Alteration in swallowing reflex after extubation in intensive care unit patients.
OBJECTIVE
To assess the swallowing reflex after prolonged endotracheal intubation and to assess the influence of age and duration of intubation on this reflex.


METHODS
Prospective, observational, clinical study.


METHODS
The intensive care unit of a university teaching hospital.


METHODS
The swallowing reflex was studied after extubation in 34 patients and compared with the deglutition in 30 nonintubated patients with a nasogastric tube and 15 nonintubated patients without a nasogastric tube.


METHODS
Four volumes of normal saline (0.25, 0.50, 0.75, and 1 mL) were injected at the epipharynx level. Swallowing efficiency was assessed by the latency between instillation and the first swallow, as identified on a submental electromyogram. The tests were performed immediately (day 0), and at 1 (day 1), 2 (day 2), and 7 (day 7) days after extubation in the intubated group. Nonintubated patients were tested once.


RESULTS
On day 0, the latency was increased for each bolus in the extubated group when compared with the control groups. Significant shortening of latency after 0.50, 0.75, and 1 mL injections of normal saline occurred on days 1 and 2 when compared with day 0, whereas no change was observed after 0.25 mL of normal saline was injected. On day 7, a significant improvement was observed, regardless of the volume injected. There was no correlation between swallowing latency and either the age of the patients or the duration of endotracheal intubation.


CONCLUSIONS
These data indicate that prolonged endotracheal intubation impairs the swallowing reflex, with improvement within 1 wk. This phenomenon could contribute to microinhalations and aspiration pneumonia after extubation.
de Larminat
V
V
Département d'Anesthésie-Réanimation Chirurgicale, Hôpital Bichat, Paris, France.
Montravers
P
P
Dureuil
B
B
Desmonts
J M
JM
D000368:Aged; D003679:Deglutition; D003680:Deglutition Disorders / Q000503:physiopathology; D005260:Female; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D011015:Pneumonia, Aspiration / Q000503:physiopathology; D011446:Prospective Studies; D011930:Reaction Time; D013997:Time Factors