危重症患者拔管后吞咽困难评估工具的测量学特性：一项系统综述
Measurement properties of instruments for post-extubation dysphagia in critically ill patients: A systematic review.
文献信息
| PMID | 42849168 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Lilly Koppelkamm |
| 作者单位 | Charité - University Medical Center Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Nephrology and Medical Intensive Care, Augustenburger Platz 1, 13353 Berlin, Germany. Electronic address: lilly-johanna.koppelkamm@charite.de. |
| 期刊 | Intensive & critical care nursing |
| SCI 分区 | Q1 |
| IF | 5.2 |
| 研究类型 | 综述 Meta · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
目的： 拔管后吞咽困难（PED）是危重症患者接受有创机械通气后常见但常被低估的并发症。在常规ICU实践中，对PED进行系统性评估并不常见。本系统综述旨在识别用于评估危重症成人患者PED的临床工具，并评价其测量学特性。
方法： 本综述按照COSMIN测量工具系统综述方法学进行。在多个数据库及其他来源中进行了全面的证据检索。若研究开发或应用了标准化评估工具以识别危重症成人（≥18岁）的PED，则纳入研究。
结果： 在审查的2769篇摘要中，22项研究符合纳入标准。共识别出16种用于评估PED的不同工具。这些工具被归类为饮水试验、多稠度试验以及不包含吞咽评估的评估方法。有9种工具报告了测量学特性，主要集中于内容效度、效标效度和信度，且大多显示出良好的测量学特性。拔管后吞咽困难筛查工具是唯一在全部三种特性上均被评价的工具，并显示出充分的测量学特性。总体证据质量大多为低至极低。
结论： 针对危重症成人PED存在多种临床评估工具。大多数工具显示出良好的效标效度，表明其具有临床应用的潜力。然而，其他测量学特性在很大程度上仍不明确，且证据质量总体较低。因此，目前尚不清楚哪种工具最适合评估PED。需要进一步研究其效度和信度，以确定适合常规ICU使用的工具。
对临床实践的意义： 对PED进行系统性检测十分重要。应使用具有良好诊断性能的评估工具，以改善ICU照护。
英文摘要
OBJECTIVES: Post-extubation dysphagia (PED) is a common but often under-recognised complication in critically ill patients following invasive mechanical ventilation. Systematic assessment of PED in routine ICU practice is not common. This systematic review aimed to identify clinical instruments used to assess PED in critically ill adult patients and to evaluate their measurement properties.
METHODS: This review was conducted in accordance with the COSMIN methodology for systematic reviews of measurement instruments. A comprehensive evidence search was performed in multiple databases and other sources. Studies were included if they developed or applied standardised assessment instruments for the identification of PED in critically ill adults (≥18 years).
RESULTS: Of 2769 abstracts reviewed, 22 studies met criteria for inclusion. Sixteen different instruments for the assessment of PED were identified. These were categorised into water swallow tests, multi-consistency tests, and assessments without a swallowing evaluation. For nine instruments, measurement properties were reported, focusing on content validity, criterion validity and reliability, and demonstrated mostly good measurement properties. The Post-Extubation Dysphagia Screening Tool was the only evaluated across all three properties and showed sufficient measurement properties. The overall quality of evidence was mostly low to very low.
CONCLUSIONS: There are various clinical assessment instruments for PED in critically ill adults. Most instruments showed good criterion validity, indicating their potential for clinical use. However, other measurement properties are largely unknown, and the quality of evidence is generally low. Thus, it is currently unclear which tool is best suited for assessing PED. Further research investigating validity and reliability is needed to identify instruments suitable for routine ICU use.
IMPLICATIONS FOR CLINICAL PRACTICE: Systematic detection of PED is important. Assessment instruments with good diagnostic performance should be used to improve ICU care.