Dysphagia in Intensive Care Evaluation (DICE): An International Cross-Sectional Survey

the DICE study investigators; Peter E. Spronk; Laura E.J. Spronk; Ingrid Egerod; Jennifer McGaughey; Jackie McRae; Louise Rose; M. B. Brodsky; M. B. Brodsky; L. Rose; J. Lut; P. Clavé; R. Nanchal; Y. Inamoto; J. I. van der Hoeven; P. E. Spronk; A. Freeman-Sanderson; M. Hiesmayr; C. Veraar; C. E. Hickmann; R. Gosselink; S. Gershman; S. Skoretz; R. Martino; M. Mpouzika; M. Cerny; V. Chrobok; L. Zeinerova; I. Egerod; G. Kaldan; J. McRae; M. Bäcklund; T. Ramos; P. Nydahl; M. Kalafati; T. Andrews; R. Sperlinga; H. Katsukawa; F. Kasai; L. E.J. Spronk; A. Miles; J. McGaughey; S. Duncan; M. Fossum; V. Ágústdóttir; T. Senneset; M. Larsson; G. Hammond; R. Owczuk; E. Akerman; G. Jones

doi:10.1007/s00455-021-10389-y

Dysphagia in Intensive Care Evaluation (DICE): An International Cross-Sectional Survey

the DICE study investigators, Peter E. Spronk, Laura E.J. Spronk, Ingrid Egerod, Jennifer McGaughey, Jackie McRae, Louise Rose, M. B. Brodsky, M. B. Brodsky, L. Rose, J. Lut, P. Clavé, R. Nanchal, Y. Inamoto, J. I. van der Hoeven, P. E. Spronk, A. Freeman-Sanderson, M. Hiesmayr, C. Veraar, C. E. HickmannR. Gosselink, S. Gershman, S. Skoretz, R. Martino, M. Mpouzika, M. Cerny, V. Chrobok, L. Zeinerova, I. Egerod, G. Kaldan, J. McRae, M. Bäcklund, T. Ramos, P. Nydahl, M. Kalafati, T. Andrews, R. Sperlinga, H. Katsukawa, F. Kasai, L. E.J. Spronk, A. Miles, J. McGaughey, S. Duncan, M. Fossum, V. Ágústdóttir, T. Senneset, M. Larsson, G. Hammond, R. Owczuk, E. Akerman, G. Jones

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Abstract

Dysphagia occurs commonly in the intensive care unit (ICU). Despite the clinical relevance, there is little worldwide research on prevention, assessment, evaluation, and/or treatment of dysphagia for ICU patients. We aimed to gain insight into this international knowledge gap. We conducted a multi-center, international online cross-sectional survey of adult ICUs. Local survey distribution champions were recruited through professional and personal networks. The survey was administered from November 2017 to June 2019 with three emails and a final telephone reminder. Responses were received from 746 ICUs (26 countries). In patients intubated > 48 h, 17% expected a > 50% chance that dysphagia would develop. This proportion increased to 43% in patients intubated > 7 days, and to 52% in tracheotomized patients. Speech-language pathologist (SLP) consultation was available in 66% of ICUs, only 4% reported a dedicated SLP. Although 66% considered a routine post-extubation dysphagia protocol important, most (67%) did not have a protocol. Few ICUs routinely assessed for dysphagia after 48 h of intubation (30%) or tracheostomy (41%). A large proportion (46%) used water swallow screening tests to determine aspiration, few (8%) used instrumental assessments (i.e., flexible endoscopic evaluation of swallowing). Swallowing exercises were used for dysphagia management by 30% of ICUs. There seems to be limited awareness among ICU practitioners that patients are at risk of dysphagia, particularly as ventilation persists, protocols, routine assessment, and instrumental assessments are generally not used. We recommend the development of a research agenda to increase the quality of evidence and ameliorate the implementation of evidence-based dysphagia protocols by dedicated SLPs.

