Standardized Endoscopic Swallowing Evaluation for Tracheostomy Decannulation in Critically Ill Neurologic Patients - a prospective evaluation
| Autor: | Tobias Warnecke, Rainer Dziewas, Inga Claus, Sonja Suntrup-Krueger, Sriramya Lapa, Mao Ogawa, Sigrid Ahring, Stephan Oelenberg, Karoline Burkardt, Paul Muhle, Bendix Labeit |
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| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
FEES medicine.medical_treatment Neurosciences. Biological psychiatry. Neuropsychiatry 03 medical and health sciences 0302 clinical medicine Tracheostomy Swallowing Decannulation Intensive care Medicine 030212 general & internal medicine RC346-429 Neuroradiology Mechanical ventilation business.industry Dysphagia Aspiration Emergency medicine Observational study Neurology. Diseases of the nervous system Neurosurgery medicine.symptom Airway business 030217 neurology & neurosurgery RC321-571 Research Article |
| Zdroj: | Neurological Research and Practice Neurological Research and Practice, Vol 3, Iss 1, Pp 1-10 (2021) |
| ISSN: | 2524-3489 |
| Popis: | Background Removal of a tracheostomy tube in critically ill neurologic patients is a critical issue during intensive care treatment, particularly due to severe dysphagia and insufficient airway protection. The “Standardized Endoscopic Evaluation for Tracheostomy Decannulation in Critically Ill Neurologic Patients” (SESETD) is an objective measure of readiness for decannulation. This protocol includes the stepwise evaluation of secretion management, spontaneous swallowing, and laryngeal sensitivity during fiberoptic endoscopic evaluation of swallowing (FEES). Here, we first evaluated safety and secondly effectiveness of the protocol and sought to identify predictors of decannulation success and decannulation failure. Methods A prospective observational study was conducted in the neurological intensive care unit at Münster University Hospital, Germany between January 2013 and December 2017. Three hundred and seventy-seven tracheostomized patients with an acute neurologic disease completely weaned from mechanical ventilation were included, all of whom were examined by FEES within 72 h from end of mechanical ventilation. Using regression analysis, predictors of successful decannulation, as well as decannulation failure were investigated. Results Two hundred and twenty-seven patients (60.2%) could be decannulated during their stay according to the protocol, 59 of whom within 24 h from the initial FEES after completed weaning. 3.5% of patients had to be recannulated due to severe dysphagia or related complications. Prolonged mechanical ventilation showed to be a significant predictor of decannulation failure. Lower age was identified to be a significant predictor of early decannulation after end of weaning. Transforming the binary SESETD into a 4-point scale helped predicting decannulation success in patients not immediately ready for decannulation after the end of respiratory weaning (optimal cutoff ≥1; sensitivity: 64%, specifity: 66%). Conclusions The SESETD showed to be a safe and efficient tool to evaluate readiness for decannulation in our patient collective of critically ill neurologic patients. |
| Databáze: | OpenAIRE |
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