Screening and Intervention of Postextubation Dysphagia

Screen and Intervene: A Diagnostic Accuracy Study and A Randomized, Open-label, Controlled Trial for Postextubation Dysphagia

This clinical trial aims to test the validity of a two-item swallowing screen and to examine the effects of the Swallowing and Oral-Care (SOC) Program on resumption of oral intake, incidence of penetration and aspiration, and incidence of pneumonia in adult patients who successfully extubated after ≥ 48 hours of endotracheal intubation.

Endotracheal intubation is life-sustaining, but it may contribute to postextubation dysphagia (PED) increasing the risk of penetration, aspiration, and aspiration pneumonia. Up to 84% of extubated patients had PED and approximately 60% penetrated and aspirated that can lead to aspiration pneumonia. The aims of this three-year, two-stage study are: 1) In the first stage, the investigators develop a two-item swallowing screen involving oral stereognosis and cough reflex test for predicting the resumption of oral intake and feeding-tube dependence by using a diagnostic accuracy study method; 2) In the second stage, the investigators conduct a randomized, open-label, controlled trial design to examine the effect of a once-daily, 7-day SOC Program on resumption of oral intake, incidence of penetration and aspiration, and incidence of pneumonia in adult patients who successfully extubated after ≥ 48 hours of endotracheal intubation.

Inclusion Criteria:

• Patient who is over 20 years old.
• Patient how has received over 48 hours endotracheal intubation and had been successfully extubated.

Exclusion Criteria:

• Patient who has a history of neuromuscular disease (e.g., parkinsonism or stroke) or head and neck deformities.
• Patient who has preexisting difficulty swallowing.
• Patient who has received a tracheostomy.
• Patient who were unable to follow verbal instructions.
• Patient who were on contact and droplet precautions (e.g., open tuberculosis)
• Patient who were receiving continuous noninvasive ventilation after extubation that precluded the delivery of an SOC intervention