TABLE 1.
Clinical Characteristics of the Patients and Results of FEES
| Clinical Variables | Patient 1 | Patient 2 | Patient 3 | Patient 4 | Patient 5 | Patient 6 |
|---|---|---|---|---|---|---|
| Age (yr)/sex | 60/male | 45/male | 63/male | 60/male | 56/male | 50/male |
| Comorbidities | None | None | Hypertension, coronary heart disease, former smoker | Hypothyroidism | Morbid obesity, congestive heart failure, hypertension, atrial fibrillation, former smoker | None |
| Length of MV (d) | 23a | 20a | 33 | 32 | 46 | 12 |
| Acute respiratory distress syndrome (classification based on [8]) | Moderate-severe | Moderate-severe | Severe | Severe | Moderate | Severe |
| MV in prone position (d) | 0 | 5 | 6 | 4 | 0 | 4 |
| Septic shock | Yes | No | Yes | Yes | No | No |
| Vasopressor use (d) | 8 | 1 | 9 | 10 | 1 | 0 |
| Renal replacement therapy (d) | 3 | 8 | 12 | 20 | 5 | 0 |
| Tracheostomy (days after start of intubation) | 9 | 7 | 5 | 9 | 9 | 6 |
| Extracorporeal membrane oxygenation (d) | 0 | 0 | 8 | 9 | 0 | 0 |
| Bacterial superinfection (number of antibiotics/days of use) | Yes (5/23) | Yes (3/9) | Yes (3/22) | Yes (4/19) | Yes (1/8) | Yes (1/5) |
| Fungal superinfection (number of antimycotics/days of use) | No (0/0) | No (0/0) | Yes (2/18) | No (0/0) | No (0/0) | No (0/0) |
| Complications during ICU treatment | Pulmonary embolism | Urinary tract infection, deep vein thrombosis | Septic cardiomyopathy | Deep vein thrombosis, subcortical stroke, myocarditis, mediastinal emphysema, gastritis | Pericardial effusion | None |
| Neurological diagnoses | CIP | Encephalopathy, CIP, right-sided tongue palsyb | Encephalopathy, CIP | Encephalopathy, CIP | Encephalopathy, CIP | None |
| Salient FEES findings | Moderate-to-severe laryngeal hypesthesia (right > left), delayed swallowing reflex, predeglutitive silent penetration, aspiration of liquid, and bilateral vocal fold adductor pareses | Severe laryngeal hypesthesia, reduced spontaneous swallowing, massive pooling and impaired clearing of pharyngel, secretions, right-sided vocal cord palsy | Severe laryngeal hypesthesia, reduced spontaneous swallowing, massive pooling and impaired clearing of pharyngeal secretions, impaired pharyngeal contraction, weak tongue-base retraction and incomplete epiglottic inversion | Moderate to severe laryngeal hypesthesia (left > right), impaired oral bolus control with premature spillage and aspiration of liquid, incomplete left-sided vocal cord palsy | Severe laryngeal hypesthesia, massive pooling and impaired clearing of pharyngeal secretions, reduced spontaneous swallowing, impaired pharyngeal contraction and incomplete epiglottic inversion | Moderate pharyngo-laryngeal hypesthesia, irregular arytenoid cartilage movement |
| Time of decannulation (post intubation/post weaning/post FEES [d]) | 28/2/0 | 54/36/35c | 61/26/25c | 38/6/1 | None (FEES done at day 24 after intubation) | 13/1/0 |
CIP = critical illness polyneuropathy, FEES = flexible endoscopic evaluation of swallowing, MV = mechanical ventilation.
aTwo episodes of MV.
bMRI without abnormalities.
cDecannulation after discharge.