Comparison of the Consequences of Short- Versus Long-Term Intubation on Speech and Swallowing.

Introduction: Intubated, ventilator unweanable patients with ventilatory pump failure can be extubated to continuous noninvasive positive pressure ventilatory support; however, delays may result in untoward effects on speech and swallowing.

Methods: This is a retrospective chart review of ventilatory pump failure patients to determine need for postextubation gastrostomy tubes and consequences on speech for intubations less than (short) versus greater than (long) 3 wks.

Results: One hundred sixty-five patients were intubated for a mean 20.7 ± 23.5 (range = 1-240) days. All recovered prehospitalization speech status within 2 hrs to 3 days. One hundred four of the short group were intubated 1.6 ± 1.3 (range = 1-9) times for 9.9 ± 5.1 (range = 1-20) days versus 61 of the long group intubated 2.4 ± 3.3 (range = 1-26) times for 39.0 ± 30.5 (range = 21-210) days, 10.6% vs. 8.2%, respectively, required postextubation gastrostomy tubes indefinitely.

Discussion: There was no difference in untoward effects on speech or swallowing from short- versus long-term intubation. Had the patients undergone tracheotomies, the majority would have had gastrostomy tubes placed permanently and suffer morbidity and mortality from the tubes. Thus, an option is to permit patients to remain intubated and, even if unweanable, extubate them to continuous noninvasive positive pressure ventilatory support rather than tracheotomy.