الفهرس 
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Abstract
Summary
Mechanical ventilation is made through endotracheal intubation, which is frequently a crucial and life-saving procedure. Although endotracheal intubation is a well-established operation that has been used since the late eighteenth century, there are some risks involved, including laryngeal damage and post-extubation dysphagia (PED).(McIntyre et al., 2020).
Dysphagia is a subjective sensation of difficulty in moving food from the mouth to the stomach. The term dysphagia is derived from two Greek words: ”dys” (difficulty) and ”phagia” (eat). (Lugaro et al., 2017). Post-extubation dysphagia (PED) has been reported in 14% to 83% of adult patients undergoing prolonged mechanical ventilation. (Brodsky et al., 2021).
The aim of the study:
The current study aims to identify the ascertain risk factors for dysphagia at Assiut university hospital.
Design:
Descriptive research design that was conducted in this study.
Setting:
This study was conducted in three ICU (general intensive care unit, traumatic unit and anesthesia care unit) at Assuit University Hospitals.
Sampling:
Convenient sample of 100 adult (age 18-60 years) intubated patients>48 h, hemodynamic stable, and has a Glasgow Coma Scale score that was >14 points
Study tools:
Two main tools were used during data collection, the first was developed by the researcher and the second was adopted by the researcher.
Tool one: ” Contributing factors for post-extubation assessment “Including: it was developed by the researcher after extensive review of the related literature. (Chen & Qian, 2020; McIntyre et al., 2021; Oliveira et al., 2018). This tool was used to assess patient profile and condition, and divided into two parts:
Part 1: Demographic and clinical data:
This part will include patient’s demographic data such as patient’s age, sex, and clinical data: it includes: Patient data, Mechanical ventilation data., Invasive device data: and acute physiological and chronic health evaluation II (APACHE II),Neurological data, Confusion Assessment Method for ICU (CAM ICU),Richmond Agitation-Sedation Scale (RASS score).
Part 2: Hemodynamic parameter: heart rate, blood pressure, CVP, urine output.
Tool two:Gugging Swallow Screen (GuSS-ICU) bedside swallowing screening tool: is post-extubation swallowing screen. This tool was used to detecting swallowing disorders for patient in ICU. It was adopted by the researchers.(Trapl-grundschober et al., 2018). Gugging Swallowing Screen was done by the researcher to assess the occurrence of dysphagia after 24 hours The GUSS consists of two tests:
1- The indirect swallowing test (test 1):which includes patients who have been intubated > 72 h, extubated>24 h, RASS score, the CAM-ICU, fed via a naos-gastric tube (NGT), stridor present, ask patient to cough, observe a saliva swallow, drooling, and voice change) .
2- The direct swallowing test (test 2): which consists of 3 subtests, these subtests were performed sequentially. This would include administered of water, semi-solid and bread with four distinct signs that were being assessed for deglutition, coughing, drooling and voice change. Whether the patient was able to pass this final stage would determine whether they then able to tolerate a free diet. (da Silva Ferreira et al., 2018)
Each subtest has a maximum 5 points which can be reached. The highest total score ranged from twenty to twenty five points that denotes normal swallowing ability without aspiration risk. In which total 4 levels of severity can be determined:
- 0-9 Points: severe dysphagia and high risk for aspiration;
- 10-14 Points: moderate dysphagia and moderate risk of aspiration;
- 15-19 Points: mild dysphagia with low risk of aspiration;
- 20-25 Points: normal swallowing ability.
The main results:
It was noted that the greatest percentage of studied patients were moderate dysphagia (60.4 %), with significant statistically difference between some of risk factors and occurrence of post-extubation dysphasia with (p value<0.01). .These risk factors include duration of intubation, gastric tube size, gastric tube period, and length of stay in the intensive care unit.