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Reducing the lag…

Reducing the lag…. Critical Care & Tracheostomy Discussion and EBP Group 2008. Evidence. Reducing the lag between published research and the clinical application Hot topics Clinical questions – focus on intubation Example through clinical practice. Research. Clinical Practice.

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Reducing the lag…

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  1. 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 Research Clinical Practice

  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.) . (http://medical-dictionary.thefreedictionary.com/intubation)

  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?

  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

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