A scoping review of assessment tools for post-extubation dysphagia in ICU patients on mechanical ventilation_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

YANG Yun ^1,2 ,  ZHANG Liya ^1,3 , QIN Jianfeng ² , HU Wei ² , LI Zhenzhen ²

1. School of Medicine, Tongji University, Shanghai 200331, P.R. China;
2. Department of Critical Care Medicine, Shanghai Tianyou Hospital, Shanghai 200331, P.R. China;
3. Nursing Department, Tongji Hospital Affiliated to Tongji University, Shanghai 200065, P.R. China;

Corresponding?author：

ZHANG Liya, Email: lialia7@126.com

Keywords：

Mechanical ventilation; post-extubation dysphagia; assessment tools; scoping review; intensive care unit

DOI：

10.7507/1671-6205.202605103

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To systematically review the research status of various assessment tools for post-extubation dysphagia (PED) in mechanically ventilated ICU patients, and analyze their clinical characteristics and application scenarios. Methods In accordance with the 2020 JBI scoping review guidelines and the PCC framework, relevant literature was retrieved from eight domestic and international databases from inception to May 2025. Two researchers independently screened the literature and extracted data. Results A total of 24 studies involving 24 PED assessment tools were included, which were classified into three categories (screening, diagnostic, and dynamic monitoring). Screening tools are sensitive and convenient, suitable for bedside preliminary screening; diagnostic tools are precise and reliable, relying on multidisciplinary collaboration; dynamic monitoring tools focus on tracking long-term recovery. Together, they cover the full-course management of patients. Existing studies show significant heterogeneity, and there is insufficient domestic evidence. Conclusions Current PED assessment tools have formed a hierarchical application framework, yet unified clinical application standards are lacking. It is recommended to standardize the assessment procedure, promote the localization of tools and nurse-led screening, and optimize the assessment process combined with biomarkers and intelligent technology, so as to improve the early identification and clinical management quality of PED.

