Predictors of Extubation Failure Related to Aspiration and/or Excessive Upper Airway Secretions.

Autor:	Houzé MH; Rehabilitation Unit., Deye N; Medical Intensive Care Unit, and Inserm U942 nicolas.deye@aphp.fr., Mateo J; Surgical Intensive Care Unit., Mégarbane B; Medical Intensive Care Unit, and Inserm U942., Bizouard F; Rehabilitation Unit., Baud FJ; Medical Intensive Care Unit, and Inserm U942., Payen de la Garanderie D; Surgical Intensive Care Unit., Vicaut E; Research Unit., Yelnik AP; PRM Department, GHU Saint Louis-Lariboisière-Fernand Widal, AP-HP, Paris Diderot University, Paris, France.
Jazyk:	angličtina
Zdroj:	Respiratory care [Respir Care] 2020 Apr; Vol. 65 (4), pp. 475-481. Date of Electronic Publication: 2019 Nov 19.
DOI:	10.4187/respcare.07025
Abstrakt:	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. (Clinical trials.gov registration NCT00780078.). (Copyright © 2020 by Daedalus Enterprises.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu