A Systematic Review of the Prevalence and Characteristics of Oropharyngeal Dysphagia in Critically Ill Patients During the Acute and Postacute Recovery Phase.

Abstract

To determine the prevalence and characteristics of oropharyngeal dysphagia in critically ill adults during acute and postacute care settings. This systematic review was registered on PROSPERO and used Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Five electronic databases were searched (PubMed, Scopus, Cochrane Library, CINAHL, and Embase) from the time of inception to September 2024 using search terms: dysphagia, deglutition disorders, swallowing disorders, sepsis, postintensive care syndrome, COVID-19, critical illness. Independent review of articles was conducted by two raters using four inclusion criteria: 1) adults older than 18 years; 2) diagnosis of COVID-19, sepsis, critical illness, or ostintensive care syndrome and dysphagia; 3) underwent clinical swallow evaluation; and 4) in acute or postacute care setting. Two raters independently assessed levels of research evidence and risk of bias using the Oxford center for Evidence-based Medicine Levels of Evidence and the Modified Downs and Black Checklist and extracted demographics, study design, dysphagia assessment methods, outcomes, and comorbidities. After removing duplicates, 5058 articles were identified and 4844 screened out based on title/abstract. Full-text review was completed for 214 articles, and 51 met inclusion. Prevalence of dysphagia ranged from 15% to 100%. Dysphagia persisted in up to 74% of individuals at hospital discharge and up to 22% of patients 10 to 17 months posthospital discharge. Due to study design limitations, high risk of bias, and heterogeneity in methods/outcomes, firm conclusions cannot be drawn. However, current data suggest a high prevalence of dysphagia in critically ill adults who persists greater than or equal to 12 months posthospital discharge. Given the high rates of silent aspiration, prospective, longitudinal research is needed to further understand the prevalence and impact of chronic dysphagia on health and quality of life in critically ill adults.