Meta-analysis and systematic review of risk factors for dysphagia in lung transplant recipients_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

ZHU Yan , LAN Meijuan , LIANG Jiangshuyuan , CAI Lingyun , GUO Luyao , GU Peipei ,  ZENG Fei

Nursing Department of the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang;

Corresponding author：

ZENG Fei, Email: zengfei@zju.edu.cn

Keywords：

Lung transplantation; dysphagia; risk factors; meta-analysis

DOI：

10.7507/1671-6205.202406095

Video：

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Objective To investigate the risk factors of dysphagia in lung transplant recipients through meta-analysis. Method Cohort studies and case-control studies on risk factors for dysphagia after lung transplantation in Science, Scopus and ProQuest databases were searched from the establishment of the database to July 2023. After literature screening, data extraction and quality evaluation, Meta-analysis was performed using Rev Man 5.4 and Stata17.0 software. Results 12 literatures were included, and the results of meta-analysis showed: The incidence of dysphagia in lung transplant recipients was 67% (95%CI 0.59~0.75, I² =92.44%, P<0.001). There were three risk factors for dysphagia in lung transplant recipients, namely, reintubation (OR=5.34, 95%CI 3.07~9.28, I² =0%, P<0.001), mechanical ventilation (OR= 4.25, 95%CI 2.95~6.12, I² =0%, P<0.001), extracorporeal life support (OR=2.13, 95%CI 1.69~2.67, I² =0%, P<0.001).Conclusions Lung transplant recipients with re-intubation, mechanical ventilation and extracorporeal life support are more likely to have dysphagia after surgery. Nursing staff can combine risk factors and formulate targeted nursing measures to reduce the incidence of dysphagia after lung transplantation.

Citation： ZHU Yan, LAN Meijuan, LIANG Jiangshuyuan, CAI Lingyun, GUO Luyao, GU Peipei, ZENG Fei. Meta-analysis and systematic review of risk factors for dysphagia in lung transplant recipients. Chinese Journal of Respiratory and Critical Care Medicine, 2024, 23(10): 719-726. doi: 10.7507/1671-6205.202406095 Copy

