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Nielsen AH, Kaldan G, Gade LM, Egerod I. Postextubation dysphagia management in Danish intensive care units: A national survey. Acta Anaesthesiol Scand 2024; 68:949-955. [PMID: 38719567 DOI: 10.1111/aas.14438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 04/02/2024] [Accepted: 04/23/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Postextubation dysphagia (PED) is a common complication to endotracheal intubation in critically ill patients and may lead to pneumonia, prolonged ventilation, longer hospital stays, and increased mortality. Recognizing dysphagia is paramount to preventing adverse events. The aim of this study was to describe PED management by investigating practice in Danish intensive care units (ICUs) focusing on current practice in 2023 (screening, prevention, and treatment), perceived best practice (barriers and facilitators), and when possible, to compare practice in 2017 and 2023. METHODS Self-reported, cross-sectional survey of dysphagia practice in Danish ICUs administered from April to May 2023. In addition, data were compared with the 2017 Dysphagia in Intensive Care Evaluation study, when possible. RESULTS Only half of Danish ICUs reported to have a PED protocol, and less than half routinely screen patients for dysphagia after extubation. Most common screening methods were the oral mechanism examination, water test, and Facio-oral tract therapy. Nurses and physicians often relied on an overall physical assessment of the patient. Best treatment methods were uniformly agreed to be patient positioning, modification of food and fluids, use of ergonomic utensils, and compensatory maneuvers. Key barriers to dysphagia management were lack of specialized staff, under-recognition of dysphagia as a health issue, and lack of standardized protocols. CONCLUSION Awareness of PED is increasing and identification, prevention, and treatment is slowly improving, but systematic implementation of protocols for dysphagia screening and treatment could enhance dysphagia management in Danish ICUs.
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Affiliation(s)
- Anne Højager Nielsen
- Department of Anesthesiology and Intensive Care, Gødstrup Hospital, Herning, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - Gudrun Kaldan
- Research Unit 98A52, Centre for Cancer and Organ Diseases, Rigshospitalet, Copenhagen O, Denmark
| | - Lotte Madsen Gade
- Department of Anesthesiology and Intensive Care, Gødstrup Hospital, Herning, Denmark
| | - Ingrid Egerod
- Department of Intensive Care, Rigshospitalet, University of Copenhagen, Copenhagen O, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen N, Denmark
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Santana-Padilla YG, Linares-Pérez T, Santana-López BN, Santana-Cabrera L. Dysphagia management by nurses in Spanish intensive care units. ENFERMERIA INTENSIVA 2024:S2529-9840(24)00031-4. [PMID: 38981780 DOI: 10.1016/j.enfie.2024.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 02/18/2024] [Accepted: 02/26/2024] [Indexed: 07/11/2024]
Abstract
INTRODUCTION/PURPOSE Dysphagia is a disorder that presents with specific signs and symptoms in critically ill patients. Intensive care unit (ICU) nurses are responsible for monitoring and detecting abnormalities in critically ill patients, so they must be trained to assess swallowing and the complications that may arise. The aim of this research is to analyse the dynamics of the detection and assessment of dysphagia by ICU nurses. METHOD Cross-sectional descriptive study using an electronic questionnaire to nurses from different Spanish ICUs. The survey was adapted from previous research and consisted of 6 sections with 30 items of qualitative questions. The collection period was between December 2022 and March 2023. Statistical analysis was performed using frequencies and percentages, and the Chi-Square test was used for bivariate analysis. OUTCOMES 43 nurses were recruited. Dysphagia is considered an important problem (90,7%) but in 50,3% of the units there is no standard or care protocol for this disorder. The most common technique is the swallowing test (32,6%). There is a consensus in our sample that aspiration pneumonia is the main problem; however, nurses in the busiest care units consider sepsis to be a frequent complication (p = ,029). The most common treatment is modification of food consistency (86,0%). CONCLUSION The findings of this research show a low systematisation of dysphagia screening in the units included. There is a need for greater implementation of interventions and clinical protocols for monitoring complications as well as for compensatory and rehabilitative management.
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Affiliation(s)
- Y G Santana-Padilla
- Subdirección de Enfermería del Hospital Universitario Materno-Infantil de Canarias, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain.
