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Intubation, IntratrachealPALSSNCT03726086

Post-extubation Assessment of Laryngeal Symptoms and Severity

An observational study of Intubation, Intratracheal and Critical Illness, run by Johns Hopkins University at 1 site in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The goal of this study is to learn more about voice and airway problems that patients experience during and after the time patients have an oral endotracheal tube in patients' airway to help patients breathe while receiving mechanical ventilation in an intensive care unit (ICU). Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
laryngoscopy
How many people
365 participants
Where
1 siteUnited States
Study dates
12 Feb 2019to 10 Jun 2023
Phase
Observational
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Study population: Patients admitted to the intensive care unit (ICU) who are orally intubated with mechanical ventilaton meeting inclusion/exclusion criteria

Who may be able to join

  • ≥18 years old
  • Required mechanical ventilation via an oral endotracheal tube
  • Anticipated intubation ≥8 hours

Who cannot join

  • Pre-existing dysphonia, dysphagia
  • Pre-existing central nervous system, neuromuscular, or connective tissue disease
  • Prior tracheotomy and/or tracheotomy placed prior to enrollment
  • History of major thoracic surgery (e.g., sternotomy, thoracotomy) prior to the current admission
  • Head and/or neck disease
  • Head and/or neck surgery other than tonsillectomy
  • Known or suspected anatomical abnormalities or pre-intubation trauma of the oral cavity, pharynx, larynx, or esophagus
  • Unlikely to be extubated (i.e., expected death)

Trial locations and contacts

1 site in 1 country.

United States1 site
  • Johns Hopkins Hospital

    Baltimore, Maryland, 21287

Other trials in United States

About this study

The goal of this study is to learn more about voice and airway problems that patients experience during and after the time patients have an oral endotracheal tube in patients' airway to help patients breathe while receiving mechanical ventilation in an intensive care unit (ICU).

Being tested
laryngoscopy
Keywords
larynx, injury, voice, trachea
Medical subject headings
Critical Illness, Laryngeal Diseases, Wounds and Injuries, Tracheal Diseases

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • laryngoscopyDiagnostic test

    A flexible camera (fiberoptic endoscope) is placed in the patient's nose to view the nose, throat, and airway.

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Laryngeal injury as assessed by 4-point categorical scale

    Characterize injuries to the larynx and surrounding tissues/anatomy after mechanical ventilation is no longer required and the oral endotracheal tube is removed. Injuries will be graded on a 4-point categorical scale ranging from 0 (no injury) to 3 (severe injury).

    Measured: Within 72 hours post-extubation

  2. Laryngeal injury symptom grading by Laryngeal Hypersensitivity Questionnaire (LHQ)

    Characterize patient symptoms of laryngeal injury within 48 hours of anticipated extubation. Symptoms will be assessed using a 4-point ordinal scale based on the LHQ, ranging from 1 (all of the time) to 4 (none of the time).

    Measured: Within 48 hours of anticipated extubation

  3. Laryngeal injury symptom grading by LHQ

    Characterize patient symptoms of laryngeal injury within 72 hours post-extubation. Symptoms will be assessed using a 4-point ordinal scale based on the LHQ, ranging from 1 (all of the time) to 4 (none of the time).

    Measured: Within 72 hours post-extubation

  4. Laryngeal injury symptom grading by LHQ

    Characterize patient symptoms of laryngeal injury at 7 days post-extubation or at discharge whichever comes first. Symptoms will be assessed using a 4-point ordinal scale based on the LHQ, ranging from 1 (all of the time) to 4 (none of the time).

    Measured: 7 days post-extubation or hospital discharge, whichever occurs first

Secondary outcomes (11)
  1. Oral endotracheal tube size

    Size of the endotracheal tube

    Measured: At the time of intubation (directly following study enrollment)

  2. Duration of orotracheal intubation

    Number of days from placement to extubation of the oral endotracheal tube

    Measured: From date of intubation to date of extubation or placement of a tracheostomy tube, whichever occurs first, assessed up to 14 days

  3. Perceptual voice characteristics as assessed by Grade Rough Breathy Asthenic Strained (GRBAS) method

    Assessed from standardized voice samples and digital recordings using the grade, rough, breathy, asthenic, and strained (GRBAS) method with a 4-point ordinal scale ranging from 0 (normal) to 3 (severe).

