O009 - TRAJECTORIES AND DETERMINANTS OF RECOVERY OF SAFE AND ADEQUATE ORAL INTAKE AFTER MECHANICAL VENTILATION: A PROSPECTIVE TIME-TO-EVENT ANALYSIS

O009

TRAJECTORIES AND DETERMINANTS OF RECOVERY OF SAFE AND ADEQUATE ORAL INTAKE AFTER MECHANICAL VENTILATION: A PROSPECTIVE TIME-TO-EVENT ANALYSIS

V. A. Fugas^1,2,3,*, J. I. Barion^1,3, M. V. Malachevsky^1,3, P. Astegiano^1,2,3, M. D. Vago^3,4

¹Unidad de Soporte Nutricional, ²Unidad de Terapia Intensiva, ³Equipo Interdisciplinario de Disfagia, ⁴Servicio de Fonoaudiología, Hospital Dr. José María Cullen, Santa Fe, Argentina

Rationale: Achieving safe and adequate oral intake after mechanical ventilation (MV) is a fundamental aspect of functional recovery in post–critical illness; it extends beyond the ICU and is frequently underrecognized.

Methods: Prospective observational study (Jan 2025–Feb 2026) including critically ill adults (≥18 years) with MV ≥48h. Time-to-event was calculated from weaning to the event: safe swallowing (GUSS-ICU=10) and adequate oral intake (≥90% energy/protein targets). Dysphagia (GUSS-ICU<10) and malnutrition (GLIM) were assessed at first post-weaning swallowing assessment per protocol. Patients were censored at day 7 after eligibility for oral intake (GUSS-ICU>6), discharge, transfer or death. Time-to-event analyses used Kaplan–Meier, log-rank test and Cox model.

Results: 127 patients were included (58.3% male, mean age 39 years, mean APACHE II 16). Tracheostomy was present in 31.5%, and 31.5% were malnourished at first swallowing assessment. During follow-up, 86 (67.7%) achieved the event. Median time to event was 12 days (95% CI 8.9–15.1). Time to event was longer in patients with tracheostomy (27 vs 8 days, p<0.001), and with malnutrition (23 vs 8 days, p=0.001) and dysphagia (12 vs 7 days, p=0.003). In multivariable Cox analysis (n=116, 76 events), tracheostomy (HR 0.11, 95% CI 0.05–0.22), dysphagia (HR 0.29, 95% CI 0.18–0.47), and malnutrition (HR 0.49, 95% CI 0.29–0.83) at first swallowing assessment were independently associated with a reduced hazard of achieving the event. Age, sex, APACHE II and MRC were not associated.

Conclusion: Tracheostomy, dysphagia and malnutrition at the first post-weaning swallowing assessment are independently associated with delayed achievement of safe and adequate oral intake after MV. These findings support early interdisciplinary strategies targeting airway management, swallowing rehabilitation and nutritional optimization.

Disclosure of Interest: V. Fugas Grant / Research Support from: ESICM fellowship 2024 sponsored by Fresenius Kabi, Speakers Bureau of: Invited speaker, Fresenius Kabi webinar (2025), J. Barion: None declared, M. Malachevsky: None declared, P. Astegiano: None declared, M. Vago: None declared