@article {Houz{\'e}475, author = {Marie-H{\'e}l{\`e}ne Houz{\'e} and Nicolas Deye and Joaquim Mateo and Bruno M{\'e}garbane and Fran{\c c}oise Bizouard and Fr{\'e}d{\'e}ric J Baud and Didier Payen de la Garanderie and Eric Vicaut and Alain P Yelnik and for the EVAKIN Study Group}, title = {Predictors of Extubation Failure Related to Aspiration and/or Excessive Upper Airway Secretions}, volume = {65}, number = {4}, pages = {475--481}, year = {2020}, doi = {10.4187/respcare.07025}, publisher = {Respiratory Care}, abstract = {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{\textquoteright}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{\textendash}75]; male/female ratio 1.5; Simplified Acute Physiologic score II 54 [IQR 42{\textendash}66]; duration of mechanical ventilation 11 d [IQR 8{\textendash}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{\textendash}7] vs 8 [IQR 7{\textendash}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{\textendash}0.59, P = .01), as well as normal left pharyngeal gag reflex (odds ratio 0.13, 95\% CI 0.03{\textendash}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.)}, issn = {0020-1324}, URL = {https://rc.rcjournal.com/content/65/4/475}, eprint = {https://rc.rcjournal.com/content/65/4/475.full.pdf}, journal = {Respiratory Care} }