Original language	English
Pages (from-to)	1451-1460
Number of pages	10
Journal	Dysphagia
Volume	37
Issue number	6
DOIs	https://doi.org/10.1007/s00455-021-10389-y
Publication status	Published - Dec 2022

Keywords

Critical care
Dysphagia
Intensive care
Survey
Swallowing

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Dysphagia in Intensive_SPRONK_Publishedonline29January2022_GREEN AAMAccepted author manuscript, 217 KB

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the DICE study investigators, Spronk, P. E., Spronk, L. E. J., Egerod, I., McGaughey, J., McRae, J., Rose, L., Brodsky, M. B., Brodsky, M. B., Rose, L., Lut, J., Clavé, P., Nanchal, R., Inamoto, Y., van der Hoeven, J. I., Spronk, P. E., Freeman-Sanderson, A., Hiesmayr, M., Veraar, C., ... Jones, G. (2022). Dysphagia in Intensive Care Evaluation (DICE): An International Cross-Sectional Survey. Dysphagia, 37(6), 1451-1460. https://doi.org/10.1007/s00455-021-10389-y

@article{63441d11d0444b579e14e1d69b555496,

title = "Dysphagia in Intensive Care Evaluation (DICE): An International Cross-Sectional Survey",

abstract = "Dysphagia occurs commonly in the intensive care unit (ICU). Despite the clinical relevance, there is little worldwide research on prevention, assessment, evaluation, and/or treatment of dysphagia for ICU patients. We aimed to gain insight into this international knowledge gap. We conducted a multi-center, international online cross-sectional survey of adult ICUs. Local survey distribution champions were recruited through professional and personal networks. The survey was administered from November 2017 to June 2019 with three emails and a final telephone reminder. Responses were received from 746 ICUs (26 countries). In patients intubated > 48 h, 17% expected a > 50% chance that dysphagia would develop. This proportion increased to 43% in patients intubated > 7 days, and to 52% in tracheotomized patients. Speech-language pathologist (SLP) consultation was available in 66% of ICUs, only 4% reported a dedicated SLP. Although 66% considered a routine post-extubation dysphagia protocol important, most (67%) did not have a protocol. Few ICUs routinely assessed for dysphagia after 48 h of intubation (30%) or tracheostomy (41%). A large proportion (46%) used water swallow screening tests to determine aspiration, few (8%) used instrumental assessments (i.e., flexible endoscopic evaluation of swallowing). Swallowing exercises were used for dysphagia management by 30% of ICUs. There seems to be limited awareness among ICU practitioners that patients are at risk of dysphagia, particularly as ventilation persists, protocols, routine assessment, and instrumental assessments are generally not used. We recommend the development of a research agenda to increase the quality of evidence and ameliorate the implementation of evidence-based dysphagia protocols by dedicated SLPs.",

keywords = "Critical care, Dysphagia, Intensive care, Survey, Swallowing",

author = "{the DICE study investigators} and Spronk, {Peter E.} and Spronk, {Laura E.J.} and Ingrid Egerod and Jennifer McGaughey and Jackie McRae and Louise Rose and Brodsky, {M. B.} and Brodsky, {M. B.} and L. Rose and J. Lut and P. Clav{\'e} and R. Nanchal and Y. Inamoto and {van der Hoeven}, {J. I.} and Spronk, {P. E.} and A. Freeman-Sanderson and M. Hiesmayr and C. Veraar and Hickmann, {C. E.} and R. Gosselink and S. Gershman and S. Skoretz and R. Martino and M. Mpouzika and M. Cerny and V. Chrobok and L. Zeinerova and I. Egerod and G. Kaldan and J. McRae and M. B{\"a}cklund and T. Ramos and P. Nydahl and M. Kalafati and T. Andrews and R. Sperlinga and H. Katsukawa and F. Kasai and Spronk, {L. E.J.} and A. Miles and J. McGaughey and S. Duncan and M. Fossum and V. {\'A}g{\'u}std{\'o}ttir and T. Senneset and M. Larsson and G. Hammond and R. Owczuk and E. Akerman and G. Jones",

