For patients in critical care who have undergone prolonged mechanical ventilation, regaining the ability to eat orally and preventing pneumonia are crucial steps post-extubation. A recent study investigated the effectiveness of a structured swallowing and Oral Care Program (SOC) in improving these outcomes. This article delves into the findings, highlighting how this program can significantly benefit patients recovering from critical illness.
This open-label, controlled trial meticulously examined the impact of an SOC program compared to standard care. Participants, all of whom had been extubated after receiving mechanical ventilation for 48 hours or more, were randomly assigned to either the SOC group or the control group. The SOC intervention consisted of three key protocols delivered by a dedicated SOC nurse:
- Oral-motor exercises: To strengthen the muscles involved in swallowing.
- Sensory stimulation and lubrication: To enhance oral sensation and facilitate swallowing.
- Safe-swallowing education: To guide patients on techniques for safe and effective swallowing.
This comprehensive oral care program was administered daily for seven consecutive days, starting the day after extubation, or until the patient was discharged or in unfortunate cases, death occurred. The study rigorously assessed oral-feeding resumption, defined as reaching level 6 or 7 on the Functional Oral Intake Scale within seven days post-extubation, and the occurrence of radiographically confirmed pneumonia within 30 days. Independent assessors, blinded to the patient groups, evaluated these outcomes using electronic medical records.
The results of the study, involving 145 participants, demonstrated a clear advantage of the oral care program. The SOC group, receiving an average of 6.2 days of intervention at approximately 15 minutes per day, showed no adverse effects. Remarkably, by day 7, over half of the SOC participants (51.4%) had successfully resumed oral feeding, compared to only 32.9% in the control group. Furthermore, the incidence of pneumonia was significantly lower in the SOC group (15.3%) than in the control group (35.6%).
Statistical analysis further reinforced these findings. Patients in the SOC group were 2.35 times more likely to resume oral feeding and had a 72% reduced odds of developing pneumonia, even after accounting for factors like age and duration of intubation exceeding six days.
In conclusion, this study provides strong evidence that implementing an oral care program for critically ill patients following prolonged mechanical ventilation is highly beneficial. The program significantly increases the likelihood of successful oral feeding resumption and substantially reduces the risk of pneumonia within 30 days post-extubation. These outcomes underscore the importance of integrating such programs into routine post-extubation care to advance dysphagia management and improve recovery for this vulnerable patient population.
This research was registered at ClinicalTrials.gov under the identifier NCT03284892, highlighting its commitment to transparency and rigorous scientific methodology.