| | - T Linares-Pérez
- Centro de Salud Cueva Torres, Gerencia de Atención Primaria, Las Palmas de Gran Canaria, Spain
| | - B N Santana-López
- Cuidados Intensivos, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain; Departamento de Enfermería, Universidad Fernando Pessoa-Canarias (UFPC), Santa María de Guía, Spain
| | - L Santana-Cabrera
- Medicina Intensiva, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
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Umay E, Eyigor S, Demirag K, Kaymak Karatas G, Gundogdu I, Giray E, Panpalli Ates M, Gonenli Kocer B, Gurcay E, Unlu Z, Bengisu S, Karaahmet F, Bagcier F, Vural M, Aydeniz B, Kullukcu H, Oztekin F, Alicura S, Uz C, Barmak E, Uzunkulaoglu A, Adiguzel E. Best Practice Recommendations for Dysphagia Management in Intensive Care Unit (ICU): A Delphi Study from Multidisciplinary Experts in Turkey. Dysphagia 2024; 39:241-254. [PMID: 37542552 DOI: 10.1007/s00455-023-10606-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 07/16/2023] [Indexed: 08/07/2023]
Abstract
There is no study about all aspects of oropharyngoesophageal (OPE) dysphagia from diagnosis to follow-up in a multidisciplinary manner in the world. In order to close this gap, we aimed to create a recommendation study that can be used in clinical practice, addressing all aspects of dysphagia in the ICU in detail with the opinion of experienced multidisciplinary experts. This recommendation paper was generated by a multidisciplinary team, using the seven-step process and a three-modified Delphi round via e-mail. Firstly, 15 open-ended questions were created, and then detailed recommendations including general principles, management, diagnosis, rehabilitation, and follow-up were created with the answers from these questions, Each recommendation item was voted on by the experts as overall consensus (strong recommendation), approaching consensus (weak recommendation), and divergent consensus (not recommended).In the first Delphi round, a questionnaire consisting of 413 items evaluated with a scale of 0-10 was prepared from the opinions and suggestions given to 15 open-ended questions. In the second Delphi round, 55.4% were accepted and revised suggestions were created. At the end of the third Delphi round, the revised suggestion form was approved again and the final proposals containing 133 items were created. This study includes comprehensive and detailed recommendations, including a broad perspective from diagnosis to treatment and follow-up, as detailed as possible, for management of dysphagia in patients with both oropharyngeal- and esophageal-dysphagia in ICU.
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Affiliation(s)
- Ebru Umay
- Ankara Etlik City Physical Medicine and Rehabilitation Hospital, University of Health Sciences Turkey, Halil Sezai Erkut Street, No. 5, 06170, Yenimahalle, Ankara, Turkey.
| | - Sibel Eyigor
- Department of Physical Medicine and Rehabilitation, Ege University, Izmir, Turkey
| | - Kubilay Demirag
- Department of Anesthesiology and Reanimation, Ege University, Izmir, Turkey
| | | | - Ibrahim Gundogdu
- Ankara Etlik City Physical Medicine and Rehabilitation Hospital, University of Health Sciences Turkey, Halil Sezai Erkut Street, No. 5, 06170, Yenimahalle, Ankara, Turkey
| | - Esra Giray
- Department of Physical Medicine and Rehabilitation, Fatih Sultan Mehmet Training and Research Hospital, University of Health Sciences Turkey, Istanbul, Turkey
| | - Mehlika Panpalli Ates
- Department of Neurology, Ankara Etlik City Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Bilge Gonenli Kocer
- Department of Neurology, Ankara Etlik City Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Eda Gurcay
- Gaziler Physical Medicine and Rehabilitation Training and Research Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Zeliha Unlu
- Department of Physical Medicine and Rehabilitation, Celal Bayar University, Manisa, Turkey
| | - Serkan Bengisu
- Department of Speech and Language Therapy, Fenerbahce University, Istanbul, Turkey
| | - Fatih Karaahmet
- Department of Gastroenterology, Medicana International Ankara Hospital, Ankara, Turkey
| | - Fatih Bagcier
- Department of Physical Medicine and Rehabilitation, Basaksehir Cam Sakura Hospital, Istanbul, Turkey
| | - Meltem Vural
- Department of Physical Medicine and Rehabilitation, Bakırköy Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Banu Aydeniz
- Department of Physical Medicine and Rehabilitation, Bakırköy Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Humeyra Kullukcu
- Department of Neurosurgery, Ankara Medical Park Hospital, Ankara, Turkey
| | - Fevzi Oztekin
- Department of Neurology, Ankara Etlik City Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Sibel Alicura
- Department of Otolaryngology, Head and Neck Surgery, Ankara Etlik City Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Cuma Uz
- Ankara Etlik City Physical Medicine and Rehabilitation Hospital, University of Health Sciences Turkey, Halil Sezai Erkut Street, No. 5, 06170, Yenimahalle, Ankara, Turkey
| | - Elife Barmak
- Department of Speech and Language Therapy, Ankara Etlik City Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Aslihan Uzunkulaoglu
- Ankara Etlik City Physical Medicine and Rehabilitation Hospital, University of Health Sciences Turkey, Halil Sezai Erkut Street, No. 5, 06170, Yenimahalle, Ankara, Turkey
| | - Emre Adiguzel
- Ankara Etlik City Physical Medicine and Rehabilitation Hospital, University of Health Sciences Turkey, Halil Sezai Erkut Street, No. 5, 06170, Yenimahalle, Ankara, Turkey
