关键词: 拔管后吞咽障碍, 4R危机管理理论, 评估, 危重病护理

Abstract:

Objective To construct and implement a swallowing disorder assessment and management program for tracheal intubated patients after extubation based on the 4R crisis management theory，providing standardized and scientific interventions for oral feeding. Methods Utilizing the expert meeting method with the 4R crisis management theory framework，a swallowing disorder assessment and management program was developed for post-extubation tracheal intubated patients. A convenience sampling method was employed to select patients with tracheal intubations treated from July to December 2023 in the emergency ICU，central ICU，and cardiovascular surgery ICU of a tertiary hospital in Zhejiang Province.The patients treated from October to December were assigned to an experimental group（n=68），while those treated from July to September were designated as a control group（n=58）. The experimental group received the 4R crisis management-based intervention，whereas the control group received standard ICU assessment and management. Outcomes indicators included the incidence of post-extubation swallowing disorders，time to first oral intake，incidence of aspiration during initial feeding，nasogastric and nasointestinal tube placement duration，incidence of aspiration pneumonia during hospitalization，re-intubation rates，ICU readmission rates，ICU stay duration，and total hospitalization days. Results Of the initially recruited subjects，68 in the experimental group and 54 in the control group were included in the final analysis. After the intervention，the experimental group exhibited significantly lower rates of post-extubation swallowing disorders，shorter time to first liquid oral intake，aspiration incidence during first feeding，shorter durations of nasogastric and nasointestinal tube placement，aspiration pneumonia，ICU readmission compared to the control group（P<0.05）. No significant differences were observed between the groups in time to first regular oral intake，re-intubation rates（P>0.05）. Conclusion The risk management program for dysphagia following tracheal extubation based on the 4R crisis management theory is scientifically robust and safe，offering a valuable reference for clinical assessments and management of swallowing and eating post-extubation in tracheal intubated patients.

Key words: Post-Extubation Dysphagia, 4R Crisis Management Theory, Assessment, Critical Care