Treating postextubation dysphagia after stroke with pharyngeal electrical stimulation -insights from a randomized controlled pilot trial.

Suntrup-Krueger S; Labeit B; von Itter J; Jung A; Claus I; Ahring S; Warnecke T; Dziewas R; Muhle P

Abstract

Postextubation dysphagia is a major risk factor for extubation failure in acute stroke. Pharyngeal electrical stimulation (PES) is a novel neurostimulation technique for neurogenic dysphagia rehabilitation. We conducted a randomized controlled pilot trial evaluating PES early after extubation in acute stroke (N ​= ​60) focusing on dysphagia recovery trajectories and related outcomes until discharge. Patients with severe postextubation dysphagia, defined as Fiberoptic Endoscopic Dysphagia Severity Scale (FEDSS) score >4, received daily PES (real or sham, 10 ​min/day) for 3 consecutive days. By day 3, significantly fewer patients in the PES group exhibited persistent absence of spontaneous swallows (8 vs. 41 ​%) or pharyngeal sensory loss (4 vs. 55 ​%) compared to the sham group, indicating enhanced airway safety. Functional Oral Intake Scale (FOIS) score at day 3 was significantly higher in the PES group (4.1 vs 2.1 ​pts). FEDSS at days 5-7 and 8-10 showed a sustained treatment effect over time (2.4 vs. 3.7 ​pts. and 2.2 vs. 3.4 ​pts), resulting in better FOIS at discharge (4.7 vs. 3.5 pts.). PES shortened LOS in the intensive care unit (ICU) (3.1 vs. 8.5 days, p ​= ​0.008) and total hospital stay (13.8 vs. 21.9 days, p ​= ​0.004) from study inclusion. Tracheotomy rates were 13 vs. 33 ​% (p ​< ​0.067). The proportion of patients still cannulated at discharge (7 vs. 10 ​%) and the modified Rankin Scale at discharge (3.9 vs. 4.0) were comparable. PES enhanced recovery of postextubation dysphagia, improved airway safety and shortened length of ICU and hospital stay in acute stroke.