1.	Walter JM, Corbridge TC, Singer BD. Invasive mechanical ventilation[J]. South Med J, 2018, 111(12): 746-753.
2.	McIntyre M, Doeltgen S, Dalton N, et al. Post-extubation dysphagia incidence in critically ill patients: a systematic review and meta-analysis[J]. Aust Crit Care, 2021, 34(1): 67-75.
3.	Bertschi D, Rotondo F, Waskowski J, et al. Post-extubation dysphagia in the ICU-a narrative review: epidemiology, mechanisms and clinical management (Update 2025)[J]. Crit Care, 2025, 29(1): 244.
4.	李華強, 高佳新, 劉建成, 等. 重癥監護室獲得性吞咽障礙發病率的Meta分析[J]. 中國呼吸與危重監護雜志, 2023, 22(7): 492-499.
5.	Zuercher P, Schenk NV, Moret C, et al. Risk factors for dysphagia in ICU patients after invasive mechanical ventilation[J]. Chest, 2020, 158(5): 1983-1991.
6.	Spronk PE, Spronk LE, Egerod I, et al. Dysphagia in intensive care evaluation (DICE): an international cross-sectional survey[J]. Dysphagia, 2022, 37(6): 1451-1460.
7.	朱巖, 蘭美娟, 梁江淑淵, 等. 肺移植受者發生吞咽障礙危險因素的Meta分析和系統評價[J]. 中國呼吸與危重監護雜志, 2024, 23(10): 719-726.
8.	Banda KJ, Chu H, Kang XL, et al. Prevalence of dysphagia and risk of pneumonia and mortality in acute stroke patients: a meta-analysis[J]. BMC Geriatr, 2022, 22(1): 420.
9.	Lee TW, Hong JW, Yoo JW, et al. Unplanned extubation in patients with mechanical ventilation: Experience in the medical intensive care unit of a single tertiary hospital[J]. Tuberc Respir Dis (Seoul), 2015, 78(4): 336-340.
10.	Peters MDJ, Marnie C, Tricco AC, et al. Updated methodological guidance for the conduct of scoping reviews[J]. JBI Evid Synth, 2020, 18(10): 2119-2126.
11.	Schandl A, Bergstr?m L, Selg J, et al. Identifying dysphagia in the intensive care unit: validation of the Swedish version of the Gugging swallowing screen-Intensive care unit[J]. Acta Anaesthesiol Scand, 2025, 69(5): e70031.
12.	Nielsen AH, Winding R, Busk BH, et al. Nurse-led dysphagia screening in the intensive care unit - An implementation study[J]. Aust Crit Care, 2025, 38(1): 101100.
13.	Troll C, Trapl-Grundschober M, Teuschl Y, et al. A bedside swallowing screen for the identification of post-extubation dysphagia on the intensive care unit - validation of the Gugging Swallowing Screen (GUSS)-ICU[J]. BMC Anesthesiol, 2023, 23(1): 122.
14.	Martínez de Lagrán ZI, Laguna LB, Soria CV, et al. Utility of the modified volume-viscosity swallow test for bedside screening of dysphagia in critically ill patients[J]. Clin Nutr ESPEN, 2023, 53: 214-223.
15.	Armas-Navarro LP, Santana-Padilla YG, Mendoza-Segura L, et al. Dysphagia in intensive care, a real problem: analysis of risk factors[J]. Enferm Intensiva (Engl Ed), 2023, 34(3): 115-125.
16.	Mu?oz-Garach M, Moreno-Romero O, Ramirez-Puerta R, et al. Accuracy of modified blue-dye testing in predicting dysphagia in tracheotomized critically ill patients[J]. Diagnostics (Basel), 2023, 13(4): 616.
17.	Zayed AM, Afsah O, Elhadidy T, et al. Screening for oropharyngeal dysphagia in hospitalized COVID-19 patients: a prospective study[J]. Eur Arch Otorhinolaryngol, 2023, 280(5): 2623-2631.
18.	Tang JY, Feng XQ, Huang XX, et al. Development and validation of a predictive model for patients with post-extubation dysphagia[J]. World J Emerg Med, 2023, 14(1): 49-55.
19.	Zuercher P, Lang B, Moser M, et al. Dysphagia incidence in intensive care unit patients with coronavirus disease 2019: retrospective analysis following systematic dysphagia screening[J]. J Laryngol Otol, 2022, 136(12): 1278-1283.
20.	Yamada T, Ochiai R, Kotake Y. Changes in maximum tongue pressure and postoperative dysphagia in mechanically ventilated patients after cardiovascular surgery[J]. Indian J Crit Care Med, 2022, 26(12): 1253-1258.
21.	Siao SF, Tseng WH, Wang TG, et al. Predicting feeding-tube dependence in patients following endotracheal extubation: a two-item swallowing screen[J]. BMC Pulm Med, 2021, 21(1): 403.
22.	Mukdad L, Toppen W, Nguyen S, et al. A targeted swallow screen for the detection of postoperative dysphagia in liver transplant patients[J]. Prog Transplant, 2019, 29(1): 4-10.
23.	Suntrup-Krueger S, Schmidt S, Warnecke T, et al. Extubation readiness in critically ill stroke patients[J]. Stroke, 2019, 50(8): 1981-1988.
24.	Leder SB, Warner HL, Suiter DM, et al. Evaluation of swallow function post-extubation: is it necessary to wait 24 hours?[J]. Ann Otol Rhinol Laryngol, 2019, 128(7): 619-624.
25.	Regala M, Marvin S, Ehlenbach WJ. Association between postextubation dysphagia and long-term mortality among critically ill older adults[J]. J Am Geriatr Soc, 2019, 67(9): 1895-1901.
26.	Omura K, Komine A, Yanagigawa M, et al. Frequency and outcome of post-extubation dysphagia using nurse-performed swallowing screening protocol[J]. Nurs Crit Care, 2019, 24(2): 70-75.
