背景:拔管后吞咽困难(PED)是一种常见的拔管后并发症,可能导致严重问题,例如营养不良和住院和重症监护病房(ICU)停留时间更长。
目的:探讨拔管后成年危重患者口服摄入准备情况的相关因素。
方法:这项前瞻性观察性研究涉及125名拔管患者。使用gugging吞咽屏幕(GUSS)评估口服摄入的准备情况,回归分析用于确定其预测因子。
结果:参与者的中位年龄为40.0岁,51.2%为女性。GUSS评分中位数为12.0(可能范围,0-20),35.2%的患者有严重的吞咽困难(0-9分)。双变量回归分析显示,年龄较大,男性,APACHEII评分更高,体重指数(BMI)≥30,吸烟史,ICU停留时间更长,肌肉松弛剂的使用,大口径气管导管和口胃管以及频繁的插管尝试与较低的GUSS评分相关(p值<.05).多因素回归分析显示,年龄,BMI和吸烟史预测了GUSS评分变异性的37.2%(F=23.865,p值<.001)。加上ICU住院时间,肌肉松弛剂的使用,气管内导管的大小,口胃管的大小和插管频率尝试回归模型将可预测性提高到86.0%(F=88.809,p值<.001).
结论:超过三分之一的拔管患者患有严重PED,误吸风险高。几个可改变的因素,如肌肉松弛剂的使用和气管和口胃管的大小,预测拔管后口服准备。
结论:使用适当尺寸的气管导管和口胃管,仔细评估插管困难的高风险患者,以及最少使用肌肉松弛剂可能有助于增加患者拔管后口服摄入的准备。
BACKGROUND: Post-extubation
dysphagia (PED) is a common post-extubation complication that may lead to serious problems, such as malnutrition and longer hospital and intensive care unit (ICU) stays.
OBJECTIVE: To explore factors associated with the readiness for oral intake in post-extubated critically ill adult patients.
METHODS: This prospective observational
study involved 125 extubated patients. Readiness for oral intake was assessed using the Gugging Swallowing Screen (GUSS), and regression analysis was used to determine its predictors.
RESULTS: The median age of the participants was 40.0 years, and 51.2% were female. The median GUSS score was 12.0 (possible range, 0-20), and 35.2% of the studied patients had severe
dysphagia (scored 0-9). Bivariate regression analysis showed that older age, male, higher APACHE II score, body mass index (BMI) ≥30, smoking history, longer ICU stay, muscle relaxants use, large-bore endotracheal and orogastric tubes and frequent intubation attempts were associated with lower GUSS score (p-value <.05). Multivariate regression analysis showed that age, BMI and smoking history predicted 37.2% of the variability in the GUSS score (F = 23.865, p-value <.001). Adding the ICU length of stay, muscle relaxants use, size of the endotracheal tube, size of the orogastric tube and frequency of intubation attempts to the regression model raised the predictability to 86.0% (F = 88.809, p-value <.001).
CONCLUSIONS: More than one-third of extubated patients have severe PED with a high risk of aspiration. Several modifiable factors, such as muscle relaxant use and endotracheal and orogastric tube size, predict post-extubation readiness for oral intake.
CONCLUSIONS: Using endotracheal and orogastric tubes of appropriate sizes, careful assessment of patients with a high risk for difficult intubation, and minimal use of muscle relaxants may help increase patients\' readiness for post-extubation oral intake.