    Measured: Within 72 hours post-extubation

  4. Perceptual voice characteristics as assessed by GRBAS method

    Assessed from standardized voice samples and digital recordings using the grade, rough, breathy, asthenic, and strained (GRBAS) method with a 4-point ordinal scale ranging from 0 (normal) to 3 (severe).

    Measured: 7 days post-extubation or hospital discharge, whichever occurs first

  5. Acoustic voice measurement as assessed by voice analysis software

    Assessed from standardized voice samples and digital recordings using the Computerized Speech Lab (PENTAX Medical) with voice analysis software (viz., Multi-Dimensional Voice Program (MDVP); Analysis of Dysphonia in Speech and Voice (ADSV)) to quantify voice characteristics across a number of parameters

    Measured: Within 72 hours post-extubation

  6. Acoustic voice measurement as assessed by voice analysis software

    Assessed from standardized voice samples and digital recordings using the Computerized Speech Lab (PENTAX Medical) with voice analysis software (viz., Multi-Dimensional Voice Program (MDVP); Analysis of Dysphonia in Speech and Voice (ADSV)) to quantify voice characteristics across a number of parameters.

    Measured: 7 days post-extubation or hospital discharge, whichever occurs first

  7. Patient perception of voice and voice symptoms assessed by the Voice Symptom Scale (VoiSS)

    a 30-item questionnaire that uses scaled scores across 3 domains-impairment (15 items), physical symptoms (8 items), and emotional response (7 items).

    Measured: Within 72 hours post-extubation and at 7 days post-extubation or hospital discharge, whichever occurs first

  8. Isometric Hand Grip Strength-Dynamometry

    Grip strength provides a measure of distal muscle strength that has important functional application for patients. Grip strength, tested by hand grip dynamometry, will be assessed in each hand using a Jamar Preston hand dynamometer

    Measured: Within 48 hours of anticipated extubation, within 72 hours post-extubation, and at 7 days post-extubation or hospital discharge, whichever occurs first

  9. Peak tongue strength assessed using the Iowa Oral Performance Instrument (IOPI)

    Tongue strength, tested using tongue bulb pressure, will be assessed using the Iowa Oral Performance Instrument (IOPI)

    Measured: Within 48 hours of anticipated extubation, within 72 hours post-extubation, and at 7 days post-extubation or hospital discharge, whichever occurs first

  10. Yale Swallow Protocol

    A cognitive screen and administration of a cup containing 3 oz. (90 ml) of water handed to the patient for uninterrupted continuous consumption via cup or straw. Interrupted consumption (i.e., stopping, resting), and/or coughing, choking, throat clearing, or a change in vocal quality (i.e., a wet, gurgly quality after consumption is completed) signifies a failed screening.

    Measured: Within 72 hours post-extubation

  11. Function Oral Intake Scale (FOIS)

    A 7-point clinical scale to document change in functional oral intake of food and liquid in patients.

    Measured: Within 90 days of extubation or at ICU discharge, whichever occurs first

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted31 Oct 2018
  2. Study start12 Feb 2019
  3. Primary completion10 Jun 2023
  4. Study completion10 Jun 2023

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Cohort
Time perspective
Prospective
Enrolment
365 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03726086
Sponsor's protocol ID
IRB00151643
Other IDs
R01NR017433-01A1
Acronym
PALSS
Status last verified
Jul 2023
First submitted
26 Oct 2018
Last updated
6 Jul 2023
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Adhikari NK, Fowler RA, Bhagwanjee S, Rubenfeld GD. Critical care and the global burden of critical illness in adults. Lancet. 2010 Oct 16;376(9749):1339-46. doi: 10.1016/S0140-6736(10)60446-1. Epub 2010 Oct 11.

    PubMed 20934212
  • Balas MC, Vasilevskis EE, Burke WJ, Boehm L, Pun BT, Olsen KM, Peitz GJ, Ely EW. Critical care nurses' role in implementing the "ABCDE bundle" into practice. Crit Care Nurse. 2012 Apr;32(2):35-8, 40-7; quiz 48. doi: 10.4037/ccn2012229.

