Effects of a swallowing and oral-care program on resuming oral feeding and reducing pneumonia in patients following endotracheal extubation: a randomized, open-label, controlled trial
Abstract Background The resumption of oral feeding and free from pneumonia are important therapeutic goals for critically ill patients who have been successfully extubated after prolonged (≥ 48 h) endotracheal intubation. We aimed to examine whether a swallowing and oral-care (SOC) program provided...
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| Format: | Article |
| Language: | English |
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BMC
2023-07-01
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| Series: | Critical Care |
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| Online Access: | https://doi.org/10.1186/s13054-023-04568-6 |
| _version_ | 1797778823315456000 |
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| author | Shu-Fen Siao Shih-Chi Ku Wen-Hsuan Tseng Yu-Chung Wei Yu-Chun Chang Tzu-Yu Hsiao Tyng-Guey Wang Cheryl Chia-Hui Chen |
| author_facet | Shu-Fen Siao Shih-Chi Ku Wen-Hsuan Tseng Yu-Chung Wei Yu-Chun Chang Tzu-Yu Hsiao Tyng-Guey Wang Cheryl Chia-Hui Chen |
| author_sort | Shu-Fen Siao |
| collection | DOAJ |
| description | Abstract Background The resumption of oral feeding and free from pneumonia are important therapeutic goals for critically ill patients who have been successfully extubated after prolonged (≥ 48 h) endotracheal intubation. We aimed to examine whether a swallowing and oral-care (SOC) program provided to critically ill patients extubated from prolonged mechanical ventilation improves their oral-feeding resumption and reduces 30-day pneumonia incidence. Methods In this randomized, open-label, controlled trial, participants were consecutively enrolled and randomized to receive the SOC program or usual care. The interventions comprised three protocols: oral-motor exercise, sensory stimulation and lubrication, and safe-swallowing education. Beginning on the day following patient extubation, an SOC nurse provided the three-protocol care for seven consecutive days or until death or hospital discharge. With independent outcome assessors, oral-feeding resumption (yes, no) corresponded to level 6 or level 7 on the Functional Oral Intake Scale (censored seven days postextubation) along with radiographically documented pneumonia (yes, no; censored 30 days postextubation), abstracted from participants’ electronic medical records were coded. Results We analyzed 145 randomized participants (SOC group = 72, control group = 73). The SOC group received, on average, 6.2 days of intervention (14.8 min daily) with no reported adverse events. By day 7, 37/72 (51.4%) of the SOC participants had resumed oral feeding vs. 24/73 (32.9%) of the control participants. Pneumonia occurred in 11/72 (15.3%) of the SOC participants and in 26/73 (35.6%) of the control participants. Independent of age and intubation longer than 6 days, SOC participants were likelier than their control counterparts to resume oral feeding (adjusted hazard ratio, 2.35; 95% CI 1.38–4.01) and had lower odds of developing pneumonia (adjusted odds ratio, 0.28; 95% CI 0.12–0.65). Conclusions The SOC program effectively improved patients’ odds that oral feeding would resume and the 30-day pneumonia incidence would decline. The program might advance dysphagia care provided to critically ill patients extubated from prolonged mechanical ventilation. Trial registration: NCT03284892, registered on September 15, 2017. |
| first_indexed | 2024-03-12T23:23:06Z |
| format | Article |
| id | doaj.art-3df0630a005a4772987f404830e81c4c |
| institution | Directory Open Access Journal |
| issn | 1364-8535 |
| language | English |
| last_indexed | 2024-03-12T23:23:06Z |
| publishDate | 2023-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Critical Care |
| spelling | doaj.art-3df0630a005a4772987f404830e81c4c2023-07-16T11:18:23ZengBMCCritical Care1364-85352023-07-012711910.1186/s13054-023-04568-6Effects of a swallowing and oral-care program on resuming oral feeding and reducing pneumonia in patients following endotracheal extubation: a randomized, open-label, controlled trialShu-Fen Siao0Shih-Chi Ku1Wen-Hsuan Tseng2Yu-Chung Wei3Yu-Chun Chang4Tzu-Yu Hsiao5Tyng-Guey Wang6Cheryl Chia-Hui Chen7School of Nursing, National Taiwan University College of MedicineDepartment of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of MedicineDepartment of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of MedicineGraduate Institute of Statistics and Information