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Karunaratne TB, Clavé P, Ortega O. Complications of oropharyngeal dysphagia in older individuals and patients with neurological disorders: insights from Mataró hospital, Catalonia, Spain. Front Neurol 2024; 15:1355199. [PMID: 38523610 PMCID: PMC10958785 DOI: 10.3389/fneur.2024.1355199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 02/26/2024] [Indexed: 03/26/2024] Open
Abstract
Background Oropharyngeal dysphagia (OD) significantly impacts older individuals and neurologically compromised patients, hindering safe ingestion of food and liquids. Despite its prevalence, OD remains underdiagnosed and undertreated, leading to severe complications such as malnutrition, dehydration, respiratory infections, and aspiration pneumonia (AP), and increases hospital readmissions. Objectives This study analyzes the intricate relationship between OD and various clinical complications in older individuals and patients with neurological disorders. Methods Utilizing retrospective analysis and narrative review, our work consolidates findings from prior studies on Hospital de Mataro's dysphagia patient cohort. Revisiting OD's intricate association with clinical complications, it presents data via odds ratios (OR), incidence ratios (IR), and hazard ratios (HR) from univariate and multivariate analyses. Results Five studies (2001-2014) involving 3,328 patients were scrutinized. OD exhibited independent and significant associations with various complications among older patients. Older individuals with OD faced heightened 1-month (ODDS 3.28) and 1-year (OR 3.42) mortality risks post-pneumonia diagnosis. OD correlated with a 2.72-fold risk of malnutrition, 2.39-fold risk of lower respiratory tract infections, 1.82-fold pneumonia readmissions (IR), and 5.07-fold AP readmissions (IR). Post-stroke OD is linked to neurological impairment (OR 3.38) and respiratory (OR 9.54) and urinary infections (OR 7.77), alongside extended hospital stays (beta coefficient 2.11). Conclusion Oropharyngeal dysphagia causes and significantly exacerbates diverse clinical complications in older and post-stroke patients, emphasizing the urgent need for proactive identification, comprehensive assessment, and tailored management. Acknowledging OD's broader implications in general medical practice is pivotal to improving patient outcomes and healthcare quality.
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Affiliation(s)
- Tennekoon B. Karunaratne
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain
| | - Pere Clavé
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Barcelona, Spain
| | - Omar Ortega
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Barcelona, Spain
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Freeman-Sanderson A, Hemsley B, Thompson K, Rogers KD, Knowles S, Hammond NE. Dysphagia in adult intensive care patients: Results of a prospective, multicentre binational point prevalence study. Aust Crit Care 2023; 36:961-966. [PMID: 36868933 DOI: 10.1016/j.aucc.2023.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 12/21/2022] [Accepted: 01/08/2023] [Indexed: 03/05/2023] Open
Abstract
BACKGROUND Dysphagia occurs in intensive care unit (ICU) patients. However, there is a lack of epidemiological data on the prevalence of dysphagia in adult ICU patients. OBJECTIVES The objective of this study was to describe the prevalence of dysphagia in nonintubated adult patients in the ICU. METHODS A prospective, multicentre, binational, cross-sectional point prevalence study was conducted in 44 adult ICUs in Australia and New Zealand. Data were collected in June 2019 on documentation of dysphagia, oral intake, and ICU guidelines and training. Descriptive statistics were used to report demographic, admission, and swallowing data. Continuous variables are reported as means and standard deviations (SDs). Precisions of estimates were reported as 95% confidence intervals (CIs). RESULTS Of the 451 eligible participants, 36 (7.9%) were documented as having dysphagia on the study day. In the dysphagia cohort, the mean age was 60.3 years (SD: 16.37) vs 59.6 years (SD: 17.1) and almost two-thirds were female (61.1% vs 40.1%). The most common admission source for those patients with dysphagia were from the emergency department (14/36, 38.9%), and seven of 36 (19.4%) had a primary diagnosis of trauma (odds ratio: 3.10, 95% CI 1.25 - 7.66). There were no statistical differences in Acute Physiology and Chronic Health Evaluation (APACHE II) scores between those with and without a dysphagia diagnosis. Patients with dysphagia were more likely to have a lower mean body weight of 73.3 kg vs 82.1 kg than patients not documented as having dysphagia (95% CI of mean difference: 0.43 to 17.07) and require respiratory support (odds ratio: 2.12, 95% 1.06 to 4.25). The majority of patients with dysphagia were prescribed modified food and fluids in the ICU. Less than half of ICUs surveyed reported unit-level guidelines, resources, or training for management of dysphagia. CONCLUSIONS The prevalence of documented dysphagia in adult ICU nonintubated patients was 7.9%. There were a higher proportion of females with dysphagia than previously reported. Approximately two-thirds of patients with dysphagia were prescribed oral intake, and the majority were receiving texture-modified food and fluids. Dysphagia management protocols, resources, and training are lacking across Australian and New Zealand ICUs.