    PubMed 22467611
  • Barr J, Fraser GL, Puntillo K, Ely EW, Gelinas C, Dasta JF, Davidson JE, Devlin JW, Kress JP, Joffe AM, Coursin DB, Herr DL, Tung A, Robinson BR, Fontaine DK, Ramsay MA, Riker RR, Sessler CN, Pun B, Skrobik Y, Jaeschke R; American College of Critical Care Medicine. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med. 2013 Jan;41(1):263-306. doi: 10.1097/CCM.0b013e3182783b72.

    PubMed 23269131
  • Benjamin B. Prolonged intubation injuries of the larynx: endoscopic diagnosis, classification, and treatment. Ann Otol Rhinol Laryngol Suppl. 1993 Apr;160:1-15. doi: 10.1177/00034894931020s401.

    PubMed 8470867
  • Bishop MJ, Weymuller EA Jr, Fink BR. Laryngeal effects of prolonged intubation. Anesth Analg. 1984 Mar;63(3):335-42. No abstract available.

    PubMed 6367543
  • Brandwein M, Abramson AL, Shikowitz MJ. Bilateral vocal cord paralysis following endotracheal intubation. Arch Otolaryngol Head Neck Surg. 1986 Aug;112(8):877-82. doi: 10.1001/archotol.1986.03780080077018.

    PubMed 3718696
  • Brodsky MB, Levy MJ, Jedlanek E, Pandian V, Blackford B, Price C, Cole G, Hillel AT, Best SR, Akst LM. Laryngeal Injury and Upper Airway Symptoms After Oral Endotracheal Intubation With Mechanical Ventilation During Critical Care: A Systematic Review. Crit Care Med. 2018 Dec;46(12):2010-2017. doi: 10.1097/CCM.0000000000003368.

    PubMed 30096101
  • Colice GL, Stukel TA, Dain B. Laryngeal complications of prolonged intubation. Chest. 1989 Oct;96(4):877-84. doi: 10.1378/chest.96.4.877.

    PubMed 2791687
  • Colice GL. Resolution of laryngeal injury following translaryngeal intubation. Am Rev Respir Dis. 1992 Feb;145(2 Pt 1):361-4. doi: 10.1164/ajrccm/145.2_Pt_1.361.

    PubMed 1736742
  • Donnelly WH. Histopathology of endotracheal intubation. An autopsy study of 99 cases. Arch Pathol. 1969 Nov;88(5):511-20. No abstract available.

    PubMed 5347141
  • Dubick MN, Wright BD. Comparison of laryngeal pathology following long-term oral and nasal endotracheal intubations. Anesth Analg. 1978 Nov-Dec;57(6):663-8. No abstract available.

    PubMed 569990
  • Eckerbom B, Lindholm CE, Alexopoulos C. Airway lesions caused by prolonged intubation with standard and with anatomically shaped tracheal tubes. A post-mortem study. Acta Anaesthesiol Scand. 1986 Jul;30(5):366-73. doi: 10.1111/j.1399-6576.1986.tb02432.x.

    PubMed 3766091
  • Hamdan AL, Sabra O, Rameh C, El-Khatib M. Persistant dysphonia following endotracheal intubation. Middle East J Anaesthesiol. 2007 Feb;19(1):5-13.

    PubMed 17511179
  • Hamdan AL, Sibai A, Rameh C, Kanazeh G. Short-term effects of endotracheal intubation on voice. J Voice. 2007 Nov;21(6):762-8. doi: 10.1016/j.jvoice.2006.06.003. Epub 2006 Aug 14.

    PubMed 16905292
  • Massard G, Rouge C, Dabbagh A, Kessler R, Hentz JG, Roeslin N, Wihlm JM, Morand G. Tracheobronchial lacerations after intubation and tracheostomy. Ann Thorac Surg. 1996 May;61(5):1483-7. doi: 10.1016/0003-4975(96)00083-5.

    PubMed 8633963

Questions about this trial

What is this clinical trial studying?

An observational study of Intubation, Intratracheal and Critical Illness, run by Johns Hopkins University at 1 site in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 8 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 6 Jul 2023. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Laryngeal injury as assessed by 4-point categorical scale (time frame: Within 72 hours post-extubation). The study lists 4 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT03726086, which also lists 22 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 6 Jul 2023.

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