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[Dysphagia] swallow assessment post extubation
We wait at least 24 hrs, longer if we can. I often give out copies of the following Leder et al article from Dysphagia 13:208-212 (1998).
Heidi
Fiberoptic Endoscopic Documentation of the High Incidence of
Aspiration following Extubation in Critically Ill Trauma Patients
Steven B. Leder, PhD,1 Stephen M. Cohn, MD,2 and Beth A. Moller, MSN3
1Yale University School of Medicine, Department of Surgery, Section of Otolaryngology, Communication Disorders Center, New Haven,
Connecticut; 2University of Miami School of Medicine, Division of Trauma and Surgical Critical Care, Department of Surgery, Miami, Florida;
and 3Yale University School of Medicine, Department of Surgery, Section of Trauma and Critical Care, New Haven, Connecticut, USA
Abstract. The purpose of this study was to investigate
the incidence of aspiration following extubation in critically
ill trauma patients. This prospective pilot study included
20 consecutive trauma patients who required orotracheal
intubation for at least 48 hours. All subjects
underwent a bedside transnasal fiberoptic endoscopic
evaluation of swallowing at 24 ? 2 hr after extubation to
determine objectively aspiration status. Aspiration was
defined as the entry of a blue dyed material into the
airway below the level of the true vocal folds, with silent
aspiration occurring in the absence of any external behavioral
signs such as coughing or choking. Aspiration
was identified in 9 of 20 (45%) subjects and 4 of these 9
(44%) were silent aspirators. Therefore, silent aspiration
occurred in 20% of the study population. Eight of the 9
(89%) aspirating subjects resumed an oral diet from 2-10
days (mean, 5 days) following extubation. All subjects
had no evidence of pulmonary complications. It was concluded
that trauma patients after orotracheal intubation
and prolonged mechanical ventilation have an increased
risk of aspiration. An objective assessment of dysphagia
to identify aspiration may reduce the likelihood of pulmonary
complications after extubation.
Key words: Aspiration - Silent aspiration - Fiberoptic
endoscope-Trauma-Orotracheal intubation-
Extubation - Deglutition - Deglutition disorders.
-----Original Message-----
From: Ubben, Polly [mailto:PUbben at stez.org]
Sent: Wednesday, December 27, 2006 8:49 AM
To: dysphagia at b9.com
Subject: [Dysphagia] swallow assessment post extubation
I am looking for information about timing swallowing assessment post extubation. We have a 250 bed acute care hospital with a CCU and Burn unit-we have really struggled with physicians trying to feed people right after extubation and, in our experience assessing these patients, many of them are still adjusting to weaning from the vent, clearing their own secretions and having the stamina to sit up...we've used our own guideline of assessment and continued NPO for 24-48 hrs post extubation...we feel it's important to be sure the patient is stable from a respiratory standpoint before trying a bunch of P.O. Many of the patients will actually end up reintubated in the first 24 hrs post trying extubation...
Does anyone have any protocol they follow or know of research supporting our informal findings?
Polly Ubben, M.A., CCC-SLP
Speech Pathology Coordinator
Saint Elizabeth Regional Medical Center
555 South 70th Street
Lincoln, NE
68510 Ph. (402)219-8745 Fax (402)219-7327
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