Effects of a swallowing and oral care intervention for patients following endotracheal extubation: a pre- and post-intervention study
Abstract Background 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 post-intervention study with historical controls tested the effects of a...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2019-11-01
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| Series: | Critical Care |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13054-019-2623-2 |
| _version_ | 1819026084476223488 |
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| author | Chung-Pei Wu Yu-Juan Xu Tyng-Guey Wang Shih-Chi Ku Ding-Cheng Chan Jang-Jaer Lee Yu-Chung Wei Tzu-Yu Hsiao Cheryl Chia-Hui Chen |
| author_facet | Chung-Pei Wu Yu-Juan Xu Tyng-Guey Wang Shih-Chi Ku Ding-Cheng Chan Jang-Jaer Lee Yu-Chung Wei Tzu-Yu Hsiao Cheryl Chia-Hui Chen |
| author_sort | Chung-Pei Wu |
| collection | DOAJ |
| description | Abstract Background 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 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. Methods The 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. Results The 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). Conclusions The 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 registration NCT02334774, registered on January 08, 2015 |
| first_indexed | 2024-12-21T05:20:57Z |
| format | Article |
| id | doaj.art-4afa7d5b40ea4beb98875951938eb172 |
| institution | Directory Open Access Journal |
| issn | 1364-8535 |
| language | English |
| last_indexed | 2024-12-21T05:20:57Z |
| publishDate | 2019-11-01 |
| publisher | BMC |
| record_format | Article |
| series | Critical Care |
| spelling | doaj.art-4afa7d5b40ea4beb98875951938eb1722022-12-21T19:14:48ZengBMCCritical Care1364-85352019-11-012311810.1186/s13054-019-2623-2Effects of a swallowing and oral care intervention for patients following endotracheal extubation: a pre- and post-intervention studyChung-Pei Wu0Yu-Juan Xu1Tyng-Guey Wang2Shih-Chi Ku3Ding-Cheng Chan4Jang-Jaer Lee5Yu-Chung Wei6Tzu-Yu Hsiao7Cheryl Chia-Hui Chen8Department of Nursing, National Taiwan University Hospital and National Taiwan University College of MedicineDepartment of Nursing, 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 MedicineDepartment of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of MedicineDepartment of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of MedicineDepartment of Dentistry, National Taiwan University Hospital and National Taiwan University College of MedicineDepartment of Statistics, Feng Chia UniversityDepartment of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of MedicineDepartment of Nursing, National Taiwan University Hospital and National Taiwan University College of MedicineAbstract Background 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 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. Methods The 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. Results The 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). Conclusions The 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 registration NCT02334774, registered on January 08, 2015http://link.springer.com/article/10.1186/s13054-019-2623-2Endotracheal intubationDysphagiaCritical illnessOral intakeSwallowingSalivation |
| spellingShingle | Chung-Pei Wu Yu-Juan Xu Tyng-Guey Wang Shih-Chi Ku Ding-Cheng Chan Jang-Jaer Lee Yu-Chung Wei Tzu-Yu Hsiao Cheryl Chia-Hui Chen Effects of a swallowing and oral care intervention for patients following endotracheal extubation: a pre- and post-intervention study Critical Care Endotracheal intubation Dysphagia Critical illness Oral intake Swallowing Salivation |
| title | Effects of a swallowing and oral care intervention for patients following endotracheal extubation: a pre- and post-intervention study |
| title_full | Effects of a swallowing and oral care intervention for patients following endotracheal extubation: a pre- and post-intervention study |
| title_fullStr | Effects of a swallowing and oral care intervention for patients following endotracheal extubation: a pre- and post-intervention study |
| title_full_unstemmed | Effects of a swallowing and oral care intervention for patients following endotracheal extubation: a pre- and post-intervention study |
| title_short | Effects of a swallowing and oral care intervention for patients following endotracheal extubation: a pre- and post-intervention study |
| title_sort | effects of a swallowing and oral care intervention for patients following endotracheal extubation a pre and post intervention study |
| topic | Endotracheal intubation Dysphagia Critical illness Oral intake Swallowing Salivation |
| url | http://link.springer.com/article/10.1186/s13054-019-2623-2 |
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