27.	Johnson KL, Speirs L, Mitchell A, et al. Validation of a postextubation dysphagia screening tool for patients after prolonged endotracheal intubation[J]. Am J Crit Care, 2018, 27(2): 89-96.
28.	Oliveira AC, Friche AA, Salom?o MS, et al. Predictive factors for oropharyngeal dysphagia after prolonged orotracheal intubation[J]. Braz J Otorhinolaryngol, 2018, 84(6): 722-728.
29.	Brodsky MB, Huang M, Shanholtz C, et al. Recovery from dysphagia symptoms after oral endotracheal intubation in acute respiratory distress syndrome survivors[J]. A 5-year longitudinal study[J]. Ann Am Thorac Soc, 2017, 14(3): 376-383.
30.	Lynch YT, Clark BJ, Macht M, et al. The accuracy of the bedside swallowing evaluation for detecting aspiration in survivors of acute respiratory failure[J]. J Crit Care, 2017, 39: 143-148.
31.	Park HS, Koo JH, Song SH. Association of post-extubation dysphagia with tongue weakness and somatosensory disturbance in non-neurologic critically ill patients[J]. Ann Rehabil Med, 2017, 41(6): 961-968.
32.	See KC, Peng SY, Phua J, et al. Nurse-performed screening for postextubation dysphagia: a retrospective cohort study in critically ill medical patients[J]. Crit Care, 2016, 20(1): 326.
33.	Kallesen M, Psirides A, Huckabee ML. Comparison of cough reflex testing with videoendoscopy in recently extubated intensive care unit patients[J]. J Crit Care, 2016, 33: 90-94.
34.	Scheel R, Pisegna JM, McNally E, et al. Endoscopic assessment of swallowing after prolonged intubation in the ICU setting[J]. Ann Otol Rhinol Laryngol, 2016, 125(1): 43-52.
35.	Fan E, Zakhary B, Amaral A, et al. Liberation from mechanical ventilation in critically ill adults[J]. An official ATS/ACCP clinical practice guideline[J]. Ann Am Thorac Soc, 2017, 14(3): 441-443.
36.	Wunderle C, Gomes F, Schuetz P, et al. ESPEN practical guideline: Nutritional support for polymorbid medical inpatients[J]. Clin Nutr, 2024, 43(3): 674-691.
37.	Mpouzika M, Iordanou S, Kyranou M, et al. Strategies of screening and treating post-extubation dysphagia: An overview of the situation in Greek-Cypriot ICUs[J]. Healthcare (Basel), 2023, 11(16): 2283.
38.	Harrell KN, Lee WB, Rooks HJ, et al. Early pneumonia diagnosis decreases ventilator-associated pneumonia rates in trauma population[J]. J Trauma Acute Care Surg, 2023, 94(1): 30-35.
39.	周菁, 田坤, 吳奎, 等. 呼吸重癥監護室搶救性氣管插管不同鎮靜鎮痛方法的比較研究[J]. 中國呼吸與危重監護雜志, 2014, 13(3): 254-258.
40.	Darmon JY, Rauss A, Dreyfuss D, et al. Evaluation of risk factors for laryngeal edema after tracheal extubation in adults and its prevention by dexamethasone[J]. A placebo-controlled, double-blind, multicenter study[J]. Anesthesiology, 1992, 77(2): 245-251.
41.	熊厚仁, 朱明華, 方明, 等. 肺部超聲引導肺康復訓練在ICU機械通氣患者中的應用[J]. 中國呼吸與危重監護雜志, 2024, 23(9): 634-639.
42.	Hou L, Li Y, Wang J, et al. Risk factors for post-extubation dysphagia in ICU: A systematic review and meta-analysis[J]. Medicine (Baltimore), 2023, 102(10): e33153.
43.	Yu W, Dan L, Cai J, et al. Incidence of post-extubation dysphagia among critical care patients undergoing orotracheal intubation: a systematic review and meta-analysis[J]. Eur J Med Res, 2024, 29(1): 444.
44.	Chen J, Lu G, Wang Z, et al. Prediction models for dysphagia in intensive care unit after mechanical ventilation: a systematic review and meta-analysis[J]. Laryngoscope, 2024, 134(2): 517-525.
45.	Zuercher P, Moret CS, Dziewas R, et al. Dysphagia in the intensive care unit: epidemiology, mechanisms, and clinical management[J]. Crit Care, 2019, 23(1): 103.
46.	Krisciunas GP, Scheel R, Slavin M. Implementing dysphagia outcome assessments into clinical settings: Leveraging principles of implementation, dissemination, and psychometrics[J]. Am J Speech Lang Pathol, 2024, 33(2): 707-715.
47.	Rosa D, Albanesi B, Bassola B, et al. Nurse's bedside screening of dysphagia: an umbrella review[J]. Recenti Prog Med, 2022, 113(6): 361-371.
48.	Manduchi B, Fitch MI, Ringash JG, et al. A core outcome set for patient-reported dysphagia for use in head and neck cancer clinical trials: an international multistakeholder Delphi study[J]. Head Neck, 2024, 46(4): 831-848.
49.	Sole ML, Talbert SR, Rathbun KP, et al. Is α-amylase an important biomarker to detect aspiration of oral secretions in ventilated patients[J]? Crit Care Explor, 2020, 2(7): e0159.
50.	Malandraki GA. Advances for dysphagia in the digital age: Integrative imaging and wearable technologies[J]. Folia Phoniatr Logop, 2023, 75(4): 208-218.
51.	Wong DW, Wang J, Cheung SM, et al. Current technological advances in dysphagia screening: Systematic scoping review[J]. J Med Internet Res, 2025, 27: e65551.
52.	郝恬, 程潔, 李琦, 等. 膈神經電刺激對ICU機械通氣患者拔管結局影響的Meta分析[J]. 中國呼吸與危重監護雜志, 2025, 24(1): 9-17.

