RT Journal Article
SR Electronic
T1 Predictors of Extubation Failure Related to Aspiration and/or Excessive Upper Airway Secretions
JF Respiratory Care
FD American Association for Respiratory Care
SP respcare.07025
DO 10.4187/respcare.07025
A1 Marie-Hélène Houzé
A1 Nicolas Deye
A1 Joaquim Mateo
A1 Bruno Mégarbane
A1 Françoise Bizouard
A1 Frédéric J Baud
A1 Didier Payen de la Garanderie
A1 Eric Vicaut
A1 Alain P Yelnik
A1 for the EVAKIN Study Group
YR 2019
UL http://rc.rcjournal.com/content/early/2019/11/19/respcare.07025.abstract
AB 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 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.