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Affiliation(s)
- Amy Freeman-Sanderson
- Graduate School of Health, University of Technology Sydney, NSW, Australia; Royal Prince Alfred Hospital, Sydney, NSW, Australia; Critical Care Division, The George Institute for Global Health, Faculty of Medicine, UNSW Sydney, Sydney, Australia; Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Australia.
| | - Bronwyn Hemsley
- Graduate School of Health, University of Technology Sydney, NSW, Australia; The University of Newcastle, NSW, Australia
| | - Kelly Thompson
- Critical Care Division, The George Institute for Global Health, Faculty of Medicine, UNSW Sydney, Sydney, Australia; Nepean Blue Mountains Local Health District, Sydney, NSW, Australia
| | - Kris D Rogers
- Graduate School of Health, University of Technology Sydney, NSW, Australia; Statistics Division, The George Institute for Global Health, Faculty of Medicine, UNSW Sydney, Sydney, Australia
| | - Serena Knowles
- Critical Care Division, The George Institute for Global Health, Faculty of Medicine, UNSW Sydney, Sydney, Australia
| | - Naomi E Hammond
- Critical Care Division, The George Institute for Global Health, Faculty of Medicine, UNSW Sydney, Sydney, Australia; Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital, Sydney, Australia
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Mpouzika M, Iordanou S, Kyranou M, Iliopoulou K, Parissopoulos S, Kalafati M, Karanikola M, Papathanassoglou E. Strategies of Screening and Treating Post-Extubation Dysphagia: An Overview of the Situation in Greek-Cypriot ICUs. Healthcare (Basel) 2023; 11:2283. [PMID: 37628481 PMCID: PMC10454777 DOI: 10.3390/healthcare11162283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/30/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open
Abstract
Post-extubation dysphagia (PED) can lead to serious health problems in critically ill patients. Contrasting its high incidence rate of 12.4% reported in a recent observational study, many ICUs lack routine bedside screening, likely due to limited awareness. This study aimed to establish baseline data on the current approaches and the status of perceived best practices in PED screening and treatment, as well as to assess awareness of PED. A nationwide cross-sectional, online survey was conducted in all fourteen adult ICUs in the Republic of Cyprus in June 2018, with a 100% response rate. Over 85% of ICUs lacked a standard screening protocol for PED. The most commonly reported assessment methods were cough reflex testing and the water swallow test. Treatment approaches included muscle strengthening exercises without swallowing and swallowing exercises. Only 28.6% of ICUs acknowledged PED as a common issue. The study identified significant gaps in awareness and knowledge regarding PED screening and treatment in Greek-Cypriot ICUs. Urgent implementation of comprehensive dysphagia education programs within the units is necessary, and interdisciplinary collaboration among nurses, intensivists, and speech and language therapists is crucial to improve the quality of care provided.
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Affiliation(s)
- Meropi Mpouzika
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, 3041 Limassol, Cyprus; (M.K.); (M.K.)
| | - Stelios Iordanou
- Limassol General Hospital, State Health Services Organization, 4131 Limassol, Cyprus;
| | - Maria Kyranou
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, 3041 Limassol, Cyprus; (M.K.); (M.K.)
| | | | | | - Maria Kalafati
- Department of Nursing, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Maria Karanikola
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, 3041 Limassol, Cyprus; (M.K.); (M.K.)
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Rowland S, Mills C, Walshe M. Perspectives on speech and language pathology practices and service provision in adult critical care settings in Ireland and international settings: A cross-sectional survey. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 25:219-230. [PMID: 35167432 DOI: 10.1080/17549507.2022.2032346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
PURPOSE Patients admitted to critical care (CC) are at risk of impaired swallowing and communication function. Speech-language pathologists (SLPs) play an important role in this context. In Ireland and internationally speech-language pathology CC guidelines are lacking, with possible variations in practice. To compare clinical practices in dysphagia, communication and tracheostomy management among SLPs working in adult CC units in Ireland and internationally, and explore their perspectives on training, skills and resources. METHOD Participants were SLPs working in CC. An international online survey sought information on (i) SLP workforce demographics and staffing levels, (ii) current dysphagia and communication assessment and management practices, (iii) practices and perspectives on training, skills and resources. RESULT 366 responses were received across 29 countries. 18.03% (66/366) of these respondents worked in Ireland. Findings showed similarities and differences in practices. Total CC SLP whole-time equivalent (WTE) at each staff grade was lower (mean difference: -0.21 to -0.65 WTE p <.001) than desired for optimal service delivery. Negative effects of under-staffing were reported. Recommendations that all tracheostomised patients receive SLP input was unmet in 66% (220/334) of services. CONCLUSION SLP input in CC is limited in terms of dedicated posts, multidisciplinary team (MDT) involvement, consistent management approaches and training opportunities internationally. Implications of findings are discussed.
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Affiliation(s)
- Sarah Rowland
- Department of Speech and Language Therapy, Tallaght University Hospital, Dublin, Ireland
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
| | - Claire Mills
- Leeds Institute for Health Sciences, University of Leeds, Leeds, UK
| | - Margaret Walshe
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
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Azevedo P, Saraiva M, Oliveira M, Oliveira I. Instrumentos de rastreio da disfagia pós-intubação prolongada: revisão sistemática da literatura. REVISTA PORTUGUESA DE ENFERMAGEM DE REABILITAÇÃO 2023. [DOI: 10.33194/rper.2023.264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Introdução: A disfagia pós-extubação afeta uma percentagem significativa de doentes. Contudo o seu rastreio não é realizado de forma sistemática, contribuindo para uma reduzida perceção do problema e predispondo à ocorrência de complicações.
