ABSTRACT
BACKGROUND: Post-extubation dysphagia (PED) is a common post-extubation complication that may lead to serious problems, such as malnutrition and longer hospital and intensive care unit (ICU) stays. AIM: To explore factors associated with the readiness for oral intake in post-extubated critically ill adult patients. STUDY DESIGN: This prospective observational study involved 125 extubated patients. Readiness for oral intake was assessed using the Gugging Swallowing Screen (GUSS), and regression analysis was used to determine its predictors. RESULTS: The median age of the participants was 40.0 years, and 51.2% were female. The median GUSS score was 12.0 (possible range, 0-20), and 35.2% of the studied patients had severe dysphagia (scored 0-9). Bivariate regression analysis showed that older age, male, higher APACHE II score, body mass index (BMI) ≥30, smoking history, longer ICU stay, muscle relaxants use, large-bore endotracheal and orogastric tubes and frequent intubation attempts were associated with lower GUSS score (p-value <.05). Multivariate regression analysis showed that age, BMI and smoking history predicted 37.2% of the variability in the GUSS score (F = 23.865, p-value <.001). Adding the ICU length of stay, muscle relaxants use, size of the endotracheal tube, size of the orogastric tube and frequency of intubation attempts to the regression model raised the predictability to 86.0% (F = 88.809, p-value <.001). CONCLUSIONS: More than one-third of extubated patients have severe PED with a high risk of aspiration. Several modifiable factors, such as muscle relaxant use and endotracheal and orogastric tube size, predict post-extubation readiness for oral intake. RELEVANCE TO CLINICAL PRACTICE: Using endotracheal and orogastric tubes of appropriate sizes, careful assessment of patients with a high risk for difficult intubation, and minimal use of muscle relaxants may help increase patients' readiness for post-extubation oral intake.
ABSTRACT
BACKGROUND: Intensive care unit-acquired weakness (ICU-AW) is common in critically ill patients and increases the duration of mechanical ventilation (MV) and weaning time. Early mobilization, range of motion (ROM) exercises, and neuromuscular electrical stimulation (NMES) can prevent ICU-AW by maintaining muscle mass. However, studies highlighting the effects of combining NMES with early physical activity in ICU patients are limited. AIM: To evaluate the effect of NMES and early physical activity on ICU-AW in mechanically ventilated patients. DESIGN: A single-blinded randomized controlled trial was conducted in Alexandria, Egypt. METHOD: Patients were randomly assigned to one of four groups: NMES, ROM, combined therapy (ROM + NMES), or conventional care (control group). The Medical Research Council (MRC) scale was used to assess the ICU-AW for the study patients over a 7-day period. The duration of the patient's MV and ICU stays were recorded. RESULTS: Of the 180 patients who were assessed for eligibility, 124 were randomly assigned to one of four groups: 32 patients in ROM exercises, 30 in NMES, 31 in combined therapy (ROM + NMES), and 31 in the control group. On day 7, ROM + NMES and NMES groups showed higher MRC scores than ROM and control groups (50.37 ± 2.34, 49.77 ± 2.19, 44.97 ± 3.61, and 41.10 ± 3.84, respectively). ANOVA test results indicated significant differences (p < .001) across the four groups. ICU-AW occurred in 0% of the ROM + NMES group, 60% of the ROM group, 13% of the NMES group, and 100% of the control group (p < .001). The MV duration (in days) in the ROM + NMES group was shorter (12.80 ± 3.800) than in the ROM, NMES, or control groups (21.80 ± 4.460, 18.73 ± 4.748, and 20.70 ± 3.932, respectively). ICU-LOS was shorter in the ROM + NMES group (17.43 ± 3.17 days) compared with the ROM group (22.53 ± 4.51 days), the NMES group (21.10 ± 5.0 days), and the control group (21.50 ± 4.42 days) with significant differences (p < .001) between the four groups. CONCLUSION: Daily sessions of NMES and early physical activity were well tolerated, preserved muscle strength, prevented ICU-AW, and decreased the duration of the MV and ICU stay. RELEVANCE TO CLINICAL PRACTICE: The findings of this study support the use of NMES and early physical exercises by critical care nurses as part of routine care for critically ill patients.