note = "Funding Information: This study was partially funded by the Gelre Hospitals science fund (Grant 2018-012). Funding Information: Survey development team: M. B. Brodsky (Johns Hopkins University, Baltimore, USA); L. Rose (King{\textquoteright}s College London, London, UK); J. Lut (Gelre Hospitals, Apeldoorn, The Netherlands); P. Clav{\'e} (Hospital de Matar{\'o}, Universitat Aut{\'o}noma de Barcelona, Centro de Investigaci{\'o}n Biom{\'e}dica en Red de Enfermedades Aparato DIgestivo, Ciberehd Barcelona, Spain); R. Nanchal (Medical college Wisconsin, USA); Y. Inamoto (Fujita Health University, Aichi, Japan); J. I. van der Hoeven (Radboud University, Nijmegen, The Netherlands); P. E. Spronk (Gelre Hospitals, Apeldoorn, The Netherlands). National study coordinators: A. Freeman-Sanderson (Australia); M. Hiesmayr, C. Veraar (Austria); C. E. Hickmann, R. Gosselink (Belgium); L. Rose, S. Gershman, S. Skoretz, R. Martino (Canada); M. Mpouzika (Cyprus); M. Cerny, V. Chrobok, L. Zeinerova (Czech Republic); I. Egerod, G. Kaldan (Denmark); J. McRae (England); M. B{\"a}cklund (Finland); T. Ramos (France); P. Nydahl (Germany); M. Kalafati (Greece); T. Andrews (Ireland); R. Sperlinga (Italy); H. Katsukawa, F. Kasai (Japan); P. E. Spronk, J. Lut, L. E. J. Spronk (Netherlands); A. Miles (New Zealand); J. McGaughey, S. Duncan (Northern Ireland (UK)); M. Fossum, V. {\'A}g{\'u}std{\'o}ttir, T. Senneset, M. Larsson, G. Hammond (Norway); R. Owczuk (Poland); S. Mestre (Portugal); J. Merriweather (Scotland); M. Tedla, Z. Frajkova (Slovakia); M. Velasco (Spain); E. Akerman (Sweden); A. Sibilla, B. Kertscher, B. Gaechter (Switzerland); S. Serel Arslan, N. Demir (Turkey); G. Jones (Wales). Publisher Copyright: {\textcopyright} 2022, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.",

year = "2022",

month = dec,

doi = "10.1007/s00455-021-10389-y",

language = "English",

volume = "37",

pages = "1451--1460",

journal = "Dysphagia",

issn = "0179-051X",

publisher = "Springer New York",

number = "6",

}

the DICE study investigators, Spronk, PE, Spronk, LEJ, Egerod, I, McGaughey, J, McRae, J, Rose, L, Brodsky, MB, Brodsky, MB, Rose, L, Lut, J, Clavé, P, Nanchal, R, Inamoto, Y, van der Hoeven, JI, Spronk, PE, Freeman-Sanderson, A, Hiesmayr, M, Veraar, C, Hickmann, CE, Gosselink, R, Gershman, S, Skoretz, S, Martino, R, Mpouzika, M, Cerny, M, Chrobok, V, Zeinerova, L, Egerod, I, Kaldan, G, McRae, J, Bäcklund, M, Ramos, T, Nydahl, P, Kalafati, M, Andrews, T, Sperlinga, R, Katsukawa, H, Kasai, F, Spronk, LEJ, Miles, A, McGaughey, J, Duncan, S, Fossum, M, Ágústdóttir, V, Senneset, T, Larsson, M, Hammond, G, Owczuk, R, Akerman, E & Jones, G 2022, 'Dysphagia in Intensive Care Evaluation (DICE): An International Cross-Sectional Survey', Dysphagia, vol. 37, no. 6, pp. 1451-1460. https://doi.org/10.1007/s00455-021-10389-y

TY - JOUR

T1 - Dysphagia in Intensive Care Evaluation (DICE)

T2 - An International Cross-Sectional Survey

AU - the DICE study investigators

AU - Spronk, Peter E.

