{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T01:02:26Z","timestamp":1790730146903,"version":"4.1.0"},"reference-count":20,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2019,11,19]],"date-time":"2019-11-19T00:00:00Z","timestamp":1574121600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Respir Care"],"published-print":{"date-parts":[[2020,4]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Extubation failure may have several causes, including swallowing dysfunction, aspiration, and excessive upper airway secretions. We hypothesized that a bedside global swallowing pattern assessment including 9 criteria (volume of pharyngeal secretions, 5 swallowing motor items, swallowing reflex, and 2 gag reflexes) performed prior to extubation could identify patients at risk of extubation failure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>In a multicenter prospective observational study, all consecutive patients intubated and mechanically ventilated for \u22656 d were included. Before a planned extubation, a physiotherapist evaluated the 9 criteria of the swallowing assessment. The final extubation decision was left to the physician's discretion, blinded to the swallowing assessment. Extubation failure was defined as the need for re-intubation related to aspiration or excessive upper airway secretions within the first 72 h after extubation. Results are expressed as median (interquartile range [IQR]).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      The study included 159 subjects (age 61 y [IQR 48\u201375]; male\/female ratio 1.5; Simplified Acute Physiologic score II 54 [IQR 42\u201366]; duration of mechanical ventilation 11 d [IQR 8\u201317]). A total of 23 subjects (14.5%) required re-intubation, with 16 occurring within the first 72 h after extubation and 7 related to aspiration or excessive secretions. Swallowing assessment was significantly lower in subjects with re-intubation related to aspiration or excessive secretions within the first 72 h after extubation versus those not re-intubated for aspiration or excessive secretions (6 [IQR 5\u20137] vs 8 [IQR 7\u20138],\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .008, respectively). Among the 9 swallowing assessment criteria, normal right pharyngeal gag reflex was associated with a lower incidence of re-intubation related to aspiration or excessive secretions (odds ratio 0.12, 95% CI 0.03\u20130.59,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .01), as well as normal left pharyngeal gag reflex (odds ratio 0.13, 95% CI 0.03\u20130.63,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .01), with a negative predictive value of 0.98 for each reflex.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>In subjects with prolonged ventilation, the presence of one or both gag reflexes could predict a reduction in extubation failure related to aspiration or excessive upper airway secretions. (Clinical trials.gov registration NCT00780078.)<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4187\/respcare.07025","type":"journal-article","created":{"date-parts":[[2019,11,19]],"date-time":"2019-11-19T17:15:37Z","timestamp":1574183737000},"page":"475-481","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":19,"title":["Predictors of Extubation Failure Related to Aspiration and\/or Excessive Upper Airway Secretions"],"prefix":"10.1177","volume":"65","author":[{"given":"Marie-H\u00e9l\u00e8ne","family":"Houz\u00e9","sequence":"first","affiliation":[{"name":"Rehabilitation Unit"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Deye","sequence":"additional","affiliation":[{"name":"Medical Intensive Care Unit, and Inserm U942"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joaquim","family":"Mateo","sequence":"additional","affiliation":[{"name":"Surgical Intensive Care Unit"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruno","family":"M\u00e9garbane","sequence":"additional","affiliation":[{"name":"Medical Intensive Care Unit, and Inserm U942"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fran\u00e7oise","family":"Bizouard","sequence":"additional","affiliation":[{"name":"Rehabilitation Unit"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fr\u00e9d\u00e9ric J","family":"Baud","sequence":"additional","affiliation":[{"name":"Medical Intensive Care Unit, and Inserm U942"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Didier","family":"Payen de la Garanderie","sequence":"additional","affiliation":[{"name":"Surgical Intensive Care Unit"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Vicaut","sequence":"additional","affiliation":[{"name":"Research Unit"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alain P","family":"Yelnik","sequence":"additional","affiliation":[{"name":"PRM Department, GHU Saint Louis-Lariboisi\u00e8re-Fernand Widal, AP-HP, Paris Diderot University, Paris, France."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"for the EVAKIN Study Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2019,11,19]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201208-1523CI"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.158.2.9711045"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-018-2150-6"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-004-2231-7"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00010206"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1097\/00003246-199503000-00012"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.4037\/ajcc2008.17.6.504"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1097\/00004311-200007000-00013"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.10550758"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.07520081"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-015-1018-2"},{"issue":"4","key":"e_1_3_3_13_2","first-page":"261","article-title":"Clinical signs and scores for the diagnosis of ventilator-associated pneumonia","volume":"68","author":"Pugin J","year":"2002","unstructured":"Pugin J. Clinical signs and scores for the diagnosis of ventilator-associated pneumonia. 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