Effects of an Swallowing and Oral Care Program in Patients Following Prolonged Endotracheal Intubation

NCT ID: NCT02334774

Last Updated: 2019-01-16

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

63 participants

Study Classification

INTERVENTIONAL

Study Start Date

2015-01-31

Study Completion Date

2015-12-31

Brief Summary

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This pre-and post-intervention study enrolled adult Intensive Care Unit(ICU) patients (≥50 years) successfully extubated after ≥48 hours endotracheal intubation and without preexisting neuromuscular disease or swallowing dysfunction.

All participants received by a trained nurse-administered, hospital-based (up to 14 days) Swallowing and Oral Care(SOC) intervention comprising toothbrushing/salivary gland massage, oral motor exercise, and advice on safe-swallowing strategies.

All participants' daily intake status (21 days) and oral health status, oral sensation(stereognosis, light touch and two-point discrimination), tongue and lip strength, salivary secretion, body weight) were assessed at 2, 7, 14 days post-extubation by a blinded research nurse.

Feasibility was evaluated as time spent providing SOC, patients adherence to SOC components, and adverse event(i.e., coughing, wet voice, or decreased oxygen saturation) during SOC intervention.

Detailed Description

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With rapid growth of medical technology, patients receiving oral endotracheal intubation have increased. Although endotracheal intubation is a life-sustaining procedure, its presence can deteriorate the structure and function of oropharynx, which may contribute to the difficulties in swallowing and subsequent oral intake. Estimated 62% of patients who had been intubated ≥48 hours will experience post-extubation dysphagia. Clearly, intervention is needed but studies are lacking in this regard. Thus, the objective of this pilot trial is to evaluate effects of an Oral Swallowing Care Program on swallowing and oral intake status in patients following prolonged endotracheal intubation.

This study employs a pre-and post-intervention design. The investigators were enrolled 63 post-extubated adult patients (50 years old and older) who had prolonged (≥48 hours) oral endotracheal intubation from six medical intensive care units at a medical center in Taipei, Taiwan.

Participants were assessed within 48 hours post-extubation for the baseline data, then a 14-day, daily Swallowing and Oral Care (SOC) Program involves toothbrushing/salivary gland massage, oral exercise(i.e., active/resistive range-of-motion\[ROM\] exercises for tongue, lips, and jaw), and advice on safe-swallowing strategies.

Outcome were assessed on 2nd, 7th, 14th, and 21st day post-extubation including oral health status, oral sensation (stereognosis, light touch and two-point discrimination), tongue and lip strength, salivary secretion, body weight. In addition, Three-Step Swallowing Screen (3-SSS) and Functional Oral Intake Scale(FOIS) were assessed daily. The data were analyzed by SPSS 12 software package.

Conditions

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Dysphagia Endotracheal Intubation Intake Status Swallowing Status

Study Design

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Allocation Method

NA

Intervention Model

SINGLE_GROUP

Pre-and post- intervention
Primary Study Purpose

SUPPORTIVE_CARE

Blinding Strategy

NONE

Study Groups

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Participants receiving an SOC Program

Participants following prolonged endotracheal intubation receiving a up to 14-day daily Swallowing and Oral Care Program.

Group Type EXPERIMENTAL

Swallowing and Oral Care Program

Intervention Type PROCEDURE

An Swallowing and Oral Care Program involves moisturizing and cleansing oral cavity, massaging salivary gland, oral motor exercise daily, and intake education as needed.