AU - Spronk, Laura E.J.

AU - Egerod, Ingrid

AU - McGaughey, Jennifer

AU - McRae, Jackie

AU - Rose, Louise

AU - Brodsky, M. B.

AU - Rose, L.

AU - Lut, J.

AU - Clavé, P.

AU - Nanchal, R.

AU - Inamoto, Y.

AU - van der Hoeven, J. I.

AU - Spronk, P. E.

AU - Freeman-Sanderson, A.

AU - Hiesmayr, M.

AU - Veraar, C.

AU - Hickmann, C. E.

AU - Gosselink, R.

AU - Gershman, S.

AU - Skoretz, S.

AU - Martino, R.

AU - Mpouzika, M.

AU - Cerny, M.

AU - Chrobok, V.

AU - Zeinerova, L.

AU - Egerod, I.

AU - Kaldan, G.

AU - McRae, J.

AU - Bäcklund, M.

AU - Ramos, T.

AU - Nydahl, P.

AU - Kalafati, M.

AU - Andrews, T.

AU - Sperlinga, R.

AU - Katsukawa, H.

AU - Kasai, F.

AU - Spronk, L. E.J.

AU - Miles, A.

AU - McGaughey, J.

AU - Duncan, S.

AU - Fossum, M.

AU - Ágústdóttir, V.

AU - Senneset, T.

AU - Larsson, M.

AU - Hammond, G.

AU - Owczuk, R.

AU - Akerman, E.

AU - Jones, G.

N1 - Funding Information: This study was partially funded by the Gelre Hospitals science fund (Grant 2018-012). Funding Information: Survey development team: M. B. Brodsky (Johns Hopkins University, Baltimore, USA); L. Rose (King’s College London, London, UK); J. Lut (Gelre Hospitals, Apeldoorn, The Netherlands); P. Clavé (Hospital de Mataró, Universitat Autónoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Aparato DIgestivo, Ciberehd Barcelona, Spain); R. Nanchal (Medical college Wisconsin, USA); Y. Inamoto (Fujita Health University, Aichi, Japan); J. I. van der Hoeven (Radboud University, Nijmegen, The Netherlands); P. E. Spronk (Gelre Hospitals, Apeldoorn, The Netherlands). National study coordinators: A. Freeman-Sanderson (Australia); M. Hiesmayr, C. Veraar (Austria); C. E. Hickmann, R. Gosselink (Belgium); L. Rose, S. Gershman, S. Skoretz, R. Martino (Canada); M. Mpouzika (Cyprus); M. Cerny, V. Chrobok, L. Zeinerova (Czech Republic); I. Egerod, G. Kaldan (Denmark); J. McRae (England); M. Bäcklund (Finland); T. Ramos (France); P. Nydahl (Germany); M. Kalafati (Greece); T. Andrews (Ireland); R. Sperlinga (Italy); H. Katsukawa, F. Kasai (Japan); P. E. Spronk, J. Lut, L. E. J. Spronk (Netherlands); A. Miles (New Zealand); J. McGaughey, S. Duncan (Northern Ireland (UK)); M. Fossum, V. Ágústdóttir, T. Senneset, M. Larsson, G. Hammond (Norway); R. Owczuk (Poland); S. Mestre (Portugal); J. Merriweather (Scotland); M. Tedla, Z. Frajkova (Slovakia); M. Velasco (Spain); E. Akerman (Sweden); A. Sibilla, B. Kertscher, B. Gaechter (Switzerland); S. Serel Arslan, N. Demir (Turkey); G. Jones (Wales). Publisher Copyright: © 2022, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

