University Medical Center Brackenridge, Austin, TX 78701, USA.
J Crit Care. 2011 Feb;26(1):108.e9-13. doi: 10.1016/j.jcrc.2010.05.036. Epub 2010 Sep 24.
Swallowing dysfunction can occur after mechanical ventilation, leading to complications such as aspiration and pneumonia. After mechanical ventilation, authors have recommended evaluating patients with contrast studies or endoscopy to identify patients at risk for swallowing dysfunction and aspiration. The purpose of the study was to determine if a bedside swallowing evaluation (BSE) can identify patients with swallowing dysfunction after mechanical ventilation.
This is a 1-year (2008) prospective study of all adult trauma patients admitted to the intensive care unit requiring mechanical ventilation. Upon separation from mechanical, all patients received a BSE. The BSE used mental status, facial symmetry, swallow reflex, and oral ice chips and water to identify swallowing dysfunction. Patients who passed the BSE were advanced to oral intake per physician orders, whereas patients who failed the BSE were allowed nothing by mouth.
A total of 345 patients were included; 54 died before separation from mechanical ventilation and were excluded. The remaining 291 patients underwent BSE after separation from mechanical ventilation, with 143 (49%) passing and 148 (51%) failing. Patients who failed the BSE required mechanical ventilation longer than those who passed (14 ± 13 vs 5 ± 20 days, P = .001). In addition, only 23% of patients extubated within 72 hours failed the BSE, whereas 78% of those intubated more than 72 hours failed the BSE (P < .001). All patients who passed the BSE were discharged from the hospital without a clinical aspiration event. Independent risk factors for failure of BSE included tracheostomy, older age, prolonged mechanical ventilation, delirium tremens, traumatic brain injury, and spine fracture. Three (2%) patients who failed the BSE had a clinical aspiration event despite taking nothing by mouth.
A simple BSE can be used to identify patients at risk for swallowing dysfunction after mechanical ventilation. More importantly, BSE can safely clear patients without swallowing dysfunction, avoiding costly and time-consuming contrast studies or endoscopic evaluation.
机械通气后可能会出现吞咽功能障碍，导致吸入和肺炎等并发症。机械通气后，作者建议通过对比研究或内窥镜检查来评估患者，以确定有吞咽功能障碍和吸入风险的患者。本研究旨在确定床边吞咽评估（BSE）是否可以识别机械通气后的吞咽功能障碍患者。
这是一项为期 1 年（2008 年）的前瞻性研究，纳入所有入住重症监护病房需要机械通气的成年创伤患者。在与机械通气分离后，所有患者均接受 BSE。BSE 使用神志状态、面部对称、吞咽反射以及口腔冰沙和水来识别吞咽功能障碍。通过 BSE 的患者可根据医生的医嘱进行口服摄入，而未通过 BSE 的患者则禁止经口进食。
共纳入 345 例患者；54 例在与机械通气分离前死亡，被排除在外。其余 291 例患者在与机械通气分离后接受了 BSE，其中 143 例（49%）通过，148 例（51%）未通过。未通过 BSE 的患者需要机械通气的时间长于通过者（14 ± 13 与 5 ± 20 天，P =.001）。此外，仅 23%的在 72 小时内拔管的患者未通过 BSE，而在超过 72 小时内插管的患者中，有 78%的患者未通过 BSE（P <.001）。所有通过 BSE 的患者均未出现临床吸入事件出院。BSE 失败的独立危险因素包括气管切开术、年龄较大、机械通气时间延长、震颤谵妄、创伤性脑损伤和脊柱骨折。尽管未通过 BSE 的 3 例（2%）患者未经口进食，但仍发生了临床吸入事件。
简单的 BSE 可用于识别机械通气后有吞咽功能障碍风险的患者。更重要的是，BSE 可以安全清除无吞咽功能障碍的患者，避免昂贵且耗时的对比研究或内窥镜检查。
