Risk Factors for Dysphagia in ICU Patients After Invasive Mechanical Ventilation.

BACKGROUND: Dysphagia is common and independently predicts death in ICU patients. Risk factors for dysphagia are largely unknown, with sparse data available from mostly small cohorts without systematic dysphagia screening. RESEARCH QUESTION: What are the key risk factors for dysphagia in ICU patients after invasive mechanical ventilation? STUDY DESIGN AND METHODS: Post hoc analysis of data from a monocentric prospective observational study (Dysphagia in Mechanically Ventilated ICU Patients [DYnAMICS]) using comprehensive statistical models to identify potential risk factors for postextubation dysphagia. A total of 933 primary admissions of adult medical-surgical ICU patients (median age, 65 years; interquartile range, 54-73; 666 [71%] men) were investigated in a tertiary care academic center. Patients received systematic bedside screening for dysphagia within 3 h postextubation. Dysphagia screening positivity (n = 116) was followed within 24 h by a confirmatory examination. RESULTS: After adjustment for confounders, baseline neurologic disease (OR, 4.45; 95% CI, 2.74-7.24; P < .01), emergency admission (OR, 2.04; 95% CI, 1.15-3.59; P < .01), days on mechanical ventilation (OR, 1.19; 95% CI, 1.06-1.34; P < .01), days on renal replacement therapy (OR, 1.1; 95% CI, 1-1.23; P = .03), and disease severity (Acute Physiology and Chronic Health Evaluation II score within first 24 h; OR, 1.03; 95% CI, 0.99-1.07; P < .01) remained independent risk factors for dysphagia postextubation. Increased BMI reduced the risk for dysphagia (6% per step increase; OR, 0.94; 95% CI, 0.9-0.99; P = .03). INTERPRETATION: In ICU patients, baseline neurologic disease, emergency admission, and duration of invasive mechanical ventilation appeared as prominent independent risk factors for dysphagia. Because all ICU patients after mechanical ventilation should be considered at risk for dysphagia, systematic screening for dysphagia is recommended in respective critically ill patients. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT02333201; URL: www.clinicaltrials.govclinicaltrials.gov.

Using a Goal Theoretical Perspective to Reduce Negative and Promote Positive Spillover After a Bike-to-Work Campaign.

Behavioral change interventions often focus on a specific behavior over a limited time period; for example, a bike-to-work intervention that incentivizes cycling to work over 2 months. While such interventions can successfully initiate behavior, they run the risk of triggering negative spillover effects after completion: Reaching the end of an intervention could reduce the motivation to maintain the behavior; or an increase in the targeted behavior (e.g., cycling to work more often) could lead to negative spillover across behaviors (e.g., cycling less in leisure time). Using a goal theoretical perspective, we tested whether an intervention focusing on a specific behavior during a limited time period (a subordinate goal) triggers negative spillover, and whether superordinate goals and/or action steps reduce negative or promote positive spillover. We conducted an experimental field study (N = 1,269) in the context of a bike-to-work campaign with a longitudinal multilevel design. Participants across all four experimental conditions had the campaign goal of cycling to work for a maximum of 2 months (a subordinate goal). A quarter of the participants additionally generated superordinate goals, a quarter action steps and a quarter superordinate goals and action steps. The last quarter was a control condition which only set the subordinate campaign goal. Surprisingly, the intervention caused no negative and some positive spillover effects. Participants increased the frequency of cycling to work across all groups and the increase could be maintained up to 2 months after the campaign. An increase in cycling to work spilled over to an increase in cycling in leisure time and to an increase in eating fruits and vegetables. No spillover effects were found regarding exercising and eating sweets and snacks. Participants focusing additionally on a superordinate goal cycled to work more frequently at the end of the campaign than the control group. Contrary to our expectations, the maintenance of cycling to work over time and the positive spillover effects across behaviors did not differ due to the goal manipulation. These results reduce the concern that interventions focusing on a subordinate goal could trigger negative spillover effects and show the need for additional experimental field studies.