Swallowing disorders (SD) are particularly common after extubation in the ICU and may be associated with an increased risk of lung disease, increased length of hospital stay, and a higher risk of early reintubation. In contrast, early detection of SDs has been shown to be associated with a decrease in these complications. Thus, there is a need for rapid and reliable assessment of SDs in ICU patients before the withdrawal of mechanical ventilation.
Videofluoroscopy (VFS) and nasofibroscopy (NF) are the gold standard examinations for diagnosing SD. However, these two examinations are not feasible in intubated patients.
In this context, ultrasound appears to be a promising alternative to identify patients at risk of SD after extubation. This examination can be performed at the intubated patient's bedside and can be used evaluate the mobility of the structures involved in swallowing. Many studies have already shown the interest of ultrasound in the evaluation of SD but none has focused on intubated patients under respiratory assistance.
The objective of the present study is to evaluate the value of ultrasound in identifying patients at risk of presenting SD after extubation.
This monocentric study will take place in the Intensive Care Unit (ICU) of the Dijon University Hospital. The duration of participation in this research will be equal to the length of stay in the ICU. During their stay, patients will undergo ultrasound and nasofibroscopy. Information on the characteristics of the ICU stay will be collected at discharge.
Major (≥18)
On mechanical ventilation for at least 48 hours
Affiliated to national health insurance
Under legal protection (curatorship, guardianship, safeguard of justice)
Pregnant, parturient or breastfeeding woman
Refusal to participate by the patient or their proxy (or an immediate family member)
Cognitive disorders incompatible with the understanding of instructions
Single group
Ultrasound
Other interventionperformed within 3 hours prior to extubation
nasofibroscopie
Other interventionperformed within 3 to 24 hours after extubation
rate of swallowing disorders
assessed by the Penetration-Aspiration Scale (PAS)
Presence (PAS score >2 for at least one of the food textures) or absence of SD evaluated by FEES
Presence (PAS score > 2 for thick liquids) or absence of severe SD, evaluated by FEES
Relationship between the presence or absence of SD and global muscle strength
Assessed by the MRC scale measurement before extubation
Relationship between the presence or absence of SD and muscle mass evaluated by ultrasound
Thickness of the right QF and cross-sectional area of the right RF muscle at rest
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