Predictors of Extubation Failure Related to Aspiration and/or Excessive Upper Airway Secretions.
extubation failure
gag reflex
mechanical ventilation
physiotherapy
swallowing disorder
weaning
Journal
Respiratory care
ISSN: 1943-3654
Titre abrégé: Respir Care
Pays: United States
ID NLM: 7510357
Informations de publication
Date de publication:
Apr 2020
Apr 2020
Historique:
pubmed:
21
11
2019
medline:
29
1
2021
entrez:
21
11
2019
Statut:
ppublish
Résumé
Extubation failure may have several causes, including swallowing dysfunction, aspiration, and excessive upper airway secretions. We hypothesized that a bedside global swallowing pattern assessment including 9 criteria (volume of pharyngeal secretions, 5 swallowing motor items, swallowing reflex, and 2 gag reflexes) performed prior to extubation could identify patients at risk of extubation failure. In a multicenter prospective observational study, all consecutive patients intubated and mechanically ventilated for ≥6 d were included. Before a planned extubation, a physiotherapist evaluated the 9 criteria of the swallowing assessment. The final extubation decision was left to the physician's discretion, blinded to the swallowing assessment. Extubation failure was defined as the need for re-intubation related to aspiration or excessive upper airway secretions within the first 72 h after extubation. Results are expressed as median (interquartile range [IQR]). The study included 159 subjects (age 61 y [IQR 48-75]; male/female ratio 1.5; Simplified Acute Physiologic score II 54 [IQR 42-66]; duration of mechanical ventilation 11 d [IQR 8-17]). A total of 23 subjects (14.5%) required re-intubation, with 16 occurring within the first 72 h after extubation and 7 related to aspiration or excessive secretions. Swallowing assessment was significantly lower in subjects with re-intubation related to aspiration or excessive secretions within the first 72 h after extubation versus those not re-intubated for aspiration or excessive secretions (6 [IQR 5-7] vs 8 [IQR 7-8], In subjects with prolonged ventilation, the presence of one or both gag reflexes could predict a reduction in extubation failure related to aspiration or excessive upper airway secretions. (Clinical trials.gov registration NCT00780078.).
Sections du résumé
BACKGROUND
BACKGROUND
Extubation failure may have several causes, including swallowing dysfunction, aspiration, and excessive upper airway secretions. We hypothesized that a bedside global swallowing pattern assessment including 9 criteria (volume of pharyngeal secretions, 5 swallowing motor items, swallowing reflex, and 2 gag reflexes) performed prior to extubation could identify patients at risk of extubation failure.
METHODS
METHODS
In a multicenter prospective observational study, all consecutive patients intubated and mechanically ventilated for ≥6 d were included. Before a planned extubation, a physiotherapist evaluated the 9 criteria of the swallowing assessment. The final extubation decision was left to the physician's discretion, blinded to the swallowing assessment. Extubation failure was defined as the need for re-intubation related to aspiration or excessive upper airway secretions within the first 72 h after extubation. Results are expressed as median (interquartile range [IQR]).
RESULTS
RESULTS
The study included 159 subjects (age 61 y [IQR 48-75]; male/female ratio 1.5; Simplified Acute Physiologic score II 54 [IQR 42-66]; duration of mechanical ventilation 11 d [IQR 8-17]). A total of 23 subjects (14.5%) required re-intubation, with 16 occurring within the first 72 h after extubation and 7 related to aspiration or excessive secretions. Swallowing assessment was significantly lower in subjects with re-intubation related to aspiration or excessive secretions within the first 72 h after extubation versus those not re-intubated for aspiration or excessive secretions (6 [IQR 5-7] vs 8 [IQR 7-8],
CONCLUSIONS
CONCLUSIONS
In subjects with prolonged ventilation, the presence of one or both gag reflexes could predict a reduction in extubation failure related to aspiration or excessive upper airway secretions. (Clinical trials.gov registration NCT00780078.).
Identifiants
pubmed: 31744867
pii: respcare.07025
doi: 10.4187/respcare.07025
doi:
Banques de données
ClinicalTrials.gov
['NCT00780078']
Types de publication
Clinical Trial
Journal Article
Multicenter Study
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
475-481Informations de copyright
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