1.	Macht M, Wimbish T, Bodine C, et al. ICU-acquired swallowing disorders. Crit Care Med, 2013, 41(10): 2396-2405.
2.	戚春霞, 厉春林, 张雅芝, 等. 重症患者ICU获得性吞咽障碍影响因素的Meta分析. 中华护理杂志, 2021, 56(8): 1236-1241.
3.	Dallal-York J, Segalewitz T, Croft K, et al. Incidence, risk factors, and sequelae of dysphagia mediated aspiration following lung transplantation. J Heart Lung Transplant, 2022, 41(8): 1095-1103.
4.	Schmidt LJ, Hoksch B, Luder G, et al. Early Assessment and Management of Dysphagia After Lung Resection: A Randomized Controlled Trial. Ann Thorac Surg, 2019, 108(4): 1059-1064.
5.	Black R, McCabe P, Glanville A, et al. Oropharyngeal dysphagia and laryngeal dysfunction after lung and heart transplantation: A systematic review. Disability & Rehabilitation, 2020, 42(15): 2083-2092.
6.	Singer ML, Fynes MM. Dysphagia after lung transplantation: Exploring best treatment practices. Dysphagia, 2016, 31(6): 838-839.
7.	Skoretz SA, Graham M, Kamitomo G, et al. The Incidence of Oropharyngeal Dysphagia and Associated Risk Factors Following Double Lung Transplantation: A Retrospective Study. J Heart Lung Transplant, 2010, 29(2): S133-S134.
8.	Lill I, Lovin D, Mohanka M, et al. Predictors and Outcomes among Patients with Early Swallow Dysfunction after Lung Transplantation. J Heart Lung Transplant, 2020, 39(4): S318.
9.	Baumann B, Byers S, Wasserman-Wincko T, et al. Postoperative Swallowing Assessment After Lung Transplantation. Ann Thorac Surg, 2017, 104(1): 308-312.
10.	Cangemi DJ, Flanagan R, Bailey A, et al. Jackhammer Esophagus After Lung Transplantation: Results of a Retrospective Multicenter Study. J Clin Gastroenterol, 2020, 54(4): 322-326.
11.	Plowman E K, DiBiase L, Anderson A, et al. Incidence of Dysphagia and Associated Morbidity in Lung Transplanted Adults. J Heart Lung Transplant, 2020, 39(4): S385.
12.	Atkins BZ, Petersen RP, Daneshmand MA, et al. Impact of Oropharyngeal Dysphagia on Long-Term Outcomes of Lung Transplantation. Ann Thorc Surg, 2010, 90(5): 1622-1642.
13.	York JD, Colsky J, Croft K, et al. Dysphagia in Lung Transplant Recipients: Prevalence, Risk Factors and Health-Related Outcomes. J Heart Lung Transplant, 2021, 40(4): S349.
14.	Miles A, Barua S, McLellan N, et al. Dysphagia and medicine regimes in patients following lung transplant surgery: A retrospective review. Int J Speech Lang Pathol, 2021, 23(4): 339-348.
15.	Reedy EL, Simpson AN, O'Rourke AK, et al. Characterizing Swallowing Impairment in a Post-Lung Transplant Population. Am J Speech Lang Pathol, 2023, 32(3): 1236-1251.
16.	Atkins BZ, Trachtenberg MS, Prince-Petersen R, et al. Assessing oropharyngeal dysphagia after lung transplantation: altered swallowing mechanisms and increased morbidity. J Heart Lung Transplant, 2007, 26(11): 1144-1148.
17.	Bhama JK, Baumann BM, Byers S, et al. Aspiration after Lung Transplantation: Incidence, Risk Factors, and Accuracy of the Bedside Swallow Evaluation. J Heart Lung Transplant, 2012, 31(4): S247-S248.
18.	Jadcherla AV, Litzenberg K, Balasubramanian G. Esophageal Dysfunction in Post-lung Transplant: An Enigma. Dysphagia, 2023, 38(3): 731-743.
19.	中国吞咽障碍评估与治疗专家共识(2017年版)第一部分评估篇. 中华物理医学与康复杂志, 2017, 39(12): 881-892.
20.	李秀云, 孟玲. 吞咽障碍康复护理专家共识. 护理学杂志, 2021, 36(15): 1-4.
21.	Sassi FC, de Medeiros GC, Zambon LS, et al. Evaluation and classification of post-extubation dysphagia in critically ill patients. Revista do Colegio Brasileiro de Cirurgioes, 2018, 45(3).
22.	Colonel P, Houzé MH, Vert H, et al. Swallowing disorders as a predictor of unsuccessful extubation: a clinical evaluation. Am J Crit Care, 2008, 17(6): 504-510.
23.	余金甜, 陈俊杉, 张爱琴. 心脏术后患者发生获得性吞咽障碍危险因素的Meta分析. 中华护理杂志, 2020, 55(03): 451-456.
24.	Di Nardo M, Tikkanen J, Husain S, et al. Postoperative Management of Lung Transplant Recipients in the Intensive Care Unit. Anesthesiology, 2022, 136(3): 482-499.
25.	周萌, 胡可鉴, 石丽, 等. 心脏术后患者发生获得性吞咽障碍的危险因素分析. 中华护理杂志, 2016, 51(04): 420-423.
26.	Bader C A, Keilmann A. [Swallowing Disorders in Tracheo(s)tomized Patients]. Laryngorhinootologie, 2017, 96(5): 280-292.
27.	梁江淑渊, 曾妃, 顾培培, 等. 肺移植术后患者匹配式运动训练方案的构建及应用. 中华护理杂志, 2023, 58(08): 901-906.
28.	Xia Y, Ragalie W, Yang E H, et al. Venoarterial Versus Venovenous Extracorporeal Membrane Oxygenation As Bridge to Lung Transplantation. Ann Thorac Surg, 2022, 114(6): 2080-2086.
29.	Hayanga J, Chan EG, Musgrove K, et al. Extracorporeal Membrane Oxygenation in the Perioperative Care of the Lung Transplant Patient. Semin Cardiothorac Vasc Anesth, 2020, 24(1): 45-53.
30.	Qin ES, Hough CL, Andrews J, et al. Intensive care unit-acquired weakness and the COVID-19 pandemic: A clinical review. PM R, 2022, 14(2): 227-238.
31.	Nasir BS, Klapper J, Hartwig M. Lung Transplant from ECMO: Current Results and Predictors of Post-transplant Mortality. Curr Transplant Rep, 2021, 8(2): 140-150.
32.	Zuercher P, Moret CS, Dziewas R, et al. Dysphagia in the intensive care unit: epidemiology, mechanisms, and clinical management. Crit Care, 2019, 23(1): 103.
33.	Hayanga AJ, Aboagye J, Esper S, et al. Extracorporeal membrane oxygenation as a bridge to lung transplantation in the United States: an evolving strategy in the management of rapidly advancing pulmonary disease. J Thorac Cardiovasc Surg, 2015, 149(1): 291-296.
34.	de Pablo A, Alonso R, Ciriza C, et al. Gastroesophageal Reflux and Esophageal Motility Disorder After Lung Transplant: Influence on the Transplanted Graft. Transplantation Proceedings, 2021, 53(6): 1989-1997.

