Postextubation fiberoptic endoscopic evaluation of swallowing after prolonged endotracheal intubation: A randomized, prospective trial

Erik Barquist, Margaret Brown, Stephen Cohn, Donna Lundy, Julie Jackowski

Research output: Contribution to journalArticle

79 Scopus citations

Abstract

Background: Critically ill trauma patients frequently require prolonged endotracheal intubation and ventilator support. After extubation, swallowing difficulties may exist in ≤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 post-extubation pneumonia.

Original languageEnglish (US)
Pages (from-to)1710-1713
Number of pages4
JournalCritical care medicine
Volume29
Issue number9
DOIs
StatePublished - Jan 1 2001

Keywords

  • Aspiration
  • Deglutition
  • Extubation
  • Fiberoptic endoscope
  • Orotracheal intubation
  • Trauma

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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