The Association Between Endotracheal Tube Size and Aspiration (During Flexible Endoscopic Evaluation of Swallowing) in Acute Respiratory Failure Survivors.
Aged
Deglutition
/ physiology
Female
Humans
Intensive Care Units
Intubation, Intratracheal
/ adverse effects
Male
Middle Aged
Prospective Studies
Respiration, Artificial
/ adverse effects
Respiratory Aspiration
/ etiology
Respiratory Insufficiency
/ therapy
Risk Factors
Survivors
/ statistics & numerical data
Journal
Critical care medicine
ISSN: 1530-0293
Titre abrégé: Crit Care Med
Pays: United States
ID NLM: 0355501
Informations de publication
Date de publication:
11 2020
11 2020
Historique:
pubmed:
18
8
2020
medline:
26
5
2021
entrez:
18
8
2020
Statut:
ppublish
Résumé
To determine whether a modifiable risk factor, endotracheal tube size, is associated with the diagnosis of postextubation aspiration in survivors of acute respiratory failure. Prospective cohort study. ICUs at four academic tertiary care medical centers. Two hundred ten patients who were at least 18 years old, admitted to an ICU, and mechanically ventilated with an endotracheal tube for longer than 48 hours were enrolled. Within 72 hours of extubation, all patients received a flexible endoscopic evaluation of swallowing examination that entailed administration of ice, thin liquid, thick liquid, puree, and cracker boluses. Patient demographics, treatment variables, and hospital outcomes were abstracted from the patient's medical records. Endotracheal tube size was independently selected by the patient's treating physicians. For each flexible endoscopic evaluation of swallowing examination, laryngeal pathology was evaluated, and for each bolus, a Penetration Aspiration Scale score was assigned. Aspiration (Penetration Aspiration Scale score ≥ 6) was further categorized into nonsilent aspiration (Penetration Aspiration Scale score = 6 or 7) and silent aspiration (Penetration Aspiration Scale score = 8). One third of patients (n = 68) aspirated (Penetration Aspiration Scale score ≥ 6) on at least one bolus, 13.6% (n = 29) exhibited silent aspiration, and 23.8% (n = 50) exhibited nonsilent aspiration. In a multivariable analysis, endotracheal tube size (≤ 7.5 vs ≥ 8.0) was significantly associated with patients exhibiting any aspiration (Penetration Aspiration Scale score ≥ 6) (p = 0.016; odds ratio = 2.17; 95% CI 1.14-4.13) and with risk of developing laryngeal granulation tissue (p = 0.02). Larger endotracheal tube size was associated with increased risk of aspiration and laryngeal granulation tissue. Using smaller endotracheal tubes may reduce the risk of postextubation aspiration.
Identifiants
pubmed: 32804785
doi: 10.1097/CCM.0000000000004554
pmc: PMC7644217
mid: NIHMS1610672
pii: 00003246-202011000-00008
doi:
Banques de données
ClinicalTrials.gov
['NCT02363686']
Types de publication
Journal Article
Multicenter Study
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
1604-1611Subventions
Organisme : NINR NIH HHS
ID : R21 NR015886
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR001863
Pays : United States
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