A Pilot Study of Pharyngeal Electrical Stimulation for Orally Intubated ICU Patients with Dysphagia
A Pilot Study of Pharyngeal Electrical Stimulation for Orally Intubated ICU Patients with Dysphagia
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DOI：
10.1007/s12028-019-00780-x
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发表时间：
2020-04-01
影响因子：
3.5
通讯作者：
Likar, Rudolf
中科院分区：
文献类型：
--
作者：
Koestenberger, Markus;Neuwersch, Stefan;Likar, Rudolf
目的吞咽困难是神经科和非神经科重症监护病房（ICU）患者的常见疾病，可导致吸入性肺炎、通气时间延长和延迟拔管。吞咽困难是死亡率增加的独立预测因素。在接受气管切开术的吞咽困难卒中患者中，使用咽部电刺激（PES）（一种治疗吞咽困难的新兴技术）已被证明可改善气道保护并缩短拔管时间。本研究的目的是确定接受PES的患者是否具有较低的肺炎患病率和重新插管频率。设计对来自一项大型临床研究的非盲干预性受试者样本进行二次分析，该研究具有历史年龄、病理学和严重程度匹配的对照组。设置三级医疗中心的ICU。患者在这项初步非盲研究中，一组15名普通和神经科ICU的插管患者在ICU住院期间接受PES，同时口服插管。对照组（n = 25）的年龄，类型和病理区域，以及简化急性生理评分和治疗干预评分系统表示的疾病严重程度相匹配，用于比较肺炎和重新插管的需要。主要结果与对照组相比，PES治疗的患者肺炎患病率（4 vs 21，p = 0.00046）和重新插管频率（0 vs 6，p = 0.046）显著降低。结论：尽管受其小样本和非盲设计的限制，但这是第一项证明PES在仍经口插管的ICU患者中获益的研究，因此提供了一种潜在的新方法，可降低混合ICU人群的发病率、死亡率和经济负担。为了进一步研究和加强我们的研究结果，建议进行统计学上有把握的随机对照研究。
Objective Dysphagia is a common disorder in neurological and non-neurological intensive care unit (ICU) patients and can lead to aspiration pneumonia, prolonged ventilation, and delayed extubation. Dysphagia is an independent predictor of increased mortality. In dysphagic stroke patients with tracheotomy, the use of pharyngeal electric stimulation (PES), an emerging technique to treat dysphagia, has been shown to improve airway protection and shorten time to decannulation. The objective of this study was to determine whether patients who receive PES have a lower prevalence of pneumonia and frequency of reintubation. Design Secondary analysis of a non-blinded interventional subject sample from a large clinical study with a historical age, pathology, and severity-matched control group. Setting ICU of a tertiary care medical center. Patients In this pilot non-blinded study, a group of 15 intubated patients in a general and a neurologic ICU received PES while orally intubated during ICU stay. A control group (n = 25) matched for age, type, and region of pathology, and severity of illness expressed by Simplified Acute Physiology Score and Therapeutic Intervention Scoring System was used to compare for pneumonia and need for reintubation. Main Results Patients treated with PES had significantly lower prevalence of pneumonia (4 vs 21, p = 0.00046) and frequency of reintubation (0 vs 6, p = 0.046) when compared to controls. Conclusion Although limited by its small size and non-blinded design, this is the first study demonstrating the benefits of PES in ICU patients still orally intubated, thus offering a potential new method to reduce morbidity, mortality, and economic burden in a mixed ICU population. In order to further investigate and strengthen our findings, a statistically powered, randomized controlled study is recommended.