Predictors of the Ability to Protect the Airway in Long-term Ventilated Patients

Massachusetts General Hospital30 enrolled

Overview

First part of a 2 part study with the same IRB protocol #, and labeled 'A'. Investigators hypothesized that clinical muscle strength assessment (manual muscle testing) predicts the ability to protect the airway during swallowing in long-term ventilated subjects. More specifically, the investigators hypothesized that low muscle strength is associated with the inability to clear secretions from the peri-laryngeal area (valleculae and pyriform sinus residue scale (VPSR scale \[NRS: 0-4\] of \> 1) and entering the materials into airway (PAS scale \[1-8\]\> 1), which should predispose to endotracheal aspiration.

Study Type

OBSERVATIONAL

Enrollment

Conditions

Swallowing Disorder Aspiration Long Term Ventilation

Interventions

Muscle Strength MeasurementOTHER

MRC score (0-60) is a clinical assessment of muscle power on abduction of the arm, flexion of the forearm, extension of the wrist, flexion of the leg, extension of the knee and dorsal flexion of the foot with the score of (0-5) on each measurement

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: 1. Patients admitted to the Respiratory Acute Care Unit and Surgical Intensive Care Unit, units with a mixed collection of long term ventilated patients in a major academic teaching hospital. 2. Age over 18 years. 3. Long-term ventilated patients (\>10 days) with tracheotomies Exclusion Criteria: 1. Decreased level of consciousness as defined by a Richmond Agitation Sedation Scale (RASS) of 0. 2. Non-cooperative patient, CAM score positive for delirium. 3. For women: pregnancy.

Outcomes

Primary Outcomes

Muscle Strength

We use Medical Research Council (MRC) scale (0-60) to evaluate the degree of muscle weakness in the tracheostomized patients.

Time frame: Within 24 hours of fiberoptic endoscopic evaluation of swallow

Secondary Outcomes

Number of Patients With Muscle Weakness (MRC<48) Who Developed Clinical Aspiration

Time frame: Within 3 month follow-up