Metodologia: Revisão Sistemática da Literatura orientada pelos princípios da Cochrane Screening and Diagnostic Test Methods Group e o Preferred Reporting Items for Systematic Reviews and Meta-Analyses, com o objetivo de identificar os instrumentos de rastreio da disfagia em doentes pós-extubação. Consultadas as bases de dados Medline, Cochrane Library, Scielo, Science Direct e CINAHL e efetuada pesquisa na literatura cinzenta. Como critérios de inclusão foram definidos estudos de validação de instrumentos de rastreio para doentes pós-extubação de intubação prolongada (superior a 48 horas).
Resultados: Revistos 7043 artigos dos quais foram selecionados sete para leitura integral, sendo que apenas um cumpria os critérios de inclusão.
Discussão: Apenas um instrumento de rastreio de disfagia validado foi identificado para esta população específica. O instrumento apresenta boa fiabilidade entre observadores, no entanto, a sensibilidade, sendo de 81%, significa que parte destes doentes não será identificado como disfágico, o que terá repercussões negativas. Este instrumento foi validado contra avaliação clínica, o que se mostra uma limitação à interpretação dos seus resultados.
Conclusão: Não existe versão em português deste instrumento, o que dificulta a elaboração de orientações que sistematizem a abordagem terapêutica para doentes pós-extubação. Advoga-se a sua tradução e validação para o contexto nacional e validação com teste de referência.
Protocolo registado na Open Science Framework osf.io/q6k7g a 16 de maio de 2022.
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Dysphagia in Intensive Care Evaluation (DICE): An International Cross-Sectional Survey. Dysphagia 2022; 37:1451-1460. [PMID: 35092486 DOI: 10.1007/s00455-021-10389-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 10/31/2021] [Indexed: 12/16/2022]
Abstract
Dysphagia occurs commonly in the intensive care unit (ICU). Despite the clinical relevance, there is little worldwide research on prevention, assessment, evaluation, and/or treatment of dysphagia for ICU patients. We aimed to gain insight into this international knowledge gap. We conducted a multi-center, international online cross-sectional survey of adult ICUs. Local survey distribution champions were recruited through professional and personal networks. The survey was administered from November 2017 to June 2019 with three emails and a final telephone reminder. Responses were received from 746 ICUs (26 countries). In patients intubated > 48 h, 17% expected a > 50% chance that dysphagia would develop. This proportion increased to 43% in patients intubated > 7 days, and to 52% in tracheotomized patients. Speech-language pathologist (SLP) consultation was available in 66% of ICUs, only 4% reported a dedicated SLP. Although 66% considered a routine post-extubation dysphagia protocol important, most (67%) did not have a protocol. Few ICUs routinely assessed for dysphagia after 48 h of intubation (30%) or tracheostomy (41%). A large proportion (46%) used water swallow screening tests to determine aspiration, few (8%) used instrumental assessments (i.e., flexible endoscopic evaluation of swallowing). Swallowing exercises were used for dysphagia management by 30% of ICUs. There seems to be limited awareness among ICU practitioners that patients are at risk of dysphagia, particularly as ventilation persists, protocols, routine assessment, and instrumental assessments are generally not used. We recommend the development of a research agenda to increase the quality of evidence and ameliorate the implementation of evidence-based dysphagia protocols by dedicated SLPs.
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Yamada T, Ochiai R, Kotake Y. Changes in Maximum Tongue Pressure and Postoperative Dysphagia in Mechanically Ventilated Patients after Cardiovascular Surgery. Indian J Crit Care Med 2022; 26:1253-1258. [PMID: 36755636 PMCID: PMC9886018 DOI: 10.5005/jp-journals-10071-24365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 10/19/2022] [Indexed: 12/03/2022] Open
Abstract
Background There is no objective quantitative parameter for dysphagia, and the relationship between changes in maximum tongue pressure values and dysphagia is unknown. This study aimed to determine whether there is a difference in the change in maximal tongue pressure after extubating patients who were ventilated after cardiovascular surgery, with or without dysphagia. Materials and methods Adult patients who underwent mechanical ventilation via endotracheal intubation following cardiovascular surgery were included. Tongue pressure was measured before cardiovascular surgery and at 6 hours; 3 and 7 days after extubation. Dysphagia was confirmed by the functional oral intake scale (FOIS) on day 7 after extubation; an FOIS level above or equal to 6 was considered "dysphagia-negative." Results Of 68 patients, 15 (22.1%) were in the dysphagia-positive group, which significantly showed a history of diabetes mellitus, prolonged mechanical ventilation, and postextubation hospitalization. Additionally, the postoperative C-reactive protein level was significantly higher in the dysphagia-positive group than in the dysphagia-negative group. Maximum tongue pressure was significantly lower in the dysphagia-positive group at 3 and 7 days postextubation. Using a cutoff value of 27.6 kPa in a receiver operating characteristic (ROC) curve for maximum tongue pressure at 3 days after extubation, the area under the curve (AUC) was 0.82, sensitivity was 84.9%, and specificity was 84.2%. Conclusion Tongue pressure at 3 days after extubation is significantly lower in patients with dysphagia after cardiovascular surgery than in patients without dysphagia. If the maximum tongue pressure value is below 27.6 kPa on the third day following extubation, oral intake should be performed with caution. How to cite this article Yamada T, Ochiai R, Kotake Y. Changes in Maximum Tongue Pressure and Postoperative Dysphagia in Mechanically Ventilated Patients after Cardiovascular Surgery. Indian J Crit Care Med 2022;26(12):1253-1258.
