التفاصيل البيبلوغرافية
| العنوان: |
Predictors of Extubation Failure Related to Aspiration and/or Excessive Upper Airway Secretions. |
| المؤلفون: |
Houze, Marie-Helene, Deye, Nicolas, Mateo, Joaquim, Megarbane, Bruno, Bizouard, Francoise, Baud, Frederic J., de la Garanderie, Didier Payen, Vicaut, Eric, Yelnik, Alain P. |
| المصدر: |
Respiratory Care; Apr2020, Vol. 65 Issue 4, p475-481, 7p, 1 Diagram, 3 Charts |
| مصطلحات موضوعية: |
AIRWAY (Anatomy), APACHE (Disease classification system), ARTIFICIAL respiration, CHI-squared test, CONFIDENCE intervals, DEGLUTITION, DEGLUTITION disorders, MEDICAL cooperation, SCIENTIFIC observation, PHYSICAL therapy, REFLEXES, RESEARCH, RISK assessment, SECRETION, STATISTICS, MECHANICAL ventilators, TREATMENT effectiveness, EXTUBATION, RESPIRATORY aspiration, DATA analysis software, DESCRIPTIVE statistics, ODDS ratio |
| مصطلحات جغرافية: |
FRANCE |
| مستخلص: |
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: 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: 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], P = .008, respectively). Among the 9 swallowing assessment criteria, normal right pharyngeal gag reflex was associated with a lower incidence of re-intubation related to aspiration or excessive secretions (odds ratio 0.12, 95% CI 0.03= 0.59, P = .01), as well as normal left pharyngeal gag reflex (odds ratio 0.13, 95% CI 0.03= 0.63, P = .01), with a negative predictive value of 0.98 for each reflex. 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. [ABSTRACT FROM AUTHOR] |
|
Copyright of Respiratory Care is the property of American Association for Respiratory Care and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.) |
| قاعدة البيانات: |
Supplemental Index |
