Predictors of Extubation Failure Related to Aspiration and/or Excessive Upper Airway Secretions
| العنوان: | Predictors of Extubation Failure Related to Aspiration and/or Excessive Upper Airway Secretions |
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| المؤلفون: | Eric Vicaut, Didier Payen de la Garanderie, Frédéric J. Baud, Nicolas Deye, Françoise Bizouard, Bruno Mégarbane, Joaquim Mateo, Alain Yelnik, Marie-Hélène Houzé |
| المصدر: | Respiratory Care. 65:475-481 |
| بيانات النشر: | Daedalus Enterprises, 2019. |
| سنة النشر: | 2019 |
| مصطلحات موضوعية: | Male, Pulmonary and Respiratory Medicine, Bodily Secretions, medicine.medical_treatment, Critical Care and Intensive Care Medicine, Gagging, 03 medical and health sciences, 0302 clinical medicine, Pharyngeal reflex, Swallowing, Interquartile range, medicine, Humans, Prospective Studies, Aged, Mechanical ventilation, Extubation failure, business.industry, Respiration, General Medicine, Odds ratio, Middle Aged, Respiration, Artificial, Deglutition, Intensive Care Units, 030228 respiratory system, Anesthesia, Airway Extubation, Reflex, Pharynx, Female, Larynx, business, Airway, Ventilator Weaning |
| الوصف: | 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 related to aspiration or excessive upper airway secretions. 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 physician9s 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. |
| تدمد: | 1943-3654 0020-1324 |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::a375e3978f9a1799d237a0afbad5f128Test https://doi.org/10.4187/respcare.07025Test |
| حقوق: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....a375e3978f9a1799d237a0afbad5f128 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 19433654 00201324 |
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