Removal of Nasogastric Feeding Tube Post Extubation in ICU : a Prospective Randomized Trial

There are several tools available to diagnose PED. These assessment methods are numerous and not subject to consensus.

There are expensive instrumental methods requiring experts, which allow for accurate diagnosis but cannot be routinely used at the ICU patient's bed. For the ICU patient, bed-side clinical assessments seem more appropriate.

The "Yale swallow protocol" (YSP), is the most used test in the literature. Its sensitivity in predicting PED at 96.5%, a negative predictive value of 97.9% and a false negative rate of less than 2%, seem to make it the most suitable.

Currently, no recommendations have been made by French or international ICU societies on the appropriate time or method for PED assessment.

Regarding the treatment of PED, the literature shows that physiotherapy management would not significantly reduce its incidence, nor accelerate the resumption of per os feeding.

No study has examined the impact of nasogastric tube removal combined with the use of a standardized swallow test on post-extubation ECD.

For all these reasons, we plan to evaluate the interventional strategy consisting in removing the nasogastric feeding tube as soon as extubation, to carry out between 1 hour and 6 hours post extubation the "Yale swallow protocol", to allow a resumption of feeding as soon as possible while screening the dysphagic patients.

The research hypothesis is therefore:

"Systematic removal of the nasogastric tube during the extubation procedure associated with an early swallow test in the ICU allows an early per-os nutritional resumption in comparison with the classical strategy of nasogastric tube management and swallowing disorders assessment"

Inclusion criteria

• Extubation prescribed by the attending physisian
• Intubation for more than 48 hours
• Presence of a nasogastric tube
• RASS score equal to 0 at the time of screening.

Exclusion criteria

• Gastric tube for gastric emptying (suction or bag)
• Inability to remain alert for prolonged periods of time for the swallow test
• Pre-existing dysphagia
• Patient fed by nasogastric tube or jejunostomy before ICU stay
• Tracheostomized patient
• Contraindication to a bed head elevation > 30°.
• Contraindication to the resumption of feeding
• Pregnant or breastfeeding woman
• Decision to limit active therapies
• Protected person (under guardianship or curatorship) / Person under court protection
• Person not affiliated to a social security system