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

项目总结 在全球范围内，每年有1300万至2000万人病情危重，需要通过气管插管进行机械通风。 重症监护病房(ICU)。仅在美国，就有大约100万例气管插管，其中近三分之一 为期&>5天。多达73%的患者会在气管插管后1天内发生喉部损伤 放置。50年来，研究表明，气管插管与气管插管 和喉部损伤，但没有考虑患者症状在识别这种损伤中可能发挥的作用。 喉部损伤和语音/通讯的研究是几个专业人士的研究重点 美国重症监护护士协会和重症监护医学会。 拔管后，患者通常会出现一系列与喉部损伤和声音改变有关的症状，包括 声音嘶哑、失声、清嗓子、喉咙痛和发声疲劳。目前，有这种症状的患者 没有被认为是喉部损伤的高危人群，而且经常被忽视，认为他们的 症状将是自我限制的。这种“观望”的喉部损伤治疗方法可能会推迟一周进行评估 至3个月(或更长)。不幸的是，这种方法导致一些患者经历了严重的、长期的- 长期后果，一些损伤导致慢性疾病，这可能是早期可以避免的 评估和适当的干预。因此，早期识别很重要，但没有标准 拔管后转诊至语言病理学家或喉科医生进行评估的惯例。现有的 文献有很大的缺陷，包括患者样本是不同的，描述不佳，以及 通常是小号的。近年来，临床实践和相关指南已改为以患者为目标 机械通气插管期间的清醒，创造了一个新的重要的互动机会 患者在插管时和拔管后不久评估自己的症状。因此，总体目标是 本研究的目的是系统地：1)确定患者与经口气管插管相关的症状，包括 在插管过程中和插管后，2)评估喉损伤和拔管后的声音功能 喉镜和感知和声学声音分析的方法，以及3)构建筛查工具，基于 患者和ICU变量以及患者症状，以帮助识别临床上重要的、后遗症患者 拔管时喉部损伤。这种对患者症状的系统评估，结合全面的 喉镜和嗓音评估，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，目的是适当地识别需要进一步评估的患者，以减少 气管插管相关损伤对喉部和嗓子的长期危害。

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.