimate of PED incidence in ICU patients undergoing orotracheal intubation.
Methods: We searched Embase, PubMed, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Database, China Science, Technology Journal Database (VIP), and SinoMed databases from inception to August 2023. Two reviewers independently screened studies and extracted data. Subsequently, a random-effects model was employed for meta-statistical analysis utilizing the "meta prop" command within Stata SE version 15.0 to ascertain the incidence of PED. In addition, we performed subgroup analyses and meta-regression to elucidate potential sources of heterogeneity among the included studies.
Results: Of 4144 studies, 30 studies were included in this review. The overall pooled incidence of PED was 36% (95% confidence interval [CI] 29-44%). Subgroup analyses unveiled that the pooled incidence of PED, stratified by assessment time (≤ 3 h, 4-6 h, ≤ 24 h, and ≤ 48 h), was as follows: 31.0% (95% CI 8.0-59.0%), 28% (95% CI 22.0-35.0%), 41% (95% CI 33.0-49.0%), and 49.0% (95% CI 34.0-63.0%), respectively. When sample size was 100 < N ≤ 300, the PED incidence was more close to the overall PED incidence. Meta-regression analysis highlighted that sample size, assessment time and mean intubation time constituted the source of heterogeneity among the included studies.
Conclusion: The incidence of PED was high among ICU patients who underwent orotracheal intubation. ICU professionals should raise awareness about PED. In the meantime, it is important to develop guidelines or consensus on the most appropriate PED assessment time and assessment tools to accurately assess the incidence of PED.
期刊介绍:
European Journal of Medical Research publishes translational and clinical research of international interest across all medical disciplines, enabling clinicians and other researchers to learn about developments and innovations within these disciplines and across the boundaries between disciplines. The journal publishes high quality research and reviews and aims to ensure that the results of all well-conducted research are published, regardless of their outcome.