气管插管拔管后吞咽障碍的言语病理学评估：服务模式评估。

Speech pathology assessment of dysphagia post endotracheal extubation: A service-model evaluation.

机构信息

Speech Pathology Department, Concord Repatriation General Hospital, NSW Australia; Intensive Care Unit, Concord Repatriation General Hospital, NSW Australia; School of Health and Rehabilitation Sciences, University of Queensland, QLD Australia; Faculty of Medical and Health Sciences, University of Sydney, NSW Australia.

School of Health and Rehabilitation Sciences, University of Queensland, QLD Australia; Centre for Functioning and Health Research, Metro South Health, Queensland Health, QLD Australia.

出版信息

Aust Crit Care. 2024 Jan;37(1):144-150. doi: 10.1016/j.aucc.2023.07.041. Epub 2023 Sep 13.

DOI:10.1016/j.aucc.2023.07.041

PMID:37709658

Abstract

BACKGROUND

As postextubation dysphagia (PED) is correlated with pneumonia, feeding-tube placement, and in-hospital mortality, early identification is paramount. Endotracheal intubation duration of ≥48 h is independently predictive for PED. Therefore, a blanket intensive care unit (ICU) referral protocol was implemented to conduct PED assessment of patients intubated for ≥48 h.

OBJECTIVES

The objective of this study was to review outcomes of an established blanket referral model for PED assessment in patients intubated for ≥48 h. Outcomes of the model were examined over a 2-year period (June 2015-June 2017) for (i) numbers and clinical characteristics of patients meeting criteria and referred for speech pathology (SP) assessment; (ii) frequency identified with PED on clinical swallow examination; (iii) severity and duration of PED; and (iv) SP management within the ICU.

RESULTS

There was 96% adherence to the pathway with 108 participants (68% male) assessed. Median intubation duration was 142 h (mode = 61; interquartile range [IQR] = 131.75), and median ICU admission was 9 days (mode = 8; IQR = 6.75). SP referral occurred at a median of 19.5 h (mode = 4; IQR = 18.75) after extubation. Dysphagia assessment occurred at a median of 22 h (mode = 4; IQR = 19), with 34% assessed on the same day and 77% within 24 h of extubation. PED was observed in 89%, with 26% exhibiting profound PED. Dysphagia recovery occurred at a median of 7 days (mode = 2; IQR = 11). Dysphagia severity was associated with duration to swallow recovery (p = 0.001). A median of two occasions of service and 90 min clinical time was spent by the speech pathologist in the ICU.

CONCLUSION

The blanket referral model enabled timely triage and assessment of dysphagia in a patient cohort at high risk of PED in our facility.

摘要

背景

由于拔管后吞咽困难（PED）与肺炎、置管和院内死亡率相关，因此早期识别至关重要。气管插管时间≥48 小时是 PED 的独立预测因素。因此，实施了一项涵盖整个重症监护病房（ICU）的转介方案，对气管插管时间≥48 小时的患者进行 PED 评估。

目的

本研究旨在回顾一项针对气管插管时间≥48 小时的患者进行 PED 评估的通用转介模型的结果。在 2 年期间（2015 年 6 月至 2017 年 6 月），对该模型的结果进行了检查，以评估：（i）符合并转介至言语病理科（SP）评估的患者数量和临床特征；（ii）在临床吞咽检查中发现 PED 的频率；（iii）PED 的严重程度和持续时间；以及（iv）在 ICU 中 SP 的管理。

结果

有 96%的患者遵循了该方案，共评估了 108 名患者（68%为男性）。中位插管时间为 142 小时（模式=61；四分位间距 [IQR]=131.75），中位 ICU 住院时间为 9 天（模式=8；IQR=6.75）。SP 转介发生在拔管后中位数 19.5 小时（模式=4；IQR=18.75）。吞咽障碍评估发生在拔管后中位数 22 小时（模式=4；IQR=19），34%在同一天评估，77%在拔管后 24 小时内评估。89%的患者出现 PED，26%的患者存在严重 PED。吞咽障碍恢复发生在中位数 7 天（模式=2；IQR=11）。吞咽障碍的严重程度与吞咽恢复的时间相关（p=0.001）。言语病理学家在 ICU 平均花费两次就诊和 90 分钟的临床时间。