Science, National Changhua University of EducationSchool of Nursing, National Taiwan University College of MedicineDepartment of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of MedicineDepartment of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University College of MedicineSchool of Nursing, National Taiwan University College of MedicineAbstract Background The resumption of oral feeding and free from pneumonia are important therapeutic goals for critically ill patients who have been successfully extubated after prolonged (≥ 48 h) endotracheal intubation. We aimed to examine whether a swallowing and oral-care (SOC) program provided to critically ill patients extubated from prolonged mechanical ventilation improves their oral-feeding resumption and reduces 30-day pneumonia incidence. Methods In this randomized, open-label, controlled trial, participants were consecutively enrolled and randomized to receive the SOC program or usual care. The interventions comprised three protocols: oral-motor exercise, sensory stimulation and lubrication, and safe-swallowing education. Beginning on the day following patient extubation, an SOC nurse provided the three-protocol care for seven consecutive days or until death or hospital discharge. With independent outcome assessors, oral-feeding resumption (yes, no) corresponded to level 6 or level 7 on the Functional Oral Intake Scale (censored seven days postextubation) along with radiographically documented pneumonia (yes, no; censored 30 days postextubation), abstracted from participants’ electronic medical records were coded. Results We analyzed 145 randomized participants (SOC group = 72, control group = 73). The SOC group received, on average, 6.2 days of intervention (14.8 min daily) with no reported adverse events. By day 7, 37/72 (51.4%) of the SOC participants had resumed oral feeding vs. 24/73 (32.9%) of the control participants. Pneumonia occurred in 11/72 (15.3%) of the SOC participants and in 26/73 (35.6%) of the control participants. Independent of age and intubation longer than 6 days, SOC participants were likelier than their control counterparts to resume oral feeding (adjusted hazard ratio, 2.35; 95% CI 1.38–4.01) and had lower odds of developing pneumonia (adjusted odds ratio, 0.28; 95% CI 0.12–0.65). Conclusions The SOC program effectively improved patients’ odds that oral feeding would resume and the 30-day pneumonia incidence would decline. The program might advance dysphagia care provided to critically ill patients extubated from prolonged mechanical ventilation. Trial registration: NCT03284892, registered on September 15, 2017.https://doi.org/10.1186/s13054-023-04568-6Endotracheal intubationDysphagiaOral feedingSwallowingMechanical ventilationExtubation |
| spellingShingle | Shu-Fen Siao Shih-Chi Ku Wen-Hsuan Tseng Yu-Chung Wei Yu-Chun Chang Tzu-Yu Hsiao Tyng-Guey Wang Cheryl Chia-Hui Chen Effects of a swallowing and oral-care program on resuming oral feeding and reducing pneumonia in patients following endotracheal extubation: a randomized, open-label, controlled trial Critical Care Endotracheal intubation Dysphagia Oral feeding Swallowing Mechanical ventilation Extubation |
| title | Effects of a swallowing and oral-care program on resuming oral feeding and reducing pneumonia in patients following endotracheal extubation: a randomized, open-label, controlled trial |
| title_full | Effects of a swallowing and oral-care program on resuming oral feeding and reducing pneumonia in patients following endotracheal extubation: a randomized, open-label, controlled trial |
| title_fullStr | Effects of a swallowing and oral-care program on resuming oral feeding and reducing pneumonia in patients following endotracheal extubation: a randomized, open-label, controlled trial |
| title_full_unstemmed | Effects of a swallowing and oral-care program on resuming oral feeding and reducing pneumonia in patients following endotracheal extubation: a randomized, open-label, controlled trial |
| title_short | Effects of a swallowing and oral-care program on resuming oral feeding and reducing pneumonia in patients following endotracheal extubation: a randomized, open-label, controlled trial |
| title_sort | effects of a swallowing and oral care program on resuming oral feeding and reducing pneumonia in patients following endotracheal extubation a randomized open label controlled trial |
| topic | Endotracheal intubation Dysphagia Oral feeding Swallowing Mechanical ventilation Extubation |
| url | https://doi.org/10.1186/s13054-023-04568-6 |
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