title: Comparison of cough reflex testing with videoendoscopy in recently extubated intensive care unit patients.
abstract: Orotracheal intubation is known to impair cough reflex, but the validity of cough reflex testing (CRT) as a screening tool for silent aspiration in this population is unknown.
  
  
  
  One hundred and six participants in a tertiary-level intensive care unit (ICU) underwent CRT and videoendoscopic evaluation of swallowing (VES) within 24 hours of extubation. Cough reflex threshold was established for each participant using nebulized citric acid.
  
  
  
  Thirty-nine (37%) participants had an absent cough to CRT. Thirteen (12%) participants aspirated on VES, 9 (69%) without a cough response. Sensitivity of CRT to identify silent aspiration was excellent, but specificity was poor. There was a significant correlation between intubation duration and presence of aspiration on VES (P= .0107). There was no significant correlation between silent aspiration on VES and length of intubation, age, sex, diagnosis at intensive care unit admission, indication for intubation, Acute Physiology and Chronic Health Evaluation III score, morphine equivalent dose, or time of testing postextubation.
  
  
  
  Intensive care unit patients are at increased risk of aspiration in the 24 hours following extubation, and an impaired cough reflex is common. However, CRT overidentifies risk of silent aspiration in this population.
authors.affiliation: The University of Canterbury Rose Centre for Stroke Recovery and Research, Leinster Chambers, Level 1, 249 Papanui Rd, Christchurch 8014, New Zealand; Capital and Coast District Health Board, Riddiford St, Private Bag 7902, Wellington South 6242, New Zealand. Electronic address: molly.kallesen@ccdhb.org.nz.
authors.forename: Molly
authors.initials: M
authors.lastname: Kallesen
authors.affiliation: Capital and Coast District Health Board, Riddiford St, Private Bag 7902, Wellington South 6242, New Zealand. Electronic address: alex.psirides@ccdhb.org.nz.
authors.forename: Alex
authors.initials: A
authors.lastname: Psirides
authors.affiliation: The University of Canterbury Rose Centre for Stroke Recovery and Research, Leinster Chambers, Level 1, 249 Papanui Rd, Christchurch 8014, New Zealand. Electronic address: maggie-lee.huckabee@canterbury.ac.nz.
authors.forename: Maggie-Lee
authors.initials: ML
authors.lastname: Huckabee
mesh_terms: D000368:Aged; D060666:Airway Extubation / Q000009:adverse effects*; D001999:Bronchoscopy; D019343:Citric Acid / Q000008:administration & dosage; D003371:Cough; D003422:Critical Care; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009330:Nebulizers and Vaporizers; D009520:New Zealand / Q000453:epidemiology; D015995:Prevalence; D012018:Reflex / Q000502:physiology*; D053120:Respiratory Aspiration / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D012680:Sensitivity and Specificity; D014741:Video Recording
chemical_list: D019343:Citric Acid
keywords: Aspiration; Cough reflex; Dysphagia; Extubation; ICU