| Postextubation fiberoptic endoscopic evaluation of swallowing after prolonged endotracheal intubation: a randomized, prospective trial. | |
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MedLine Citation:
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PMID: 11546969 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Critically ill trauma patients frequently require prolonged endotracheal intubation and ventilator support. After extubation, swallowing difficulties may exist in < or = 50% of patients. We sought to determine whether performing a swallowing evaluation would reduce the incidence of postextubation aspiration and subsequent pneumonia. DESIGN: Randomized, prospective clinical trial of fiberoptic endoscopic evaluation of swallowing (FEES) vs. routine clinical management in patients after prolonged intubation. METHODS: Seventy patients who were intubated for > 48 hrs were randomized. FEES examinations were performed within 24 +/- 2 hrs after extubation. Silent aspiration was defined as the appearance of liquid or puree bolus below the true vocal cords without coughing during a FEES examination. Clinical aspiration was defined as the removal of enteral content from below the vocal cords, usually during endotracheal tube placement. RESULTS: There were five episodes of aspiration and pneumonia in the FEES group (14%, two silent) and two in the clinical group (6%, not significant, Fisher exact test). Patients aged > 55 yrs and those with vallecular stasis on FEES examination were at significantly higher risk of postextubation aspiration. All patients with pneumonia had an associated aspiration episode. CONCLUSIONS: Patients with prolonged orotracheal intubation are at risk of aspiration after extubation. The addition of a FEES examination did not change the incidence of aspiration or postextubation pneumonia. |
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Authors:
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E Barquist; M Brown; S Cohn; D Lundy; J Jackowski |
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Publication Detail:
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Type: Clinical Trial; Journal Article; Randomized Controlled Trial |
Journal Detail:
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Title: Critical care medicine Volume: 29 ISSN: 0090-3493 ISO Abbreviation: Crit. Care Med. Publication Date: 2001 Sep |
Date Detail:
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Created Date: 2001-09-07 Completed Date: 2001-10-04 Revised Date: 2008-11-21 |
Medline Journal Info:
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Nlm Unique ID: 0355501 Medline TA: Crit Care Med Country: United States |
Other Details:
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Languages: eng Pagination: 1710-3 Citation Subset: AIM; IM |
Affiliation:
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Department of Surgery, Division of Trauma and Critical Care, University of Miami, Miami, FL, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Deglutition Deglutition Disorders / etiology* Endoscopy Female Fiber Optic Technology Humans Injury Severity Score Intensive Care Units Intubation, Intratracheal / adverse effects* Male Middle Aged Pneumonia, Aspiration / etiology* Wounds and Injuries / therapy* |
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