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Affiliation(s)
- Toru Yamada
- Department of Anesthesiology, Toho University Graduate School of Medicine, Ota-ku Omorinishi, Tokyo, Japan,Toru Yamada, Department of Anesthesiology, Toho University Graduate School of Medicine, Ota-ku Omorinishi, Tokyo, Japan, Phone: +81 337624151, e-mail:
| | | | - Yoshifumi Kotake
- Department of Anesthesiology, Ohashi Medical Center, Toho University, Ohashi, Tokyo, Japan
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Chen K, Xing L, Xu B, Li Y, Liu T, Zhang T, Shi H, Lu H, Zhou W, Hou J, Shi H, Qin D. Research progress in the risk factors and screening assessment of dysphagia in the elderly. Front Med (Lausanne) 2022; 9:1021763. [PMID: 36419790 PMCID: PMC9676222 DOI: 10.3389/fmed.2022.1021763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 10/21/2022] [Indexed: 10/30/2023] Open
Abstract
With the aging of the population, the incidence of dysphagia has gradually increased and become a major clinical and public health issue. Early screening of dysphagia in high-risk populations is crucial to identify the risk factors of dysphagia and carry out effective interventions and health management in advance. In this study, the current epidemiology, hazards, risk factors, preventive, and therapeutic measures of dysphagia were comprehensively reviewed, and a literature review of screening instruments commonly used globally was conducted, focusing on their intended populations, main indicators, descriptions, and characteristics. According to analysis and research in the current study, previous studies of dysphagia were predominantly conducted in inpatients, and there are few investigations and screenings on the incidence and influencing factors of dysphagia in the community-dwelling elderly and of dysphagia developing in the natural aging process. Moreover, there are no unified, simple, economical, practical, safe, and easy-to-administer screening tools and evaluation standards for dysphagia in the elderly. It is imperative to focus on dysphagia in the community-dwelling elderly, develop unified screening and assessment tools, and establish an early warning model of risks and a dietary structure model for dysphagia in the community-dwelling elderly.
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Affiliation(s)
- Kerong Chen
- Department of Rehabilitation Medicine, The Third People’s Hospital of Yunnan Province, Kunming, China
| | - Liwei Xing
- The First School of Clinical Medicine, Yunnan University of Chinese Medicine, Kunming, China
| | - Bonan Xu
- School of Basic Medical Sciences, Yunnan University of Chinese Medicine, Kunming, China
| | - Yi Li
- Department of Rehabilitation Medicine, The Third People’s Hospital of Yunnan Province, Kunming, China
| | - Tianyun Liu
- Department of Rehabilitation Medicine, The Third People’s Hospital of Yunnan Province, Kunming, China
| | - Tingjuan Zhang
- Department of Rehabilitation Medicine, The Third People’s Hospital of Yunnan Province, Kunming, China
| | - Hongping Shi
- Department of Rehabilitation Medicine, The Third People’s Hospital of Yunnan Province, Kunming, China
| | - Hanmei Lu
- Department of Rehabilitation Medicine, The Third People’s Hospital of Yunnan Province, Kunming, China
| | - Wengang Zhou
- Department of Medical, The Third People’s Hospital of Yunnan Province, Kunming, China
| | - Jianhong Hou
- Department of Orthopedics, The Third People’s Hospital of Yunnan Province, Kunming, China
| | - Hongling Shi
- Department of Rehabilitation Medicine, The Third People’s Hospital of Yunnan Province, Kunming, China
| | - Dongdong Qin
- School of Basic Medical Sciences, Yunnan University of Chinese Medicine, Kunming, China
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12
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Santana-Cabrera L, Rico Rodríguez J, Simón Bautista D, Santana-López BN, Alcaraz Jiménez J, Martín González JC. Perception of dysphagia in the ICU of Spain, diagnostic and therapeutic management. Med Intensiva 2022; 46:533-537. [PMID: 35649887 DOI: 10.1016/j.medine.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 05/23/2021] [Accepted: 06/06/2021] [Indexed: 06/15/2023]
Affiliation(s)
- L Santana-Cabrera
- Servicio de Medicina Intensiva, Complejo Hospitalario Universitario Insular Materno Infantil, Canary Islands, Spain.
