Aspiration in Acute Respiratory Failure Survivors
University of Colorado, Denver
Summary
The purpose of this study is to learn more about problems with swallowing that could develop in patients who are very sick and need a machine to help them breathe.
Description
The purpose of this study is to learn more about problems with swallowing that could develop in patients who are very sick and need a machine to help them breathe. Patients are asked to be in this study because they had problems breathing on their own and therefore needed the help of a machine called a ventilator. In order for this ventilator to push air into the lungs, patients need a tube placed in the throat called an endotracheal tube. The process of placing this endotracheal tube was called intubation. The tube has now been removed, which is a process called extubation. Sometimes, people…
Eligibility
- Age range
- 18+ years
- Sex
- All
- Healthy volunteers
- No
Inclusion Criteria: 1. Admission to an ICU. 2. Mechanical ventilation with an endotracheal tube for greater than 48 hours. Exclusion Criteria: 1. Likely persistent contraindications to enteral/oral nutrition administration. 2. Pre-existing history of dysphagia or aspiration. 3. Pre-existing or acute primary central or peripheral neuromuscular disorder. 4. Presence of a chronic tracheostomy (present prior to ICU admission). 5. Pre-existing head and neck cancer or surgery. 6. Coagulopathy resulting in uncontrolled nasal or pharyngeal bleeding. 7. Delirium for more than 96 hours after extubati…
Interventions
- Diagnostic Test3-Screenings Protocol
The 3-Screenings Protocol is a modified bedside swallow exam (BSE) consisting of a study developed five-item decision tree algorithm including voice quality assessment and a 2-ounce water consistency assessment, the Yale Swallow Test, with a scored 3-ounce Water Swallow Test (3-WST), and the Toronto Bedside Swallowing Screening Test (TOR-BSST).
- Diagnostic TestFEES
A thin, flexible endoscope designed for assessment of laryngeal structures is passed through the nose to the oropharynx, visualizing the laryngeal structures, and the base of tongue and the pharynx. If needed 4% topical lidocaine and/or oxymetazoline (Afrin) will be administered. Swallowing will then be evaluated directly with six food boluses of 5 ml each. All patients will be allowed to swallow spontaneously without a verbal command to swallow. Video of the examinations will be recorded and presence of dysphagia will be designated independently by 3 different observers (one pulmonary physician and two speech language pathologists (SLPs)). This procedure will take 5-10 minutes. The camera will then be removed.
- Diagnostic TestTracheal Ultrasound
Ultrasound imaging of the trachea, measuring tracheal diameter and endotracheal tube (ETT) size ratio within 72 hours prior to extubation
Locations (5)
- Stanford UniverityStanford, California
- University of ColoradoAurora, Colorado
- Yale UniversityNew Haven, Connecticut
- Tufts Medical CenterBoston, Massachusetts
- Boston UniversityBoston, Massachusetts