1. Walter JM, Corbridge TC, Singer BD. Invasive mechanical ventilation[J]. South Med J, 2018, 111(12): 746-753.
2. McIntyre M, Doeltgen S, Dalton N, et al. Post-extubation dysphagia incidence in critically ill patients: a systematic review and meta-analysis[J]. Aust Crit Care, 2021, 34(1): 67-75.
3. Bertschi D, Rotondo F, Waskowski J, et al. Post-extubation dysphagia in the ICU-a narrative review: epidemiology, mechanisms and clinical management (Update 2025)[J]. Crit Care, 2025, 29(1): 244.
4. 李華強, 高佳新, 劉建成, 等. 重癥監護室獲得性吞咽障礙發病率的Meta分析[J]. 中國呼吸與危重監護雜志, 2023, 22(7): 492-499.
5. Zuercher P, Schenk NV, Moret C, et al. Risk factors for dysphagia in ICU patients after invasive mechanical ventilation[J]. Chest, 2020, 158(5): 1983-1991.
6. Spronk PE, Spronk LE, Egerod I, et al. Dysphagia in intensive care evaluation (DICE): an international cross-sectional survey[J]. Dysphagia, 2022, 37(6): 1451-1460.
7. 朱巖, 蘭美娟, 梁江淑淵, 等. 肺移植受者發生吞咽障礙危險因素的Meta分析和系統評價[J]. 中國呼吸與危重監護雜志, 2024, 23(10): 719-726.
8. Banda KJ, Chu H, Kang XL, et al. Prevalence of dysphagia and risk of pneumonia and mortality in acute stroke patients: a meta-analysis[J]. BMC Geriatr, 2022, 22(1): 420.
9. Lee TW, Hong JW, Yoo JW, et al. Unplanned extubation in patients with mechanical ventilation: Experience in the medical intensive care unit of a single tertiary hospital[J]. Tuberc Respir Dis (Seoul), 2015, 78(4): 336-340.
10. Peters MDJ, Marnie C, Tricco AC, et al. Updated methodological guidance for the conduct of scoping reviews[J]. JBI Evid Synth, 2020, 18(10): 2119-2126.
11. Schandl A, Bergstr?m L, Selg J, et al. Identifying dysphagia in the intensive care unit: validation of the Swedish version of the Gugging swallowing screen-Intensive care unit[J]. Acta Anaesthesiol Scand, 2025, 69(5): e70031.
12. Nielsen AH, Winding R, Busk BH, et al. Nurse-led dysphagia screening in the intensive care unit - An implementation study[J]. Aust Crit Care, 2025, 38(1): 101100.
13. Troll C, Trapl-Grundschober M, Teuschl Y, et al. A bedside swallowing screen for the identification of post-extubation dysphagia on the intensive care unit - validation of the Gugging Swallowing Screen (GUSS)-ICU[J]. BMC Anesthesiol, 2023, 23(1): 122.
14. Martínez de Lagrán ZI, Laguna LB, Soria CV, et al. Utility of the modified volume-viscosity swallow test for bedside screening of dysphagia in critically ill patients[J]. Clin Nutr ESPEN, 2023, 53: 214-223.
15. Armas-Navarro LP, Santana-Padilla YG, Mendoza-Segura L, et al. Dysphagia in intensive care, a real problem: analysis of risk factors[J]. Enferm Intensiva (Engl Ed), 2023, 34(3): 115-125.
16. Mu?oz-Garach M, Moreno-Romero O, Ramirez-Puerta R, et al. Accuracy of modified blue-dye testing in predicting dysphagia in tracheotomized critically ill patients[J]. Diagnostics (Basel), 2023, 13(4): 616.
17. Zayed AM, Afsah O, Elhadidy T, et al. Screening for oropharyngeal dysphagia in hospitalized COVID-19 patients: a prospective study[J]. Eur Arch Otorhinolaryngol, 2023, 280(5): 2623-2631.
18. Tang JY, Feng XQ, Huang XX, et al. Development and validation of a predictive model for patients with post-extubation dysphagia[J]. World J Emerg Med, 2023, 14(1): 49-55.
