Symptoms Assessment and Screening for Laryngeal Injury Post-extubation in ICU
ICU拔管后喉损伤的症状评估和筛查
基本信息
- 批准号:10418749
- 负责人:
- 金额:$ 63.7万
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 财政年份:2018
- 资助国家:美国
- 起止时间:2018-09-25 至 2024-06-30
- 项目状态:已结题
- 来源:
- 关键词:Absence of pain sensationAcousticsAcute respiratory failureAgeAmericanArtificial RespirationBreathingCategoriesChronicClinicalCommunicationCritical CareCritical IllnessDataDevelopmentEarly identificationEdemaEvaluationExhibitsFatigueFoundationsGoalsGranulomaGuidelinesHoarsenessHourImageInjuryIntensive Care UnitsInterventionIntratracheal IntubationIntubationKnowledgeLanguageLaryngeal InjuryLaryngoscopesLaryngoscopyLarynxLifeLightLiteratureMeasuresMechanical ventilationMedicalMedicineMethodsModernizationNursing SocietiesOutcomePainPathologistPatient CarePatientsPersonsPharyngeal structurePhysiciansPlayProceduresProfessional OrganizationsReportingResearchResearch PriorityRoleSamplingSavingsScreening procedureSedation procedureSeveritiesSoft Tissue InjuriesSolidSore ThroatSpeechStandardizationStenosisStroboscopySymptomsTimeTubeUlcerVoiceWakefulnessassociated symptombaseclinical practicecommon symptomcritical care nursingendotrachealexperiencefollow-uphigh riskpreventprospectivescreeningsexsystematic reviewvocal cord
项目摘要
PROJECT SUMMARY
Globally, each year 13 - 20 million people become critically ill and are intubated with mechanical ventilation in
an intensive care unit (ICU). In the U.S. alone, there are approximately 1 million intubated, with nearly one-third
for >5 days. As many as 73% of these patients will sustain laryngeal injury within 1 day of endotracheal tube
placement. For >50 years, research has demonstrated a strong association between endotracheal intubation
and laryngeal injury, but without considering the role that patient symptoms may play in identifying such injury.
Research in laryngeal injury and voice/communication is a research priority among several professional
societies, including the American Association of Critical Care Nurses and the Society of Critical Care Medicine.
After extubation, patients often have a range of symptoms related to laryngeal injury and voice changes, including
hoarseness, loss of voice, throat clearing, sore throat, and vocal fatigue. At present, patients with such symptoms
are not identified as being high-risk for laryngeal injury and are often overlooked with the thought that their
symptoms will be self-limited. Such a “wait and see” approach to laryngeal injury may defer evaluation for 1 week
to 3 months (or longer). Unfortunately, this approach has resulted in some patients experiencing serious, long-
term consequences, with some injuries resulting in chronic conditions that may have been avoidable with early
evaluation and appropriate intervention. Hence, early identification is important, but there is no standard of
practice for referral to a speech-language pathologist or laryngologist after extubation for evaluation. The existing
literature has important weaknesses, including patient samples that are heterogeneous, poorly described, and
often small-sized. In recent years, clinical practice and associated guidelines have changed to target patient
wakefulness during intubation with mechanical ventilation, creating a new and important opportunity to interact
with patients to evaluate their symptoms during intubation and soon after extubation. Therefore, the overall goals
of this research are to systematically: 1) determine patient symptoms related to orotracheal intubation, both
during and after intubation, 2) evaluate laryngeal injury and voice function after extubation using advanced
methods of laryngoscopy and perceptual and acoustic voice analyses, and 3) construct a screening tool, based
on patient and ICU variables and patient symptoms, to assist in identifying patients with clinically important, post-
extubation laryngeal injury. This systematic evaluation of patient symptoms, combined with comprehensive
laryngoscopic and voice assessment, will inform the development of a clinical screening tool for use by clinicians
in the ICU with the aim of appropriately identifying patients needing further evaluation to reduce the short- and
long-term harms of endotracheal tube-related injury on the larynx and voice.
