A Pilot Study of Pharyngeal Electrical Stimulation for Orally Intubated ICU Patients with Dysphagia

Neurocrit Care. 2020 Apr;32(2):532-538. doi: 10.1007/s12028-019-00780-x.

Abstract

Objective: Dysphagia is a common disorder in neurological and non-neurological intensive care unit (ICU) patients and can lead to aspiration pneumonia, prolonged ventilation, and delayed extubation. Dysphagia is an independent predictor of increased mortality. In dysphagic stroke patients with tracheotomy, the use of pharyngeal electric stimulation (PES), an emerging technique to treat dysphagia, has been shown to improve airway protection and shorten time to decannulation. The objective of this study was to determine whether patients who receive PES have a lower prevalence of pneumonia and frequency of reintubation.

Design: Secondary analysis of a non-blinded interventional subject sample from a large clinical study with a historical age, pathology, and severity-matched control group.

Setting: ICU of a tertiary care medical center.

Patients: In this pilot non-blinded study, a group of 15 intubated patients in a general and a neurologic ICU received PES while orally intubated during ICU stay. A control group (n = 25) matched for age, type, and region of pathology, and severity of illness expressed by Simplified Acute Physiology Score and Therapeutic Intervention Scoring System was used to compare for pneumonia and need for reintubation.

Main results: Patients treated with PES had significantly lower prevalence of pneumonia (4 vs 21, p = 0.00046) and frequency of reintubation (0 vs 6, p = 0.046) when compared to controls.

Conclusion: Although limited by its small size and non-blinded design, this is the first study demonstrating the benefits of PES in ICU patients still orally intubated, thus offering a potential new method to reduce morbidity, mortality, and economic burden in a mixed ICU population. In order to further investigate and strengthen our findings, a statistically powered, randomized controlled study is recommended.

Keywords: Dysphagia; Intensive care unit; Pharyngeal electrical stimulation; Pneumonia prevalence; Reintubation frequency; Ventilation.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Airway Extubation / statistics & numerical data
  • Cohort Studies
  • Deglutition Disorders / therapy*
  • Electric Stimulation Therapy / methods*
  • Female
  • Historically Controlled Study
  • Humans
  • Intensive Care Units
  • Intubation, Intratracheal
  • Male
  • Middle Aged
  • Mouth
  • Pharynx*
  • Pilot Projects
  • Pneumonia, Aspiration / epidemiology
  • Pneumonia, Aspiration / prevention & control*