Abstract

BackgroundFor patients who survive a critical illness and have their oral endotracheal tube removed, dysphagia is highly prevalent, and without intervention, it may persist far beyond hospital discharge. This pre- and post-intervention study with historical controls tested the effects of a swallowing and oral care (SOC) intervention on patients’ time to resume oral intake and salivary flow following endotracheal extubation.MethodsThe sample comprised intensive care unit patients (≥ 50 years) successfully extubated after ≥ 48 h endotracheal intubation. Participants who received usual care (controls, n = 117) were recruited before 2015, and those who received usual care plus the intervention (n = 54) were enrolled after 2015. After extubation, all participants were assessed by a blinded nurse for daily intake status (21 days) and whole-mouth unstimulated salivary flow (2, 7, 14 days). The intervention group received the nurse-administered SOC intervention, comprising toothbrushing/salivary gland massage, oral motor exercise, and safe-swallowing education daily for 14 days or until hospital discharge.ResultsThe intervention group received 8.3 ± 4.2 days of SOC intervention, taking 15.4 min daily with no reported adverse event (coughing, wet voice, or decreased oxygen saturation) during and immediately after intervention. Participants who received the intervention were significantly more likely than controls to resume total oral intake after extubation (aHR 1.77, 95% CI 1.08–2.91). Stratified by age group, older participants (≥ 65 years) in the SOC group were 2.47-fold more likely than their younger counterparts to resume total oral intake (aHR 2.47, 95% CI 1.31–4.67). The SOC group also had significantly higher salivary flows 14 days following extubation (β = 0.67, 95% CI 0.29–1.06).ConclusionsThe nurse-administered SOC is safe and effective, with greater odds of patients’ resuming total oral intake and increased salivary flows 14 days following endotracheal extubation. Age matters with SOC; it more effectively helped participants ≥ 65 years old resume total oral intake postextubation.Trial registrationNCT02334774, registered on January 08, 2015

Highlights

  • For patients who survive a critical illness and have their oral endotracheal tube removed, dysphagia is highly prevalent and may persist far beyond hospital discharge [1]

  • Our previous studies of the sequelae of prolonged endotracheal intubation in this group of intensive care unit (ICU) patients [6, 14, 15] revealed that reduced salivary flow [14], sensorimotor impairment of the tongue [15], poor lip seal [14], and restricted mouth opening [14] were highly prevalent and may persist 14 days postextubation. As these sequelae contribute to dysphagia and delay oral intake after extubation [1, 16], we developed a nurse-administered, hospital-based swallowing and oral care (SOC) intervention comprising toothbrushing/salivary gland massage, oral motor exercise, and safe-swallowing education

  • Baseline intake level was significantly worse for the SOC group (63.0% were at Functional oral intake scale (FOIS) level 1 [nothing by mouth]) than for the control group (41.0% were at FOIS level 1; P < 0.01)

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Summary

Introduction

For patients who survive a critical illness and have their oral endotracheal tube removed, dysphagia is highly prevalent and may persist far beyond hospital discharge [1]. For patients who survive a critical illness and have their oral endotracheal tube removed, dysphagia is highly prevalent, and without intervention, it may persist far beyond hospital discharge. This pre- and postintervention study with historical controls tested the effects of a swallowing and oral care (SOC) intervention on patients’ time to resume oral intake and salivary flow following endotracheal extubation

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