19. Zuercher P, Lang B, Moser M, et al. Dysphagia incidence in intensive care unit patients with coronavirus disease 2019: retrospective analysis following systematic dysphagia screening[J]. J Laryngol Otol, 2022, 136(12): 1278-1283.
20. Yamada T, Ochiai R, Kotake Y. Changes in maximum tongue pressure and postoperative dysphagia in mechanically ventilated patients after cardiovascular surgery[J]. Indian J Crit Care Med, 2022, 26(12): 1253-1258.
21. Siao SF, Tseng WH, Wang TG, et al. Predicting feeding-tube dependence in patients following endotracheal extubation: a two-item swallowing screen[J]. BMC Pulm Med, 2021, 21(1): 403.
22. Mukdad L, Toppen W, Nguyen S, et al. A targeted swallow screen for the detection of postoperative dysphagia in liver transplant patients[J]. Prog Transplant, 2019, 29(1): 4-10.
23. Suntrup-Krueger S, Schmidt S, Warnecke T, et al. Extubation readiness in critically ill stroke patients[J]. Stroke, 2019, 50(8): 1981-1988.
24. Leder SB, Warner HL, Suiter DM, et al. Evaluation of swallow function post-extubation: is it necessary to wait 24 hours?[J]. Ann Otol Rhinol Laryngol, 2019, 128(7): 619-624.
25. Regala M, Marvin S, Ehlenbach WJ. Association between postextubation dysphagia and long-term mortality among critically ill older adults[J]. J Am Geriatr Soc, 2019, 67(9): 1895-1901.
26. Omura K, Komine A, Yanagigawa M, et al. Frequency and outcome of post-extubation dysphagia using nurse-performed swallowing screening protocol[J]. Nurs Crit Care, 2019, 24(2): 70-75.
27. Johnson KL, Speirs L, Mitchell A, et al. Validation of a postextubation dysphagia screening tool for patients after prolonged endotracheal intubation[J]. Am J Crit Care, 2018, 27(2): 89-96.
28. Oliveira AC, Friche AA, Salom?o MS, et al. Predictive factors for oropharyngeal dysphagia after prolonged orotracheal intubation[J]. Braz J Otorhinolaryngol, 2018, 84(6): 722-728.
29. Brodsky MB, Huang M, Shanholtz C, et al. Recovery from dysphagia symptoms after oral endotracheal intubation in acute respiratory distress syndrome survivors[J]. A 5-year longitudinal study[J]. Ann Am Thorac Soc, 2017, 14(3): 376-383.
30. Lynch YT, Clark BJ, Macht M, et al. The accuracy of the bedside swallowing evaluation for detecting aspiration in survivors of acute respiratory failure[J]. J Crit Care, 2017, 39: 143-148.
31. Park HS, Koo JH, Song SH. Association of post-extubation dysphagia with tongue weakness and somatosensory disturbance in non-neurologic critically ill patients[J]. Ann Rehabil Med, 2017, 41(6): 961-968.
32. See KC, Peng SY, Phua J, et al. Nurse-performed screening for postextubation dysphagia: a retrospective cohort study in critically ill medical patients[J]. Crit Care, 2016, 20(1): 326.
33. Kallesen M, Psirides A, Huckabee ML. Comparison of cough reflex testing with videoendoscopy in recently extubated intensive care unit patients[J]. J Crit Care, 2016, 33: 90-94.
34. Scheel R, Pisegna JM, McNally E, et al. Endoscopic assessment of swallowing after prolonged intubation in the ICU setting[J]. Ann Otol Rhinol Laryngol, 2016, 125(1): 43-52.
35. Fan E, Zakhary B, Amaral A, et al. Liberation from mechanical ventilation in critically ill adults[J]. An official ATS/ACCP clinical practice guideline[J]. Ann Am Thorac Soc, 2017, 14(3): 441-443.
