Swallow screen and education in patients following endotracheal extubation: A pre- and postintervention study

Patients with hemorrhagic stroke often have dysphagia and delayed oral feeding after extubation. Fewer than 33% of intensive care units (ICUs) implement swallow screens, with limited evidence-based early oral feeding protocols. We evaluated a nurse-administered "swallow screen and education" (SSE) program on oral feeding status, pneumonia incidence, and weight trajectory.

A pre-post intervention study with matched historical controls was conducted in a neurosurgical ICU. Twenty-eight consecutive patients with hemorrhagic stroke (aged ≥20 years) received the SSE program 24-h after extubation. Twenty-eight matched controls received the usual care. Outcomes included 24-h and 7-day nothing by mouth (NBM) rates, 30-day pneumonia incidence, and 4-week weight trajectory.

The SSE group showed lower 24-h NBM rates vs controls (42.86% vs 78.57%; odds ratio [OR] = 0.21; 95% CI, 0.063-0.661; P = 0.006). By day 7, differences persisted but were not statistically significant (28.57% vs 38.46%). The SSE group exhibited lower pneumonia incidence (3.57% vs 17.86%). After adjusting for confounders, SSE independently predicted reduced pneumonia risk (adjusted OR = 0.029; 95% CI, 0.001-0.708; P = 0.030). Weight decreased significantly in both groups (week 3: -2.681 kg, P < 0.001; week 4: -2.965 kg, P = 0.008).

Our preliminary findings suggest that the SSE program was associated with lower 24-h NBM rates after extubation and reduced pneumonia risk without affecting weight trajectories in this small hemorrhagic stroke cohort. This pragmatic intervention demonstrates potential clinical utility and scalability in neurosurgical ICUs. Future research should include larger randomized controlled trials with instrumental swallowing assessments while addressing weight loss in this vulnerable population.