Symptoms Assessment and Screening for Laryngeal Injury Post-extubation in ICU

项目摘要 在全球范围内，每年有1300万至2000万人患重症，并在2009年接受机械通气插管。 重症监护室（ICU）。仅在美国，就有大约100万人插管，近三分之一的人 >5天。这些患者中有73%在气管插管后1天内会发生喉损伤 安置50多年来，研究表明，气管插管与 和喉损伤，但没有考虑患者症状在识别此类损伤中可能发挥的作用。 喉损伤和语音/通信的研究是几个专业的研究重点 协会，包括美国重症监护护士协会和重症监护医学协会。 拔管后，患者通常会出现一系列与喉损伤和声音变化相关的症状，包括 声音嘶哑、失声、清嗓子、喉咙痛和声音疲劳。目前，有此类症状的患者 没有被确定为喉损伤的高风险，并且经常被忽视，认为他们的 症状将是自限性的。这种“等待和观望”的方法喉损伤可能会推迟评估1周 3个月（或更长时间）。不幸的是，这种方法导致一些患者经历严重的，长期的- 长期的后果，一些伤害导致慢性疾病，这可能是可以避免的早期 评估和适当的干预。因此，早期识别很重要，但没有标准。 拔管后转诊至言语语言病理学家或喉科医生进行评估的实践。现有 文献有重要的弱点，包括患者样本异质性，描述不佳， 往往是小规模的。近年来，临床实践和相关指南已改变为目标患者 机械通气插管期间的觉醒，创造了一个新的和重要的机会， 与患者一起评估插管期间和拔管后不久的症状。因此，总体目标 本研究的目的是系统地：1）确定与经口气管插管相关的患者症状， 插管期间和插管后，2）使用先进的喉损伤评估和拔管后的语音功能 喉镜检查和感知和声学语音分析的方法，以及3）构建基于 基于患者和ICU变量以及患者症状，以帮助识别具有临床重要性的患者，后 拔管喉损伤。这种对患者症状的系统评估，结合全面的 喉镜检查和语音评估，将为临床医生使用的临床筛查工具的开发提供信息 在ICU中，目的是适当识别需要进一步评估的患者，以减少短期和 气管插管相关损伤对喉和嗓音的长期危害。

PROJECT SUMMARY Globally, each year 13 - 20 million people become critically ill and are intubated with mechanical ventilation in an intensive care unit (ICU). In the U.S. alone, there are approximately 1 million intubated, with nearly one-third for >5 days. As many as 73% of these patients will sustain laryngeal injury within 1 day of endotracheal tube placement. For >50 years, research has demonstrated a strong association between endotracheal intubation and laryngeal injury, but without considering the role that patient symptoms may play in identifying such injury. Research in laryngeal injury and voice/communication is a research priority among several professional societies, including the American Association of Critical Care Nurses and the Society of Critical Care Medicine. After extubation, patients often have a range of symptoms related to laryngeal injury and voice changes, including hoarseness, loss of voice, throat clearing, sore throat, and vocal fatigue. At present, patients with such symptoms are not identified as being high-risk for laryngeal injury and are often overlooked with the thought that their symptoms will be self-limited. Such a “wait and see” approach to laryngeal injury may defer evaluation for 1 week to 3 months (or longer). Unfortunately, this approach has resulted in some patients experiencing serious, long- term consequences, with some injuries resulting in chronic conditions that may have been avoidable with early evaluation and appropriate intervention. Hence, early identification is important, but there is no standard of practice for referral to a speech-language pathologist or laryngologist after extubation for evaluation. The existing literature has important weaknesses, including patient samples that are heterogeneous, poorly described, and often small-sized. In recent years, clinical practice and associated guidelines have changed to target patient wakefulness during intubation with mechanical ventilation, creating a new and important opportunity to interact with patients to evaluate their symptoms during intubation and soon after extubation. Therefore, the overall goals of this research are to systematically: 1) determine patient symptoms related to orotracheal intubation, both during and after intubation, 2) evaluate laryngeal injury and voice function after extubation using advanced methods of laryngoscopy and perceptual and acoustic voice analyses, and 3) construct a screening tool, based on patient and ICU variables and patient symptoms, to assist in identifying patients with clinically important, post- extubation laryngeal injury. This systematic evaluation of patient symptoms, combined with comprehensive laryngoscopic and voice assessment, will inform the development of a clinical screening tool for use by clinicians in the ICU with the aim of appropriately identifying patients needing further evaluation to reduce the short- and long-term harms of endotracheal tube-related injury on the larynx and voice.