36. Wunderle C, Gomes F, Schuetz P, et al. ESPEN practical guideline: Nutritional support for polymorbid medical inpatients[J]. Clin Nutr, 2024, 43(3): 674-691.
37. Mpouzika M, Iordanou S, Kyranou M, et al. Strategies of screening and treating post-extubation dysphagia: An overview of the situation in Greek-Cypriot ICUs[J]. Healthcare (Basel), 2023, 11(16): 2283.
38. Harrell KN, Lee WB, Rooks HJ, et al. Early pneumonia diagnosis decreases ventilator-associated pneumonia rates in trauma population[J]. J Trauma Acute Care Surg, 2023, 94(1): 30-35.
39. 周菁, 田坤, 吳奎, 等. 呼吸重癥監護室搶救性氣管插管不同鎮靜鎮痛方法的比較研究[J]. 中國呼吸與危重監護雜志, 2014, 13(3): 254-258.
40. Darmon JY, Rauss A, Dreyfuss D, et al. Evaluation of risk factors for laryngeal edema after tracheal extubation in adults and its prevention by dexamethasone[J]. A placebo-controlled, double-blind, multicenter study[J]. Anesthesiology, 1992, 77(2): 245-251.
41. 熊厚仁, 朱明華, 方明, 等. 肺部超聲引導肺康復訓練在ICU機械通氣患者中的應用[J]. 中國呼吸與危重監護雜志, 2024, 23(9): 634-639.
42. Hou L, Li Y, Wang J, et al. Risk factors for post-extubation dysphagia in ICU: A systematic review and meta-analysis[J]. Medicine (Baltimore), 2023, 102(10): e33153.
43. Yu W, Dan L, Cai J, et al. Incidence of post-extubation dysphagia among critical care patients undergoing orotracheal intubation: a systematic review and meta-analysis[J]. Eur J Med Res, 2024, 29(1): 444.
44. Chen J, Lu G, Wang Z, et al. Prediction models for dysphagia in intensive care unit after mechanical ventilation: a systematic review and meta-analysis[J]. Laryngoscope, 2024, 134(2): 517-525.
45. Zuercher P, Moret CS, Dziewas R, et al. Dysphagia in the intensive care unit: epidemiology, mechanisms, and clinical management[J]. Crit Care, 2019, 23(1): 103.
46. Krisciunas GP, Scheel R, Slavin M. Implementing dysphagia outcome assessments into clinical settings: Leveraging principles of implementation, dissemination, and psychometrics[J]. Am J Speech Lang Pathol, 2024, 33(2): 707-715.
47. Rosa D, Albanesi B, Bassola B, et al. Nurse's bedside screening of dysphagia: an umbrella review[J]. Recenti Prog Med, 2022, 113(6): 361-371.
48. Manduchi B, Fitch MI, Ringash JG, et al. A core outcome set for patient-reported dysphagia for use in head and neck cancer clinical trials: an international multistakeholder Delphi study[J]. Head Neck, 2024, 46(4): 831-848.
49. Sole ML, Talbert SR, Rathbun KP, et al. Is α-amylase an important biomarker to detect aspiration of oral secretions in ventilated patients[J]? Crit Care Explor, 2020, 2(7): e0159.
50. Malandraki GA. Advances for dysphagia in the digital age: Integrative imaging and wearable technologies[J]. Folia Phoniatr Logop, 2023, 75(4): 208-218.
51. Wong DW, Wang J, Cheung SM, et al. Current technological advances in dysphagia screening: Systematic scoping review[J]. J Med Internet Res, 2025, 27: e65551.
52. 郝恬, 程潔, 李琦, 等. 膈神經電刺激對ICU機械通氣患者拔管結局影響的Meta分析[J]. 中國呼吸與危重監護雜志, 2025, 24(1): 9-17.

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Latest ArticlesA scoping review of assessment tools for post-extubation dysphagia in ICU patients on mechanical ventilation

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