Browsing by Author "Ku, Shih-Chi"

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Swallowing dysfunction following endotracheal intubation Age matters
(2016-06-01)
Tsai, Min-Hsuan
;
Ku, Shih-Chi
;
Wang, Tyng-Guey
;
Hsiao, Tzu-Yu
;
Lee, Jang-Jaer
To evaluate postextubation swallowing dysfunction (PSD) 21 days after endotracheal extubation and to examine whether PSD is time-limited and whether age matters. For this prospective cohort study, we evaluated 151 adult critical care patients (=20 years) who were intubated for at least 48hours and had no pre-existing neuromuscular disease or swallowing dysfunction. Participants were assessed for time (days) to pass bedside swallow evaluations (swallow 50mL of water without difficulty) and to resume total oral intake. Outcomes were compared between younger (20- 64 years) and older participants (=65 years). PSD, defined as inability to swallow 50mL of water within 48hours after extubation, affected 92 participants (61.7% of our sample). At 21 days postextubation, 17 participants (15.5%) still failed to resume total oral intake and were feeding- tube dependent. We found that older participants had higher PSD rates at 7, 14, and 21 days postextubation, and took significantly longer to pass the bedside swallow evaluations (5.0 vs 3.0 days; P=0.006) and to resume total oral intake (5.0 vs 3.0 days; P=0.003) than their younger counterparts. Older participants also had significantly higher rates of subsequent feeding- tube dependence than younger patients (24.1 vs 5.8%; P=0.008). Excluding patients with pre- existing neuromuscular dysfunction, PSD is common and prolonged. Age matters in the time needed to recover. Swallowing and oral intake should be monitored and interventions made, if needed, in the first 7 to 14 days postextubation, particularly for older patients.
Tongue Weakness and Somatosensory Disturbance Following Oral Endotracheal Extubation
(2015-04-01)
Su, Han
;
Hsiao, Tzu-Yu
;
Ku, Shih-Chi
;
Wang, Tyng-Guey
;
Lee, Jang-Jaer
The tongue plays important roles in mastication, swallowing, and speech, but its sensorimotor function might be affected by endotracheal intubation. The objective of this pilot study was to describe disturbances in the sensorimotor functions of the tongue over 14 days following oral endotracheal extubation. We examined 30 post-extubated patients who had prolonged (a parts per thousand yen48 h) oral endotracheal intubation from six medical intensive care units. Another 36 patients were recruited and examined from dental and geriatric outpatient clinics served as a comparison group. Tongue strength was measured by the Iowa Oral Performance Instrument. Sensory disturbance of the tongue was measured by evaluating light touch sensation, oral stereognosis, and two-point discrimination with standardized protocols. Measurements were taken at three time points (within 48 h, and 7 and 14 days post-extubation) for patients with oral intubation but only once for the comparison group. The results show that independent of age, gender, tobacco used, and comorbidities, tongue strength was lower and its sensory functions were more impaired in patients who had oral intubation than in the comparison group. Sensory disturbances of the tongue gradually recovered, taking 14 days to be comparable with the comparison group, while weakness of the tongue persisted. In conclusion, patients with oral endotracheal intubation had weakness and somatosensory disturbances of the tongue lasting at least 14 days from extubation but whether is caused by intubation and whether is contributed to postextubation dysphagia should be further investigated.