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Open Access 01-12-2021 | Foreign Body Aspiration | Research article

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

Authors: Paul Muhle, Sonja Suntrup-Krueger, Karoline Burkardt, Sriramya Lapa, Mao Ogawa, Inga Claus, Bendix Labeit, Sigrid Ahring, Stephan Oelenberg, Tobias Warnecke, Rainer Dziewas

Published in: Neurological Research and Practice | Issue 1/2021

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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Title: Standardized Endoscopic Swallowing Evaluation for Tracheostomy Decannulation in Critically Ill Neurologic Patients – a prospective evaluation
Authors: Paul Muhle
Sonja Suntrup-Krueger
Karoline Burkardt
Sriramya Lapa
Mao Ogawa
Inga Claus
Bendix Labeit
Sigrid Ahring
Stephan Oelenberg
Tobias Warnecke
Rainer Dziewas
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Foreign Body Aspiration
Foreign Body Aspiration
Aspiration
Tracheostomy
Dysphagia
Dysphagia
Flexible Endoscopic Evaluation of Swallowing
Flexible Endoscopic Evaluation of Swallowing
Dysphagia
Published in: Neurological Research and Practice / Issue 1/2021
Electronic ISSN: 2524-3489
DOI: https://doi.org/10.1186/s42466-021-00124-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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