项目概要
全球每年有 13 - 2000 万人病情危重并接受机械通气插管
仅在美国,就有大约 100 万人接受插管治疗,其中近三分之一。
多达 73% 的患者在气管插管后 1 天内会出现喉部损伤。
50 多年来,研究表明气管插管之间存在密切关系。
和喉部损伤,但没有考虑患者症状在识别此类损伤中可能发挥的作用。
喉损伤和语音/通讯研究是多个专业人士的研究重点
协会,包括美国重症监护护士协会和重症监护医学协会。
拔管后,患者通常会出现一系列与喉部损伤和声音变化相关的症状,包括
声音嘶哑、失声、清嗓子、喉咙痛、声音疲劳等症状。
不被认为是喉部损伤的高风险人群,并且经常被忽视,因为人们认为他们的
这种对喉损伤的“观望”方法可能会将评估推迟 1 周。
不幸的是,这种方法导致一些患者经历了严重的、长期的。
长期后果,一些伤害会导致慢性疾病,而早期的治疗本来是可以避免的
因此,早期识别很重要,但没有标准。
练习拔管后转诊至言语病理学家或喉科医生进行评估。
文献存在重要的弱点,包括患者样本异质、描述不明确以及
近年来,临床实践和相关指南已针对目标患者发生了变化。
在机械通气插管期间保持清醒,创造了新的重要的互动机会
与患者一起评估插管期间和拔管后的症状,从而确定总体目标。
这项研究的目的是系统地:1)确定与经口气管插管相关的患者症状,
插管期间和插管后,2) 使用先进的技术评估拔管后的喉部损伤和发声功能
喉镜检查方法以及感知和声学声音分析,以及3)构建一个筛选工具,基于
患者和 ICU 变量以及患者症状,以协助识别具有临床重要意义的患者
本文系统评估患者症状,并结合综合拔管喉损伤。
喉镜和声音评估,将为开发临床筛查工具提供信息,供以下人员使用
在 ICU 中,目的是适当地识别需要进一步评估的患者,以减少短期和
气管插管相关损伤对喉部和声音的长期危害。
项目成果
期刊论文数量(13)
专著数量(0)
科研奖励数量(0)
会议论文数量(0)
专利数量(0)
Letter to the Editor: "What matters most to adults with a tracheostomy in ICU and the implications for clinical practice: A qualitative systematic review and metasynthesis.".
致编辑的信:“对于 ICU 中接受气管切开术的成人来说最重要的是什么以及对临床实践的影响:定性系统评价和荟萃分析”。
- DOI:
- 发表时间:2023-10
- 期刊:
- 影响因子:3.7
- 作者:Pandian, Vinciya;Freeman;McGrath, Brendan A;Brenner, Michael J
- 通讯作者:Brenner, Michael J
Acquired laryngeal and subglottic stenosis following COVID-19-Preparing for the coming deluge.
COVID-19 后获得性喉和声门下狭窄 - 为即将到来的洪水做好准备。
- DOI:
- 发表时间:2024-01
- 期刊:
- 影响因子:4.2
- 作者:Allgood, Sarah;Peters, Jessica;Benson, Andrew;Maragos, Carol;McIltrot, Kimberly;Slater, Tammy;Akst, Lee;Best, Simon R;Galiatsatos, Panagis;Brodsky, Martin B;Brenner, Michael J;Pandian, Vinciya
- 通讯作者:Pandian, Vinciya
Oral Intubation Attempts in Patients With a Laryngectomy: A Significant Safety Threat.
喉切除术患者尝试口腔插管:一个重大的安全威胁。
- DOI:
- 发表时间:2021
- 期刊:
- 影响因子:0
- 作者:Brenner, Michael J;Cramer, John D;McGrath, Brendan A;Balakrishnan, Karthik;Stepan, Katelyn O;Pandian, Vinciya;Roberson, David W;Shah, Rahul K;Chen, Amy Y;Brook, Itzhak;Nussenbaum, Brian
- 通讯作者:Nussenbaum, Brian
Rebuttal From Drs Pandian, Murgu, and Lamb.
Pandian、Murgu 和 Lamb 博士的反驳。
- DOI:
- 发表时间:2021
- 期刊:
- 影响因子:9.6
- 作者:Pandian, Vinciya;Murgu, Septimiu;Lamb, Carla R
- 通讯作者:Lamb, Carla R
Tracheostomy care and communication during COVID-19: Global interprofessional perspectives.
COVID-19 期间的气管造口护理和沟通:全球跨专业视角。
- DOI:
- 发表时间:2022
- 期刊:
- 影响因子:2.5
- 作者:Moser, Chandler H;Freeman;Keeven, Emily;Higley, Kylie A;Ward, Erin;Brenner, Michael J;Pandian, Vinciya
- 通讯作者:Pandian, Vinciya
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Martin Bruce Brodsky其他文献
Martin Bruce Brodsky的其他文献
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{{ truncateString('Martin Bruce Brodsky', 18)}}的其他基金
Symptoms Assessment and Screening for Laryngeal Injury Post-extubation in ICU
ICU拔管后喉部损伤的症状评估和筛查
- 批准号:
10207777 - 财政年份:2018
- 资助金额:
$ 63.7万 - 项目类别:
Symptoms Assessment and Screening for Laryngeal Injury Post-extubation in ICU
ICU拔管后喉损伤的症状评估和筛查
- 批准号:
9792391 - 财政年份:2018
- 资助金额:
$ 63.7万 - 项目类别:
Understanding and Improving Dysphagia after Mechanical Ventilation
了解和改善机械通气后吞咽困难
- 批准号:
8617042 - 财政年份:2014
- 资助金额:
$ 63.7万 - 项目类别:
Understanding and Improving Dysphagia after Mechanical Ventilation
了解和改善机械通气后吞咽困难
- 批准号:
9259958 - 财政年份:2014
- 资助金额:
$ 63.7万 - 项目类别:
Understanding and Improving Dysphagia after Mechanical Ventilation
了解和改善机械通气后吞咽困难
- 批准号:
8840926 - 财政年份:2014
- 资助金额:
$ 63.7万 - 项目类别:
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Symptoms Assessment and Screening for Laryngeal Injury Post-extubation in ICU
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