1. Macht M, Wimbish T, Bodine C, et al. ICU-acquired swallowing disorders. Crit Care Med, 2013, 41(10): 2396-2405.
2. 戚春霞, 厉春林, 张雅芝, 等. 重症患者ICU获得性吞咽障碍影响因素的Meta分析. 中华护理杂志, 2021, 56(8): 1236-1241.
3. Dallal-York J, Segalewitz T, Croft K, et al. Incidence, risk factors, and sequelae of dysphagia mediated aspiration following lung transplantation. J Heart Lung Transplant, 2022, 41(8): 1095-1103.
4. Schmidt LJ, Hoksch B, Luder G, et al. Early Assessment and Management of Dysphagia After Lung Resection: A Randomized Controlled Trial. Ann Thorac Surg, 2019, 108(4): 1059-1064.
5. Black R, McCabe P, Glanville A, et al. Oropharyngeal dysphagia and laryngeal dysfunction after lung and heart transplantation: A systematic review. Disability & Rehabilitation, 2020, 42(15): 2083-2092.
6. Singer ML, Fynes MM. Dysphagia after lung transplantation: Exploring best treatment practices. Dysphagia, 2016, 31(6): 838-839.
7. Skoretz SA, Graham M, Kamitomo G, et al. The Incidence of Oropharyngeal Dysphagia and Associated Risk Factors Following Double Lung Transplantation: A Retrospective Study. J Heart Lung Transplant, 2010, 29(2): S133-S134.
8. Lill I, Lovin D, Mohanka M, et al. Predictors and Outcomes among Patients with Early Swallow Dysfunction after Lung Transplantation. J Heart Lung Transplant, 2020, 39(4): S318.
9. Baumann B, Byers S, Wasserman-Wincko T, et al. Postoperative Swallowing Assessment After Lung Transplantation. Ann Thorac Surg, 2017, 104(1): 308-312.
10. Cangemi DJ, Flanagan R, Bailey A, et al. Jackhammer Esophagus After Lung Transplantation: Results of a Retrospective Multicenter Study. J Clin Gastroenterol, 2020, 54(4): 322-326.
11. Plowman E K, DiBiase L, Anderson A, et al. Incidence of Dysphagia and Associated Morbidity in Lung Transplanted Adults. J Heart Lung Transplant, 2020, 39(4): S385.
12. Atkins BZ, Petersen RP, Daneshmand MA, et al. Impact of Oropharyngeal Dysphagia on Long-Term Outcomes of Lung Transplantation. Ann Thorc Surg, 2010, 90(5): 1622-1642.
13. York JD, Colsky J, Croft K, et al. Dysphagia in Lung Transplant Recipients: Prevalence, Risk Factors and Health-Related Outcomes. J Heart Lung Transplant, 2021, 40(4): S349.
14. Miles A, Barua S, McLellan N, et al. Dysphagia and medicine regimes in patients following lung transplant surgery: A retrospective review. Int J Speech Lang Pathol, 2021, 23(4): 339-348.
15. Reedy EL, Simpson AN, O'Rourke AK, et al. Characterizing Swallowing Impairment in a Post-Lung Transplant Population. Am J Speech Lang Pathol, 2023, 32(3): 1236-1251.
16. Atkins BZ, Trachtenberg MS, Prince-Petersen R, et al. Assessing oropharyngeal dysphagia after lung transplantation: altered swallowing mechanisms and increased morbidity. J Heart Lung Transplant, 2007, 26(11): 1144-1148.
