Feasibility of Endoscopic Evaluations of Laryngeal Function After Extubation for Research in Critically Ill Adults

Flexible nasal laryngoscopy (FNL) is commonly used in intensive care units (ICUs) to assess laryngeal anatomy and function after endotracheal intubation. The use of FNL in research may differ from clinical practice due to requirements of research protocols and related data collection and documentation. This study evaluates the feasibility of performing FNL post-extubation in critically ill adults within the context of a research protocol. Understanding the feasibility of this reference standard assessment is important for supporting future studies and improving patient care.

This prospective study, conducted in six ICUs within a single academic medical center, consecutively enrolled adult patients who required mechanical ventilation for at least 8 hr. The primary feasibility outcome was the successful completion of FNL within 72 hr of extubation. Secondary outcomes included completion of the 3-oz water swallow test (Yale Swallow Protocol) during the FNL, patient enrollment/exclusion/withdrawal rates, time from extubation to FNL, procedure duration, and patient-reported pain (using the Wong-Baker FACES Pain Rating Scale).

A total of 80 patients (75%) of 107 eligible patients fully completed FNL. Among the 24 patients who did not receive FNL, eight died, seven were medically inappropriate, and seven declined FNL. The median time from extubation to FNL was 10 hr (IQR [interquartile range]: 8-12 hr), and the median FNL procedure duration was 8.5 min (IQR: 5.8-12.9 min). The median (IQR) pain score was 2 (0, 4) of 10, reflecting only mild discomfort.

Post-extubation FNL is feasible within the context of a research protocol and well tolerated by critically ill adults.