title: Swallowing disorders as a predictor of unsuccessful extubation: a clinical evaluation.
abstract: 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.
authors.affiliation: Service de Médecine Physique et de Réadaptation, l'Hôpital Lariboisière-Fernand Widal, Université Paris VII, Paris, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Colonel
authors.forename: Marie Hélène
authors.initials: MH
authors.lastname: Houzé
authors.forename: Hélène
authors.initials: H
authors.lastname: Vert
authors.forename: Joachim
authors.initials: J
authors.lastname: Mateo
authors.forename: Bruno
authors.initials: B
authors.lastname: Mégarbane
authors.forename: Dany
authors.initials: D
authors.lastname: Goldgran-Tolédano
authors.forename: Françoise
authors.initials: F
authors.lastname: Bizouard
authors.forename: Martine
authors.initials: M
authors.lastname: Hedreul-Vittet
authors.forename: Frédéric J
authors.initials: FJ
authors.lastname: Baud
authors.forename: Didier
authors.initials: D
authors.lastname: Payen
authors.forename: Eric
authors.initials: E
authors.lastname: Vicaut
authors.forename: Alain P
authors.initials: AP
authors.lastname: Yelnik
mesh_terms: 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