Interview with Professor Joerg C. Schefold of Inselspital, Universitätsspital Bern, by Natalia Muehlemann, Nestlé Health Science
From ESICM Paris 23rd October 2018
NM:Good morning. Here we are at ESICM with Professor Joerg C. Schefold from Inselspital Bern. Professor Schefold has presented the results of a new DYnAMICS study. Professor Schefold, what are the key findings of the study?
JCS: Thank you. Well, in DYnAMICS, we organised a systematic and structured screening of patients for dysphagia (of critically ill patients, post-mechanical ventilation, for dysphagia). And this was the first large-scale clinical trial on this aspect. And what we basically found was that dysphagia is often observed on the ICU. Actually, it was observed in 10.3% of patients discharged from the ICU alive and we observed that dysphagia persists mostly in patients that are discharged from the ICU (with dysphagia). That was quite interesting because actually it persisted in 60% of patients until hospital discharge. And, furthermore, I think that dysphagia is currently an under-recognised topic and this also applies to research especially.
NM: Professor Schefold, what are the clinical consequences of dysphagia?
JCS: Well, first of all, I think it is very important to note that many patients have it. It’s mostly persistent and, very importantly, it independently predicts adverse clinical outcomes. In the DYnAMICS trial, we observed that there was an excess 9.2% mortality at 90 days post-ICU admission. I think this is a very relevant number indicating that patients with dysphagia are at an increased risk. And this is also supported by other clinical data such as that these patients require increased resource use, e.g. as assessed by clinical scoring systems, as well as that these patients have a prolonged stay in the ICU (as well as in the hospital), and that they require a much more intense treatment. I think from a practical point of view, one just needs to recognise that dysphagia is very obviously something that largely impacts on clinical outcomes in respective patients.
NM: What is the implication of your findings for the ICU clinicians?
JCS: I think when you’re looking at the numbers resulting from DYnAMICS you will note that this problem occurs often. As currently in most ICUs, it is not systematically assessed, I think there is a clear need for a systematic assessment of respective patients. And we proposed a two-step screening algorithm – a clinical algorithm – to, first of all, detect respective patients so that we recognise patients at risk. And I think the next step then would be, after implementation of such an algorithm (clinical algorithms to detect) would be a structured treatment approach. But this is certainly an area under research.