Swallowing disorders as a predictor of unsuccessful extubation: a clinical evaluation.
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.
Colonel
Philippe
P
Service de Médecine Physique et de Réadaptation, l'Hôpital Lariboisière-Fernand Widal, Université Paris VII, Paris, France.
Houzé
Marie Hélène
MH
Vert
Hélène
H
Mateo
Joachim
J
Mégarbane
Bruno
B
Goldgran-Tolédano
Dany
D
Bizouard
Françoise
F
Hedreul-Vittet
Martine
M
Baud
Frédéric J
FJ
Payen
Didier
D
Vicaut
Eric
E
Yelnik
Alain P
AP
D000328:Adult; D000368:Aged; D003680:Deglutition Disorders / Q000150:complications*; D005260:Female; D006304:Health Status; D006801:Humans; D007362:Intensive Care Units; D007442:Intubation, Intratracheal / Q000451:nursing*; D008297:Male; D008875:Middle Aged; D010808:Physical Examination; D011446:Prospective Studies