Na, Y., Choi, J., Choi, J., Oh, S. M., Jang, H., Choi, S., … & Kwon, J. Y. (2025). Videofluoroscopic swallowing study predicts clinical outcomes in critically Ill children with dysphagia: a retrospective observational study. Frontiers in Pediatrics, 13, 1507645.
Whether you evaluate and treat children in the community who may be post-hospitalization in PICU, or you work in pediatric acute, this study will inform your practice. It provides valuable contributions to our current knowledge base by highlighting the patterns of dysphagia in critically ill children who return to community care post-hospitalization. It also highlights the predictive value of VFSS in identifying silent aspiration, and in predicting significant patient outcomes, such as the length of stay in PICU and delays in initiating oral feeding. These insights are crucial for improving the quality of care for these vulnerable children while inpatient, and after discharge home to community therapy.
QUOTE: It provides significant insights into the prevalence and implications of silent aspiration in children within the PICU setting, presenting detailed findings from VFSS. The most significant predictors of silent aspiration are age, laryngeal cleft, laryngomalacia, unilateral vocal fold paralysis, developmental delay, epilepsy/seizures, syndromes, and cardiac disease, which are common diagnoses in children in PICU. Our research builds on these findings, identifying intubation duration and the act of intubation itself as significant predictors of aspiration risk. silent aspiration predicted a longer PICU LOS and poor oral feeding outcomes at hospital discharge. This finding not only aligns with but also builds upon the findings of da Silva et al, who reported extended hospital and PICU stays and delayed oral feeding in children with dysphagia. Our research underscores the critical role of early detection and intervention in managing dysphagia within the PICU. Early identification of silent aspiration through VFSS can facilitate and timely therapeutic interventions, potentially reducing the PICU length of stay and improving oral feeding outcomes at discharge.
Dysphagia in the PICU often increases hospitalization length and remains unresolved until discharge or beyond. By addressing swallowing difficulties early and implementing appropriate interventions, there is a possibility of reducing complications associated with aspiration, potentially leading to shorter PICU stays (and return to home and community followup) . Our study broadens the scope by including patients beyond those with PED (Post Extubation Dysphagia) , offering a more comprehensive view of dysphagia in pediatric critical care. Given that longer intubation periods and delayed VFSS evaluations were associated with prolonged PICU stays, it would be advisable for physicians to consider developing a protocol for performing a dysphagia work-up if intubation is prolonged.
ABSTRACT:
Background: This retrospective observational study aimed to investigate the features of acute dysphagia observed during videofluoroscopic swallowing study (VFSS) in critically ill children and their potential to anticipate clinical outcomes.
Methods: Administrative healthcare data of children aged 1–18 were analyzed. Data were collected from the pediatric intensive care unit (PICU) of a single tertiary medical center in South Korea between March 2019 and December 2022.We reviewed VFSS conducted on patients in the PICU who were referred by clinicians suspecting dysphagia.
Results: A total of 36 children were included in the study; 52.8% exhibited aspiration on VFSS. In this investigation, participants were provided with pureed food, liquids, solids, and a combination of solids and liquids (referred to as mixed) during the examination. Any occurrence of aspiration throughout the examination was deemed as aspiration. All individuals displaying aspiration were found to have silent aspiration. Silent aspiration was associated with a longer length of stay (LOS) in the PICU. Logistic regression analysis revealed that the time from PICU admission to VFSS and intubation duration significantly influenced LOS. Abnormal findings in the VFSS, including aspiration, delayed swallowing reflex, insufficient laryngeal closure, and residue, were statistically significant variables in determining the feeding mode at discharge.
Conclusion: This study highlights the importance of VFSS in assessing swallowing function in critically ill children. It suggests that VFSS findings, such as silent aspiration, can aid in predicting patient outcomes, including LOS and the delay in oral feeding.