| | - J Rico Rodríguez
- Servicio de Medicina Intensiva, Complejo Hospitalario Universitario Insular Materno Infantil, Canary Islands, Spain
| | - D Simón Bautista
- Servicio de Rehabilitación, Complejo Hospitalario Universitario Insular Materno Infantil, Canary Islands, Spain
| | - B N Santana-López
- Servicio de Medicina Intensiva, Complejo Hospitalario Universitario Insular Materno Infantil, Canary Islands, Spain
| | - J Alcaraz Jiménez
- Servicio de Medicina Intensiva, Complejo Hospitalario Universitario Insular Materno Infantil, Canary Islands, Spain
| | - J C Martín González
- Servicio de Medicina Intensiva, Complejo Hospitalario Universitario Insular Materno Infantil, Canary Islands, Spain
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13
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Dysphagia incidence in intensive care unit patients with coronavirus disease 2019: retrospective analysis following systematic dysphagia screening. J Laryngol Otol 2022; 136:1278-1283. [DOI: 10.1017/s0022215122001517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Objective
Post-extubation dysphagia in critically ill patients is known to affect about 18 per cent of mixed medical-surgical intensive care unit patients. This study investigated the incidence of post-extubation dysphagia in adult intensive care unit patients with coronavirus disease 2019.
Method
This study was a retrospective analysis of consecutive intensive care unit patients prospectively screened for dysphagia. Systematic screening of all extubated intensive care unit patients at our tertiary centre was performed using the Bernese intensive care unit dysphagia algorithm. The primary outcome measure was the incidence of post-extubation dysphagia.
Results
A total of 231 critically ill adult coronavirus disease 2019 positive patients were included, and 81 patients remained in the final analysis after exclusion criteria were applied (e.g. patients transferred). Dysphagia screening positivity was 25 of 81 (30.9 per cent), with 28.2 per cent (22 of 78) having confirmed dysphagia by specialist examination within 24 hours (n = 3 lost to follow up).
Conclusion
In this observational study, it was observed that the incidence of dysphagia in adult critically ill coronavirus disease 2019 patients was about 31 per cent (i.e. increased when compared with a historical pre-pandemic non-coronavirus disease 2019 intensive care unit cohort).
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14
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Nielsen AH, Kaldan G, Nielsen BH, Kristensen GJ, Shiv L, Egerod I. Intensive care professionals’ perspectives on dysphagia management: A focus group study. Aust Crit Care 2022:S1036-7314(22)00060-1. [DOI: 10.1016/j.aucc.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 03/11/2022] [Accepted: 04/02/2022] [Indexed: 10/18/2022] Open
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15
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Siao SF, Tseng WH, Wang TG, Wei YC, Hsiao TY, Ku SC, Chen CCH. Predicting feeding-tube dependence in patients following endotracheal extubation: a two-item swallowing screen. BMC Pulm Med 2021; 21:403. [PMID: 34872549 PMCID: PMC8647059 DOI: 10.1186/s12890-021-01771-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 11/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To meet the surging demands for intubation and invasive ventilation as more COVID-19 patients begin their recovery, clinicians are challenged to find an ultra-brief and minimally invasive screen for postextubation dysphagia predicting feeding-tube dependence persisting for 72 h after extubation. METHODS This study examined the predictive validity of a two-item swallowing screen on feeding-tube dependence over 72 h in patients following endotracheal extubation. Intensive-care-unit (ICU) patients (≥ 20 years) successfully extubated after ≥ 48 h endotracheal intubation were screened by trained nurses using the swallowing screen (comprising oral stereognosis and cough-reflex tests) 24 h postextubation. Feeding-tube dependence persisting for 72 h postextubation was abstracted from the medical record by an independent rater. To verify the results and cross-check whether the screen predicted penetration and/or aspiration during fiberoptic endoscopic evaluation of swallowing (FEES), participants agreeing to receive FEES were analyzed within 30 min of screening. RESULTS The results showed that 95/123 participants (77.2%) failed the screen, which predicted ICU patients' prolonged (> 72 h) feeding-tube dependence, yielding sensitivity of 0.83, specificity of 0.35, and accuracy of 0.68. Failed-screen participants had 2.96-fold higher odds of feeding-tube dependence (95% CI, 1.13-7.76). For the 38 participants receiving FEES, the swallowing screen had 0.89 sensitivity to detect feeding-tube dependence and 0.86 sensitivity to predict penetration/aspiration, although specificity had room for improvement (0.36 and 0.21, respectively). CONCLUSION This ultra-brief swallowing screen is sufficiently sensitive to identify high-risk patients for feeding-tube dependence persisting over 72 h after extubation. Once identified, a further assessment and care are indicated to ensure the prompt return of patients' oral feeding. TRIAL REGISTRATION NCT03284892, registered on September 15, 2017.
