[Impairment of deglutition reflex after prolonged intubation]

This study was designed to assess the swallowing reflex after an endotracheal intubation of more than 24 h, as well as the influence of age and duration of intubation on swallowing. Twenty patients (aged 58 +/- 17 years) who had been intubated for more than 24 h were compared with fifteen others (63.1 +/- 16.7 years), who had never been intubated. All had a nasogastric tube. Swallowing was assessed after administration of 0.25, 0.5, 0.75 and 1 ml volumes of normal saline, in a random sequence, into the epipharynx through a thin catheter passing through the nostril after extubation (E0), and then at 1 (E1), 8 (E8), 24 (E24) and 48 h (E48) in the extubated patients, and once in the control patients. Swallowing responses were identified by an electromyogram of the floor of the oral cavity. The efficiency of the swallowing reflex was assessed by the delay between instillation and the first swallowing response obtained, and the number of swallows recorded during the first 15 seconds following each injection. There was a significant increase in swallowing delay in intubated patients for volumes less than 1 ml during the first three measurements. Recovery occurred for 0.5 and 0.75 ml at E24 and E48, when compared with the control group. However, delay remained increased throughout the study for 0.25 ml. The number of swallows was the same in both groups for each volume tested. There was no correlation between increased delay and age or duration of intubation. These data confirmed that prolonged endotracheal intubation impairs the swallowing reflex.(ABSTRACT TRUNCATED AT 250 WORDS)