Interventions

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Swallowing and Oral Care Program

An Swallowing and Oral Care Program involves moisturizing and cleansing oral cavity, massaging salivary gland, oral motor exercise daily, and intake education as needed.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Adult patients (50 years old and older)
* People who had been extubated for over 48 hours and successfully extubated
* People or their legal representative who agree to participate in this study and sign the permit
* People who can communicate with Mandarin or Taiwanese

Exclusion Criteria

* People who have diagnosis of neurological diseases such as cerebrovascular disease, Parkinson's disease or spinal injury, etc.
* People who have abnormal structure or function of oropharynx such as patients with head neck cancer or acquired/ inherited abnormal oropharynx structure
* People who currently have endotracheostomy
* People who are unconscious or have mental disability, having difficulty following the protocol or interacting with others
* People who are absolute quarantined. such as patients with open tuberculosis
* People who had swallowing difficulties before current intubation
Minimum Eligible Age

50 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Taiwan University Hospital

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Cheryl CH Chen, Professor

Role: PRINCIPAL_INVESTIGATOR

Nursing Graduate Institute, National Taiwan University

Locations

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National Taiwan University Hospital

Taipei, , Taiwan

Site Status

Countries

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Taiwan

References

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El Solh A, Okada M, Bhat A, Pietrantoni C. Swallowing disorders post orotracheal intubation in the elderly. Intensive Care Med. 2003 Sep;29(9):1451-5. doi: 10.1007/s00134-003-1870-4. Epub 2003 Aug 2.

Reference Type BACKGROUND
PMID: 12904855 (View on PubMed)

Macht M, Wimbish T, Clark BJ, Benson AB, Burnham EL, Williams A, Moss M. Postextubation dysphagia is persistent and associated with poor outcomes in survivors of critical illness. Crit Care. 2011;15(5):R231. doi: 10.1186/cc10472. Epub 2011 Sep 29.

Reference Type BACKGROUND
PMID: 21958475 (View on PubMed)

Macht M, King CJ, Wimbish T, Clark BJ, Benson AB, Burnham EL, Williams A, Moss M. Post-extubation dysphagia is associated with longer hospitalization in survivors of critical illness with neurologic impairment. Crit Care. 2013 Jun 20;17(3):R119. doi: 10.1186/cc12791.

Reference Type BACKGROUND
PMID: 23786755 (View on PubMed)

Kim MJ, Park YH, Park YS, Song YH. Associations Between Prolonged Intubation and Developing Post-extubation Dysphagia and Aspiration Pneumonia in Non-neurologic Critically Ill Patients. Ann Rehabil Med. 2015 Oct;39(5):763-71. doi: 10.5535/arm.2015.39.5.763. Epub 2015 Oct 26.

Reference Type BACKGROUND
PMID: 26605174 (View on PubMed)

Skoretz SA, Flowers HL, Martino R. The incidence of dysphagia following endotracheal intubation: a systematic review. Chest. 2010 Mar;137(3):665-73. doi: 10.1378/chest.09-1823.

Reference Type BACKGROUND
PMID: 20202948 (View on PubMed)

Tsai MH, Ku SC, Wang TG, Hsiao TY, Lee JJ, Chan DC, Huang GH, Chen CC. Swallowing dysfunction following endotracheal intubation: Age matters. Medicine (Baltimore). 2016 Jun;95(24):e3871. doi: 10.1097/MD.0000000000003871.

Reference Type BACKGROUND
PMID: 27310972 (View on PubMed)

Brodsky MB, Huang M, Shanholtz C, Mendez-Tellez PA, Palmer JB, Colantuoni E, Needham DM. Recovery from Dysphagia Symptoms after Oral Endotracheal Intubation in Acute Respiratory Distress Syndrome Survivors. A 5-Year Longitudinal Study. Ann Am Thorac Soc. 2017 Mar;14(3):376-383. doi: 10.1513/AnnalsATS.201606-455OC.

Reference Type BACKGROUND
PMID: 27983872 (View on PubMed)

Rassameehiran S, Klomjit S, Mankongpaisarnrung C, Rakvit A. Postextubation Dysphagia. Proc (Bayl Univ Med Cent). 2015 Jan;28(1):18-20. doi: 10.1080/08998280.2015.11929174.

