背景:在重症监护病房(ICU)气管内插管后,拔管后吞咽困难(PED)是一种常见的并发症。PED与不良后果密切相关,包括抽吸,肺炎,营养不良,死亡率上升,和长期住院,导致医疗支出增加。然而,报告的PED发病率在现有文献中差异很大.因此,本综述的主要目的是对接受经口气管插管的ICU患者的PED发生率进行综合评估.
方法:我们搜索了Embase,PubMed,WebofScience,科克伦图书馆,中国国家知识基础设施(CNKI),万方数据库,中国科学,科技期刊数据库(VIP),和SinoMed数据库从成立到2023年8月。两名评审员独立筛选研究并提取数据。随后,利用StataSE15.0版中的"metaprop"命令,采用随机效应模型进行荟萃统计分析,以确定PED的发生率.此外,我们进行了亚组分析和荟萃回归,以阐明纳入研究的异质性的潜在来源.
结果:在4144项研究中,本综述包括30项研究。PED的总体合并发生率为36%(95%置信区间[CI]29-44%)。亚组分析揭示了PED的合并发病率,按评估时间分层(≤3小时,4-6小时,≤24h,且≤48h),如下:31.0%(95%CI8.0-59.0%),28%(95%CI22.0-35.0%),41%(95%CI33.0-49.0%),和49.0%(95%CI34.0-63.0%),分别。当样本量为100结论:在接受经口气管插管的ICU患者中,PED的发生率较高。ICU专业人员应提高对PED的认识。同时,对于准确评估PED的发生率,必须就最合适的PED评估时间和评估工具制定指南或达成共识.
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.
CONCLUSIONS: 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.