Comparison of the Consequences of Short vs. Long-Term Intubation on Speech and Swallowing.

Abstract

Introduction: Intubated, ventilator unweanable patients with ventilatory pump failure (VPF) can be extubated to continuous noninvasive positive pressure ventilatory support (CNVS), however, delays may result in untoward effects on speech and swallowing.Methods: Retrospective chart review of VPF patients to determine need for post-extubation gastrostomy tubes (GTs) and consequences on speech for intubations less than (short) vs. greater than (long) three weeks.Results: 165 patients were intubated for a mean 20.7 ± 23.5 (range = 1 to 240) days. All recovered pre-hospitalization speech status within two hours to 3 days. 104 of the short group were intubated 1.6 ± 1.3 (range = 1 to 9) times for 9.9 ± 5.1 (range = 1 to 20) days vs. 61 of the long group intubated 2.4 ± 3.3 (range = 1 to 26) times for 39.0 ± 30.5 (range = 21 to 210) days. 10.6% vs. 8.2%, respectively, required post-extubation GTs indefinitely.Discussion: There was no difference in untoward effects on speech or swallowing from short vs. long-term intubation. Had the patients undergone tracheotomies, the majority would have had GTs placed permanently and suffer morbidity and mortality from the tubes. Thus, an option is to permit patients to remain intubated, and even if unweanable, extubate them to CNVS rather than tracheotomy.