PY - 2022/12

Y1 - 2022/12

N2 - Dysphagia occurs commonly in the intensive care unit (ICU). Despite the clinical relevance, there is little worldwide research on prevention, assessment, evaluation, and/or treatment of dysphagia for ICU patients. We aimed to gain insight into this international knowledge gap. We conducted a multi-center, international online cross-sectional survey of adult ICUs. Local survey distribution champions were recruited through professional and personal networks. The survey was administered from November 2017 to June 2019 with three emails and a final telephone reminder. Responses were received from 746 ICUs (26 countries). In patients intubated > 48 h, 17% expected a > 50% chance that dysphagia would develop. This proportion increased to 43% in patients intubated > 7 days, and to 52% in tracheotomized patients. Speech-language pathologist (SLP) consultation was available in 66% of ICUs, only 4% reported a dedicated SLP. Although 66% considered a routine post-extubation dysphagia protocol important, most (67%) did not have a protocol. Few ICUs routinely assessed for dysphagia after 48 h of intubation (30%) or tracheostomy (41%). A large proportion (46%) used water swallow screening tests to determine aspiration, few (8%) used instrumental assessments (i.e., flexible endoscopic evaluation of swallowing). Swallowing exercises were used for dysphagia management by 30% of ICUs. There seems to be limited awareness among ICU practitioners that patients are at risk of dysphagia, particularly as ventilation persists, protocols, routine assessment, and instrumental assessments are generally not used. We recommend the development of a research agenda to increase the quality of evidence and ameliorate the implementation of evidence-based dysphagia protocols by dedicated SLPs.

AB - Dysphagia occurs commonly in the intensive care unit (ICU). Despite the clinical relevance, there is little worldwide research on prevention, assessment, evaluation, and/or treatment of dysphagia for ICU patients. We aimed to gain insight into this international knowledge gap. We conducted a multi-center, international online cross-sectional survey of adult ICUs. Local survey distribution champions were recruited through professional and personal networks. The survey was administered from November 2017 to June 2019 with three emails and a final telephone reminder. Responses were received from 746 ICUs (26 countries). In patients intubated > 48 h, 17% expected a > 50% chance that dysphagia would develop. This proportion increased to 43% in patients intubated > 7 days, and to 52% in tracheotomized patients. Speech-language pathologist (SLP) consultation was available in 66% of ICUs, only 4% reported a dedicated SLP. Although 66% considered a routine post-extubation dysphagia protocol important, most (67%) did not have a protocol. Few ICUs routinely assessed for dysphagia after 48 h of intubation (30%) or tracheostomy (41%). A large proportion (46%) used water swallow screening tests to determine aspiration, few (8%) used instrumental assessments (i.e., flexible endoscopic evaluation of swallowing). Swallowing exercises were used for dysphagia management by 30% of ICUs. There seems to be limited awareness among ICU practitioners that patients are at risk of dysphagia, particularly as ventilation persists, protocols, routine assessment, and instrumental assessments are generally not used. We recommend the development of a research agenda to increase the quality of evidence and ameliorate the implementation of evidence-based dysphagia protocols by dedicated SLPs.

KW - Critical care

KW - Dysphagia

KW - Intensive care

KW - Survey

KW - Swallowing

UR - http://www.scopus.com/inward/record.url?scp=85124108180&partnerID=8YFLogxK

U2 - 10.1007/s00455-021-10389-y

DO - 10.1007/s00455-021-10389-y

M3 - Article

C2 - 35092486

AN - SCOPUS:85124108180

SN - 0179-051X

VL - 37

SP - 1451

EP - 1460

JO - Dysphagia

JF - Dysphagia

IS - 6

ER -

Dysphagia in Intensive Care Evaluation (DICE): An International Cross-Sectional Survey

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Keywords

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