Incidence and predictors of aspiration after prolonged intubation in trauma patients

Abstract

Abstract Introduction: Prolonged intubation has been associated with increased risk for aspiration. We hypothesized that trauma patients have higher incidence of aspiration after prolonged intubation when compared to a non-trauma group. Methods: A case-control study was conducted at an academic Level-I trauma center over a 4-year period. Adult patients who underwent videofluoroscopic swallow studies (VFSS) for aspiration assessment after extubation were included in the analysis. Trauma patients requiring prolonged intubation (cases) were compared to a non-trauma control group. Aspiration was defined as the passage of the barium bolus below the true vocal folds and silent aspiration by the absence of a cough response. Demographic, clinical and VFSS data were recorded. Statistical analysis included stepwise regression analysis. Results: Seventy-two critically-ill patients (trauma n=22 and non-trauma n=50; mean age 45.4+−23 vs. 70.9+−15 years) underwent prolonged intubation (11.6±12 vs. 11.0±12 ventilator days) and VFSS. No significant differences in aspiration (50.0 vs. 36.0%) or silent aspiration rates (31.8 vs. 28.0%) were found. Sixty percent of cases sustained traumatic brain injury (TBI). After controlling for age, gender, setting of intubation, mechanism of injury, tracheostomy, neck injuries, ventilator and ICU days, GCS, and Injury Severity Score; TBI was an independent risk factor for silent aspiration after prolonged intubation (p Conclusions: Trauma patients have a non-significant increased incidence of aspiration after prolonged intubation when compared to the non-trauma population. TBI is a significant predictor of silent aspiration after prolonged intubation. VFSS performed routinely after extubation in this group of patients may prevent undetected aspirations and subsequent pneumonia.