Department of Anaesthesiology and Intensive Care Medicine, Klinikum Klagenfurt am Wörthersee, Feschnigstrasse 11, 9020, Klagenfurt am Wörthersee, Austria.
Medical University Graz, Graz, Austria.
Neurocrit Care. 2020 Apr;32(2):532-538. doi: 10.1007/s12028-019-00780-x.
Dysphagia is a common disorder in neurological and non-neurological intensive care unit (ICU) patients and can lead to aspiration pneumonia, prolonged ventilation, and delayed extubation. Dysphagia is an independent predictor of increased mortality. In dysphagic stroke patients with tracheotomy, the use of pharyngeal electric stimulation (PES), an emerging technique to treat dysphagia, has been shown to improve airway protection and shorten time to decannulation. The objective of this study was to determine whether patients who receive PES have a lower prevalence of pneumonia and frequency of reintubation.
Secondary analysis of a non-blinded interventional subject sample from a large clinical study with a historical age, pathology, and severity-matched control group.
ICU of a tertiary care medical center.
In this pilot non-blinded study, a group of 15 intubated patients in a general and a neurologic ICU received PES while orally intubated during ICU stay. A control group (n = 25) matched for age, type, and region of pathology, and severity of illness expressed by Simplified Acute Physiology Score and Therapeutic Intervention Scoring System was used to compare for pneumonia and need for reintubation.
Patients treated with PES had significantly lower prevalence of pneumonia (4 vs 21, p = 0.00046) and frequency of reintubation (0 vs 6, p = 0.046) when compared to controls.
Although limited by its small size and non-blinded design, this is the first study demonstrating the benefits of PES in ICU patients still orally intubated, thus offering a potential new method to reduce morbidity, mortality, and economic burden in a mixed ICU population. In order to further investigate and strengthen our findings, a statistically powered, randomized controlled study is recommended.
吞咽困难是神经和非神经重症监护病房（ICU）患者的常见疾病，可导致吸入性肺炎、延长通气时间和延迟拔管。吞咽困难是增加死亡率的独立预测因素。对于接受气管切开术的吞咽困难卒中患者，使用咽电刺激（PES）治疗吞咽困难是一种新兴技术，已被证明可以改善气道保护并缩短拔管时间。本研究的目的是确定接受 PES 的患者肺炎发生率和再插管频率是否较低。
对一项大型临床研究中的非盲干预对象样本进行二次分析，该研究具有历史年龄、病理学和严重程度匹配的对照组。
三级医疗中心的 ICU。
在这项非盲试点研究中，一组 15 名在普通和神经 ICU 接受气管插管的插管患者在 ICU 住院期间接受了 PES。对照组（n=25）按年龄、类型和病理学区域以及简化急性生理学评分和治疗干预评分系统表达的疾病严重程度进行匹配，用于比较肺炎和再插管的需要。
与对照组相比，接受 PES 治疗的患者肺炎发生率（4 比 21，p=0.00046）和再插管频率（0 比 6，p=0.046）显著降低。
尽管受到其规模小和非盲设计的限制，但这是第一项证明 PES 对仍经口插管的 ICU 患者有益的研究，从而提供了一种降低混合 ICU 人群发病率、死亡率和经济负担的潜在新方法。为了进一步调查和加强我们的发现，建议进行具有统计学效力的随机对照研究。
