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American Journal of Critical Care. 2008;17: 504-510
Copyright © 2008 by the American Association of Critical-Care Nurses.
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Swallowing Disorders as a Predictor of Unsuccessful Extubation: A Clinical Evaluation

By Philippe Colonel, PT, Marie Hélène Houzé, PT, Hélène Vert, PT, Joachim Mateo, MD, Bruno Mégarbane, MD, PhD, Dany Goldgran-Tolédano, MD, Françoise Bizouard, PT, Martine Hedreul-Vittet, PT, Frédéric J. Baud, MD, Didier Payen, MD, Eric Vicaut, MD, PhD and Alain P. Yelnik, MD. Philippe Colonel, Marie Hélène Houzé, Hélène Vert, Françoise Bizouard, and Martine Hedreul-Vittet are physiotherapists and Alain P. Yelnik is a physician in the Service de Médecine Physique et de Réadaptation; Joachim Mateo and Didier Payen are physicians in the Département d’Anesthésie et de Réanimation; Bruno Mégarbane, Dany Goldgran-Tolédano, and Frédéric J. Baud are physicians in Réanimation Médicale et Toxicologique; and Eric Vicaut is a physician in the Unité de Recherche Clinique; all at l’Hôpital Lariboisière-Fernand Widal, Université Paris VII, Paris, France.

Corresponding author: Bruno Mégarbane, MD, PhD, Réanimation Médicale et Toxicologique, Hôpital Lariboisière, 2 Rue Ambroise Paré, 75010 Paris, France (e-mail: bruno-megarbane{at}wanadoo.fr).

Background Unsuccessful extubation may be due to swallowing dysfunction that causes airway obstruction and impairs patients’ ability to cough and expectorate.

Objective To determine whether swallowing assessment before extubation is helpful in predicting unsuccessful extubation due to airway secretions.

Methods This prospective study included all patients intubated orotracheally for more than 6 days. Before extubation, 3 tests designed to assess (1) cervical, oral, labial, and lingual motility; (2) gag reflex; and (3) swallowing were used at the bedside. Causes of reintubation were identified, and their relationship to patients’ swallowing function before extubation was evaluated.

Results Sixty-two patients were enrolled. Data on 55 patients reintubated for swallowing dysfunction were analyzed. Nine patients were reintubated because of obstruction related to upper airway secretions. Evaluation before extubation enabled prediction of 7 of those 9 unsuccessful extubations. Among the 23 patients with central nervous system disease, 3 of 4 unsuccessful extubations were predicted. According to a multivariate logistic regression model, motility and swallowing were independent predictors of unsuccessful extubation (area under receiver-operating-characteristic curve, 80%). The gag reflex was the only significant predictor of the ability to cough (area under curve, 73%) and excessive pulmonary secretion (area under curve, 67%). Swallowing was an independent predictor of the need for suctioning (area under curve, 78%).

Conclusions Using simple bedside tests to evaluate swallowing before extubation is helpful when deciding whether to extubate patients who have been intubated for more than 6 days. Involvement of nurses in these decisions would improve patients’ management.


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AJCC 2008 17: 502. [Full Text]  





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Copyright © 2008 by the American Association of Critical-Care Nurses.