Effects of a spray-based oropharyngeal moisturising programme for patients following endotracheal extubation after cardiac surgery: A randomised, controlled three-arm trial

Abstract

Background: When a patient emerges from cardiac surgery, they may experience intense thirst and discomfort or even impaired swallowing after endotracheal extubation. This may lead to feelings of suffocation, desperation, fear, and anxiety. Although thirst relief and dysphagia prevention share similar mechanisms, there is limited evidence for a combined intervention to alleviate thirst and prevent dysphagia. Furthermore, no studies to date have targeted postoperative cardiac patients.

Objective: To evaluate the safety, feasibility, and effects of a spray-based oropharyngeal moisturising programme for cardiac surgery patients following endotracheal extubation.

Design: A randomised, controlled three-arm trial was conducted from October 2017 to December 2019.

Setting: Tertiary medical centre cardiac care unit.

Participants: Participants (N = 145) were patients who underwent cardiac surgery and received mechanical ventilation.

Methods: Participants were randomly assigned to one of three groups: a four-part programme offering spray-based therapy with either a constant low-temperature cold spray (programme A; n = 47) or low-to-normal temperature spray (programme B; n = 49), or those that received usual care (control group; n = 49). Control group patients who complained of thirst were given wet cotton swabs to moisten their mouths. The primary outcomes included discomfort and various levels of thirst intensity; secondary outcomes included dysphagia and adverse events. Outcomes were evaluated at Time 0 (baseline), Time 1 (3 h), Time 2 (6 h) and Time 3 (96 h) post intervention. Repeated-measures analyses was performed using generalised estimating equations.

Results: The baseline evaluation indicated no significant differences between the groups. Participants (average age: 55 years; 53.8% men) underwent cardiac surgery for; valvular heart disease (64.8%), coronary atherosclerotic heart disease (25.5%), or aortic dissection (9.7%). Baseline scores indicated moderately severe thirst (6.24±1.57) and discomfort (9.88±2.23). Post intervention, the thirst intensity in the intervention groups was significantly lower than that of the control group (p<0.001). The generalised estimating equation analysis showed no significant difference in reduced thirst intensity between programmes A and B (adjusted β=0.08, 95% CI: -0.59-0.76, p = 0.810) when controlling for intervention condition and time. Comparable results were found for reduced thirst discomfort (adjusted β=0.36, 95% CI: -0.66-1.38, p = 0.493). The three groups showed no significant differences for dysphagia frequency. No observable adverse events were reported during the intervention period.

Conclusions: A spray-based oropharyngeal moisturising programme is a practical and effective intervention to alleviate patient thirst after cardiac surgery and tracheal intubation that could be integrated into comfort care for post-surgical patients' critical care management.

Tweetable abstract: A spray-based oropharyngeal moisturising programme for cardiac surgery recipients following endotracheal extubation may alleviate thirst.

Keywords: Cardiac surgery; Nursing; Nursing care; Oral care; Randomised controlled trial; Spray; Thirst.