17. Bhama JK, Baumann BM, Byers S, et al. Aspiration after Lung Transplantation: Incidence, Risk Factors, and Accuracy of the Bedside Swallow Evaluation. J Heart Lung Transplant, 2012, 31(4): S247-S248.
18. Jadcherla AV, Litzenberg K, Balasubramanian G. Esophageal Dysfunction in Post-lung Transplant: An Enigma. Dysphagia, 2023, 38(3): 731-743.
19. 中国吞咽障碍评估与治疗专家共识(2017年版)第一部分评估篇. 中华物理医学与康复杂志, 2017, 39(12): 881-892.
20. 李秀云, 孟玲. 吞咽障碍康复护理专家共识. 护理学杂志, 2021, 36(15): 1-4.
21. Sassi FC, de Medeiros GC, Zambon LS, et al. Evaluation and classification of post-extubation dysphagia in critically ill patients. Revista do Colegio Brasileiro de Cirurgioes, 2018, 45(3).
22. Colonel P, Houzé MH, Vert H, et al. Swallowing disorders as a predictor of unsuccessful extubation: a clinical evaluation. Am J Crit Care, 2008, 17(6): 504-510.
23. 余金甜, 陈俊杉, 张爱琴. 心脏术后患者发生获得性吞咽障碍危险因素的Meta分析. 中华护理杂志, 2020, 55(03): 451-456.
24. Di Nardo M, Tikkanen J, Husain S, et al. Postoperative Management of Lung Transplant Recipients in the Intensive Care Unit. Anesthesiology, 2022, 136(3): 482-499.
25. 周萌, 胡可鉴, 石丽, 等. 心脏术后患者发生获得性吞咽障碍的危险因素分析. 中华护理杂志, 2016, 51(04): 420-423.
26. Bader C A, Keilmann A. [Swallowing Disorders in Tracheo(s)tomized Patients]. Laryngorhinootologie, 2017, 96(5): 280-292.
27. 梁江淑渊, 曾妃, 顾培培, 等. 肺移植术后患者匹配式运动训练方案的构建及应用. 中华护理杂志, 2023, 58(08): 901-906.
28. Xia Y, Ragalie W, Yang E H, et al. Venoarterial Versus Venovenous Extracorporeal Membrane Oxygenation As Bridge to Lung Transplantation. Ann Thorac Surg, 2022, 114(6): 2080-2086.
29. Hayanga J, Chan EG, Musgrove K, et al. Extracorporeal Membrane Oxygenation in the Perioperative Care of the Lung Transplant Patient. Semin Cardiothorac Vasc Anesth, 2020, 24(1): 45-53.
30. Qin ES, Hough CL, Andrews J, et al. Intensive care unit-acquired weakness and the COVID-19 pandemic: A clinical review. PM R, 2022, 14(2): 227-238.
31. Nasir BS, Klapper J, Hartwig M. Lung Transplant from ECMO: Current Results and Predictors of Post-transplant Mortality. Curr Transplant Rep, 2021, 8(2): 140-150.
32. Zuercher P, Moret CS, Dziewas R, et al. Dysphagia in the intensive care unit: epidemiology, mechanisms, and clinical management. Crit Care, 2019, 23(1): 103.
33. Hayanga AJ, Aboagye J, Esper S, et al. Extracorporeal membrane oxygenation as a bridge to lung transplantation in the United States: an evolving strategy in the management of rapidly advancing pulmonary disease. J Thorac Cardiovasc Surg, 2015, 149(1): 291-296.
34. de Pablo A, Alonso R, Ciriza C, et al. Gastroesophageal Reflux and Esophageal Motility Disorder After Lung Transplant: Influence on the Transplanted Graft. Transplantation Proceedings, 2021, 53(6): 1989-1997.

Chinese Journal of Respiratory and Critical Care Medicine

Meta-analysis and systematic review of risk factors for dysphagia in lung transplant recipients

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