Stroke Clinical Trial
Official title:
Pharyngeal Electrical Stimulation (PES) to Avoid Extubation Failure in Intubated Stroke at High Risk of Severe Dysphagia
Post-extubation dysphagia (PED) recently became a growing concern as a major risk factor for
extubation failure and significant contributor to poor patient outcomes with prevalence rates
ranging from 12% to 69%, being highest in neurological patients (93%).
Pharyngeal electrical stimulation (PES) has been shown to improve airway safety and
swallowing function tracheostomized stroke patients, thereby enhancing decannulation in this
patient cohort.
In the present study the investigators evaluate whether PES is safe, feasible and effective
in orotracheal intubated stroke patients at high risk of extubation failure.
Endotracheal intubation and mechanical ventilation are common procedures for critically ill
stroke patients. Although necessary and life-saving, timely extubation after ventilator
weaning is desirable, because patients with delayed extubation experience higher pneumonia
rate, increased need for tracheostomy, longer length of stay on the intensive care unit and
higher mortality. On the other hand, extubation failure (EF) and subsequent need for emergent
re-intubation is associated with similar sequelae.
Post-extubation dysphagia (PED) became a growing concern as a major risk factor for EF and
significant contributor to poor patient outcomes with prevalence rates ranging from 12% to
69%, being highest in neurological patients (93%). Damage to the central swallowing network
itself is the primary cause of PED in cerebrovascular disease, which constitutes the leading
diagnosis on neuro-ICUs. Further mechanisms include pharyngolaryngeal lesions caused by the
tube, critical illness neuropathy and myopathy leading to muscle weakness and dyscoordination
of breathing and swallowing, and an impaired sensation due to sedation, mucosal damage, or
the underlying critical illness itself. As a consequence reintubation rates in neurological
collectives are as high as 20 to 40%.
Pharyngeal electrical stimulation (PES) has been shown to improve airway safety and
swallowing function tracheostomized stroke patients, thereby enhancing decannulation in this
patient cohort.
In the present study the investigators evaluate whether PES is safe, feasible and effective
in orotracheal intubated stroke patients at high risk of extubation failure.
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