Reference Type BACKGROUND
PMID: 25552788 (View on PubMed)

Affoo RH, Trottier K, Garrick R, Mascarenhas T, Jang Y, Martin RE. The Effects of Tooth Brushing on Whole Salivary Flow Rate in Older Adults. Biomed Res Int. 2018 Feb 26;2018:3904139. doi: 10.1155/2018/3904139. eCollection 2018.

Reference Type BACKGROUND
PMID: 29682540 (View on PubMed)

Park T, Kim Y. Effects of tongue pressing effortful swallow in older healthy individuals. Arch Gerontol Geriatr. 2016 Sep-Oct;66:127-33. doi: 10.1016/j.archger.2016.05.009. Epub 2016 Jun 3.

Reference Type BACKGROUND
PMID: 27318884 (View on PubMed)

Crary MA, Mann GD, Groher ME. Initial psychometric assessment of a functional oral intake scale for dysphagia in stroke patients. Arch Phys Med Rehabil. 2005 Aug;86(8):1516-20. doi: 10.1016/j.apmr.2004.11.049.

Reference Type BACKGROUND
PMID: 16084801 (View on PubMed)

Lopez-Jornet P, Camacho-Alonso F, Bermejo-Fenoll A. A simple test for salivary gland hypofunction using Oral Schirmer's test. J Oral Pathol Med. 2006 Apr;35(4):244-8. doi: 10.1111/j.1600-0714.2006.00411.x.

Reference Type BACKGROUND
PMID: 16519773 (View on PubMed)

Chen CC, Wu KH, Ku SC, Chan DC, Lee JJ, Wang TG, Hsiao TY. Bedside screen for oral cavity structure, salivary flow, and vocal production over the 14days following endotracheal extubation. J Crit Care. 2018 Jun;45:1-6. doi: 10.1016/j.jcrc.2017.11.035. Epub 2017 Dec 16.

Reference Type BACKGROUND
PMID: 29257983 (View on PubMed)

Heffner JE. Swallowing complications after endotracheal extubation: moving from "whether" to "how". Chest. 2010 Mar;137(3):509-10. doi: 10.1378/chest.09-2477. No abstract available.

Reference Type BACKGROUND
PMID: 20202944 (View on PubMed)

Su H, Hsiao TY, Ku SC, Wang TG, Lee JJ, Tzeng WC, Huang GH, Chen CC. Tongue weakness and somatosensory disturbance following oral endotracheal extubation. Dysphagia. 2015 Apr;30(2):188-95. doi: 10.1007/s00455-014-9594-x. Epub 2015 Feb 8.

Reference Type BACKGROUND
PMID: 25663416 (View on PubMed)

Boliek CA, Rieger JM, Li SY, Mohamed Z, Kickham J, Amundsen K. Establishing a reliable protocol to measure tongue sensation. J Oral Rehabil. 2007 Jun;34(6):433-41. doi: 10.1111/j.1365-2842.2007.01735.x.

Reference Type BACKGROUND
PMID: 17518978 (View on PubMed)

Rech RS, Baumgarten A, Colvara BC, Brochier CW, de Goulart B, Hugo FN, Hilgert JB. Association between oropharyngeal dysphagia, oral functionality, and oral sensorimotor alteration. Oral Dis. 2018 May;24(4):664-672. doi: 10.1111/odi.12809. Epub 2018 Feb 27.

Reference Type BACKGROUND
PMID: 29164750 (View on PubMed)

Wu CP, Xu YJ, Wang TG, Ku SC, Chan DC, Lee JJ, Wei YC, Hsiao TY, Chen CC. Effects of a swallowing and oral care intervention for patients following endotracheal extubation: a pre- and post-intervention study. Crit Care. 2019 Nov 9;23(1):350. doi: 10.1186/s13054-019-2623-2.

Reference Type DERIVED
PMID: 31706360 (View on PubMed)

Other Identifiers

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201411079RIND

Identifier Type: -

Identifier Source: org_study_id

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