Oral Care Program for Postextubation Dysphagia
Trial question
What is the effect of a swallowing and oral care program in patients following endotracheal extubation?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
41.0% female
59.0% male
N = 145
145 patients (60 female, 85 male).
Inclusion criteria: critically ill patients who have been successfully extubated after prolonged endotracheal intubation.
Key exclusion criteria: history of neuromuscular disease or head and neck deformities; pre-existing difficulty swallowing; receipt of tracheostomy; unable to follow verbal instructions; on contact and droplet precautions; receipt of continuous noninvasive ventilation after extubation precluding the delivery of swallowing and oral-care intervention.
Interventions
N=72 swallowing and oral care program (oral motor exercise, sensory stimulation and lubrication, and safe-swallowing education provided for 7 consecutive days or until death or hospital discharge).
N=73 usual care (daily oral care with oral swabs and rinsing with 2% chlorhexidine gluconate).
Primary outcome
Rate of resumption of oral feeding 7-day postextubation
51.4%
32.9%
51.4 %
38.5 %
25.7 %
12.8 %
0.0 %
Swallowing and oral care
program
Usual
care
Significant
increase ▲
NNT = 5
Significant increase in the rate of resumption of oral feeding 7-day postextubation (51.4% vs. 32.9%; HR 2.35, 95% CI 1.38 to 4.01).
Secondary outcomes
Significant decrease in pneumonia at day 30 (15.3% vs. 35.6%; OR 0.28, 95% CI 0.12 to 0.65).
Conclusion
In critically ill patients who have been successfully extubated after prolonged endotracheal intubation, swallowing and oral care program were superior to usual care with respect to the rate of resumption of oral feeding 7-day postextubation.
Reference
Shu-Fen Siao, Shih-Chi Ku, Wen-Hsuan Tseng et al. 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. Crit Care. 2023 Jul 12;27(1):283.
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