1. Critical Care & Tracheostomy Discussion and EBP Group 2008
Reducing the lag…
Critical Care & Tracheostomy Discussion
and EBP Group
2008

2. Evidence
Reducing the lag between published research and the clinical application
Hot topics
Clinical questions – focus on intubation
Example through clinical practice
Clinical Practice
Research

3. What to do in the case of an extubated patient

4. Bob 69 year old male PMHx: Heart disease, NIDDM, OA
Lives at home with wife
Needs some help with dressing
Admitted to hospital for coronary bypass surgery.
Intubated for 10 days

5. Endotracheal intubation:
Insertion of a tube into the trachea for purposes of anesthesia, airway maintenance, aspiration of secretions, lung ventilation, or prevention of entrance of foreign material into the airway; the tube goes through the nose (nasotracheal i.) or mouth (orotracheal i.) . (

6. Bob Bob extubated day 10 Observed to be coughing with water
Speech Pathology referral requested

7. Question
In critical care patients, does intubation (ETT) versus non-invasive ventilation result in increased incidence of dysphagia?

8. Results
No article specifically address question…but…some useful clinical information.
Suggestions of acute changes to swallow function
Increased swallow latency (ETT/none)
Elderly (>65) who premorbidly are functionally impaired are more likely to experience aspiration.
Age is implicated in the recovery of dysphagia
Trauma patients may be at increased risk of aspiration
FEES allow for a rapid objective evaluation

9. Bob Commenced on modified diet Moderately dysphonic
Little change in phonation quality 2 weeks post extubation
ENT review requested

10. Question
In critical care patients, does intubation affect laryngeal health?
16 articles reviewed

11. Results
Mucosal ulcerations along posterior-medial aspects, granuloma and erythema most common injuries
Correlation with duration of intubation and laryngeal injury, injuries acquired in first 7 days (dogs)
Early laryngeal changes seen after 24 hours intubation
Prolonged intubation and reintubation correlated with increased occurances of complications
Resolution of symptoms 7 days to 4 weeks
Intraoperative complications – anesthesia

12. Other clinical benefits
Informs clinical practice
Policy development
Hot topic discussions

13. Challenges Getting the question right Covering the literature
What to do with left over information??
Reducing the lag

14. Future directions…light bulb moments