Removal of Nasogastric Feeding Tube Post Extubation in ICU : a Prospective Randomized Trial

Summary

Post-extubation dysphagia (PED) is a frequent but still underestimated condition in the intensive care units (ICU). In the international literature, the manifestations and consequences of PED lead to intra- and post-intensive care comorbidities.

The exact etiology of PED is unknown, but considered multifactorial. Numerous causes, acquired during ICU, can lead to a delay in the reintroduction of intravenous nutrition, or even favor the development of inhalation pneumopathy. One of these causes is the presence of the nasogastric tube.

The incidence of ECD varies from 3 to 62%. Its presence impacts morbidity and mortality. Preventive strategies for PED have only been studied with questionable methodologies.

The goal of ICU therapists is to detect PED as early as possible in order to implement curative strategies such as adapted nutrition and early swallowing rehabilitation.

Conditions

• Deglutition Disorders
• Intensive Care Unit Syndrome
• Swallowing Disorder
• Feeding or Eating Disorder

Interventions

PROCEDURE

Nasogastric Tube removal during extubation

The nurse in charge of the patient and under the cover of a medical prescription, will proceed to the systematic removal of the nasogastric tube during the extubation procedure

DIAGNOSTIC_TEST

Yale Swallow Protocol

The dysphagia will be evaluated in a systematic way between 1 hour and 6 hours post-extubation with the help of the "Yale Swallow Protocol" (YSP) by the caregivers trained to the passing of the "YSP" (nurse or physiotherapist or ICU doctor).

PROCEDURE

Classif Nasogastric Tube Management

The removal of the nasogastric tube will not be performed during the extubation procedure and the time of removal will be left to the discretion of the attending physician (as currently performed in the unit).

DIAGNOSTIC_TEST

Classic swallowing test

Post-extubation dysphagia will be assessed as we do in the unit. Currently, the caregivers in charge of the patient do a gel water test "Nutrisens Hydra'Fruit level 4" when the attending physician prescribes it.

Sponsors & Collaborators

• Centre Hospitalier Régional d'Orléans

  lead OTHER

Principal Investigators

• Cecile FOSSAT, Pt · CHR Orleans

Study Design

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Model

PARALLEL

Eligibility

Min Age

18 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2023-03-21

Primary Completion

2025-04-10

Completion

2025-04-10

Countries

• France

Study Locations