Standardized Endoscopic Swallowing Evaluation for Tracheostomy Decannulation in Critically Ill Neurologic Patients – a prospective evaluation

Neurological Research and Practice - Tập 3 Số 1 - 2021
Paul Muhle1, Sonja Suntrup‐Krueger1, Karoline Burkardt2, Sriramya Lapa3, Mao Ogawa4, Inga Claus1, Bendix Labeit1, Sigrid Ahring1, Stephan Oelenberg1, Tobias Warnecke1, Rainer Dziewas5
1University Hospital Muenster, Department of Neurology with Institute for Translational Neurology, Albert-Schweitzer-Campus 1 A, 48149, Muenster, Germany
2Raphaelsklinik Muenster, Department of General Surgery, Loerstraße 23, 48143, Muenster, Germany
3University Hospital Frankfurt, Department of Neurology, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany
4Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
5Klinikum Osnabrück, Department of Neurology, Am Finkenhügel 1, 49076, Osnabrück, Germany

Tóm tắt

Abstract Background Removal of a tracheostomy tube in critically ill neurologic patients is a critical issue during intensive care treatment, particularly due to severe dysphagia and insufficient airway protection. The “Standardized Endoscopic Evaluation for Tracheostomy Decannulation in Critically Ill Neurologic Patients” (SESETD) is an objective measure of readiness for decannulation. This protocol includes the stepwise evaluation of secretion management, spontaneous swallowing, and laryngeal sensitivity during fiberoptic endoscopic evaluation of swallowing (FEES). Here, we first evaluated safety and secondly effectiveness of the protocol and sought to identify predictors of decannulation success and decannulation failure. Methods A prospective observational study was conducted in the neurological intensive care unit at Münster University Hospital, Germany between January 2013 and December 2017. Three hundred and seventy-seven tracheostomized patients with an acute neurologic disease completely weaned from mechanical ventilation were included, all of whom were examined by FEES within 72 h from end of mechanical ventilation. Using regression analysis, predictors of successful decannulation, as well as decannulation failure were investigated. Results Two hundred and twenty-seven patients (60.2%) could be decannulated during their stay according to the protocol, 59 of whom within 24 h from the initial FEES after completed weaning. 3.5% of patients had to be recannulated due to severe dysphagia or related complications. Prolonged mechanical ventilation showed to be a significant predictor of decannulation failure. Lower age was identified to be a significant predictor of early decannulation after end of weaning. Transforming the binary SESETD into a 4-point scale helped predicting decannulation success in patients not immediately ready for decannulation after the end of respiratory weaning (optimal cutoff ≥1; sensitivity: 64%, specifity: 66%). Conclusions The SESETD showed to be a safe and efficient tool to evaluate readiness for decannulation in our patient collective of critically ill neurologic patients.

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Neurological Research and Practice

Tập 3 Số 1

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