Clinical predictors of outcome after pharyngeal electrical stimulation (PES) in non- stroke related neurogenic dysphagia after mechanical ventilation and tracheotomy: Results from subgroup analysis of PHADER study

Cheng, Ivy; Bath, Philip M; Hamdy, Shaheen; Muhle, Paul; Mistry, Satish; Dziewas, Rainer; Suntrup-Krueger, Sonja

Abstract

Background
Pharyngeal electrical stimulation (PES) is a neurostimulation intervention that can improve swallowing and facilitate decannulation in tracheotomised stroke patients with dysphagia. The PHAryngeal electrical stimulation for treatment of neurogenic Dysphagia European Registry (PHADER) study found that PES can reduce dysphagia severity in patients with neurogenic (non-stroke) dysphagia who required mechanical ventilation and tracheotomy. However, the predictive factors for treatment success among these patients remain unclear.

Methods
We conducted a subgroup analysis using data from PHADER, with a focus on non-stroke participants who had required mechanical ventilation and tracheotomy. Multiple linear regression was performed to predict treatment success, as measured in improvement in dysphagia severity rating scale (DSRS) total score, accounting for age, sex, time from diagnosis to PES, PES perceptual threshold and PES stimulation intensity at the first session.

Results
Fifty-seven participants (mean[standard deviation] age: 63.6[15.5] years; male: 70.2%) were included in the analysis. These comprised traumatic brain injury (22[38.6%]), critical illness polyneuropathy (15[26.4%]), and other neurological conditions that caused dysphagia (20[35.0%]). Regression analyses identified that a lower PES perceptual threshold at the first session (p = 0.027) and early intervention (p = 0.004) were significant predictors associated with treatment success at Day 9 and 3 months post PES respectively.

Conclusions
We identified two predictive factors associated with successful PES treatment in patients with neurogenic (non-stroke) dysphagia requiring mechanical ventilation and tracheotomy: a lower PES perceptual threshold at the first session and early intervention. These predictors provide critical guidance for optimizing clinical decision-making in managing non-stroke neurogenic dysphagia patients in critical care settings.

Citation

Cheng, I., Bath, P. M., Hamdy, S., Muhle, P., Mistry, S., Dziewas, R., & Suntrup-Krueger, S. (2025). Clinical predictors of outcome after pharyngeal electrical stimulation (PES) in non- stroke related neurogenic dysphagia after mechanical ventilation and tracheotomy: Results from subgroup analysis of PHADER study. Neurological Research and Practice, 7, Article 23. https://doi.org/10.1186/s42466-025-00380-5

• Journal Article Type: Article
• Acceptance Date: Mar 17, 2025
• Online Publication Date: Apr 7, 2025
• Publication Date: Apr 7, 2025
• Deposit Date: Mar 26, 2025
• Publicly Available Date: Mar 26, 2025
• Journal: Neurological Research and Practice
• Electronic ISSN: 2524-3489
• Publisher: BioMed Central
• Peer Reviewed: Peer Reviewed
• Volume: 7
• Article Number: 23
• DOI: https://doi.org/10.1186/s42466-025-00380-5
• Keywords: Dysphagia, Electrical stimulation, Mechanical ventilation, Pharynx, Tracheotomy
• Public URL: https://nottingham-repository.worktribe.com/output/47000856
• Publisher URL: https://neurolrespract.biomedcentral.com/articles/10.1186/s42466-025-00380-5#Abs1