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Affiliation(s)
- Shu-Fen Siao
- Department of Nursing, National Taiwan University College of Medicine, Taipei, Taiwan R.O.C
| | - Wen-Hsuan Tseng
- Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan R.O.C
| | - Tyng-Guey Wang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan R.O.C
| | - Yu-Chung Wei
- Graduate Institute of Statistics and Information Science, National Changhua University of Education, Changhua, Taiwan R.O.C
| | - Tzu-Yu Hsiao
- Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan R.O.C
| | - Shih-Chi Ku
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, 7, Chung Shan S. Rd., Zhongzheng Dist., Taipei, 100, Taiwan R.O.C..
| | - Cheryl Chia-Hui Chen
- Department of Nursing, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan R.O.C
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16
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Santana-Cabrera L, Rico Rodríguez J, Simón Bautista D, Santana-López BN, Alcaraz Jiménez J, Martín González JC. Perception of Dysphagia in the ICU of Spain, diagnostic and therapeutic management. Med Intensiva 2021; 46:S0210-5691(21)00169-8. [PMID: 34294446 DOI: 10.1016/j.medin.2021.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 05/23/2021] [Accepted: 06/06/2021] [Indexed: 10/20/2022]
Affiliation(s)
- L Santana-Cabrera
- Servicio de Medicina Intensiva. Complejo Hospitalario Universitario Insular Materno Infantil, Islas Canarias, España.
| | - J Rico Rodríguez
- Servicio de Medicina Intensiva. Complejo Hospitalario Universitario Insular Materno Infantil, Islas Canarias, España
| | - D Simón Bautista
- Servicio de Rehabilitación. Complejo Hospitalario Universitario Insular Materno Infantil, Islas Canarias, España
| | - B N Santana-López
- Servicio de Medicina Intensiva. Complejo Hospitalario Universitario Insular Materno Infantil, Islas Canarias, España
| | - J Alcaraz Jiménez
- Servicio de Medicina Intensiva. Complejo Hospitalario Universitario Insular Materno Infantil, Islas Canarias, España
| | - J C Martín González
- Servicio de Medicina Intensiva. Complejo Hospitalario Universitario Insular Materno Infantil, Islas Canarias, España
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17
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Dziewas R, Allescher HD, Aroyo I, Bartolome G, Beilenhoff U, Bohlender J, Breitbach-Snowdon H, Fheodoroff K, Glahn J, Heppner HJ, Hörmann K, Ledl C, Lücking C, Pokieser P, Schefold JC, Schröter-Morasch H, Schweikert K, Sparing R, Trapl-Grundschober M, Wallesch C, Warnecke T, Werner CJ, Weßling J, Wirth R, Pflug C. Diagnosis and treatment of neurogenic dysphagia - S1 guideline of the German Society of Neurology. Neurol Res Pract 2021; 3:23. [PMID: 33941289 PMCID: PMC8094546 DOI: 10.1186/s42466-021-00122-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 03/24/2021] [Indexed: 02/06/2023] Open
Abstract
Introduction Neurogenic dysphagia defines swallowing disorders caused by diseases of the central and peripheral nervous system, neuromuscular transmission, or muscles. Neurogenic dysphagia is one of the most common and at the same time most dangerous symptoms of many neurological diseases. Its most important sequelae include aspiration pneumonia, malnutrition and dehydration, and affected patients more often require long-term care and are exposed to an increased mortality. Based on a systematic pubmed research of related original papers, review articles, international guidelines and surveys about the diagnostics and treatment of neurogenic dysphagia, a consensus process was initiated, which included dysphagia experts from 27 medical societies. Recommendations This guideline consists of 53 recommendations covering in its first part the whole diagnostic spectrum from the dysphagia specific medical history, initial dysphagia screening and clinical assessment, to more refined instrumental procedures, such as flexible endoscopic evaluation of swallowing, the videofluoroscopic swallowing study and high-resolution manometry. In addition, specific clinical scenarios are captured, among others the management of patients with nasogastric and tracheotomy tubes. The second part of this guideline is dedicated to the treatment of neurogenic dysphagia. Apart from dietary interventions and behavioral swallowing treatment, interventions to improve oral hygiene, pharmacological treatment options, different modalities of neurostimulation as well as minimally invasive and surgical therapies are dealt with. Conclusions The diagnosis and treatment of neurogenic dysphagia is challenging and requires a joined effort of different medical professions. While the evidence supporting the implementation of dysphagia screening is rather convincing, further trials are needed to improve the quality of evidence for more refined methods of dysphagia diagnostics and, in particular, the different treatment options of neurogenic dysphagia. The present article is an abridged and translated version of the guideline recently published online (https://www.awmf.org/uploads/tx_szleitlinien/030-111l_Neurogene-Dysphagie_2020-05.pdf).
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Affiliation(s)
- Rainer Dziewas
- Klinik für Neurologie, Universitätsklinik Münster, 48149 Münster, Germany. .,Klinik für Neurologie und Neurologische Frührehabilitation, Klinikum Osnabrück, Am Finkenhügel 1, 49076, Osnabrück, Germany.
| | - Hans-Dieter Allescher
- Zentrum für Innere Medizin, Klinikum Garmisch-Partenkirchen GmbH, Auenstraße 6, 82467, Garmisch-Partenkirchen, Germany
| | - Ilia Aroyo
- Klinik für Neurologie und Neurointensivmedizin, Klinikum Darmstadt, Grafenstr. 9, 64283, Darmstadt, Germany
| | | | | | - Jörg Bohlender
- Universitätsspital Zürich, ORL-Klinik, Abteilung für Phoniatrie und Klinische Logopädie, Frauenklinikstr. 24, 8091, Zürich, Schweiz
| | - Helga Breitbach-Snowdon
- Schule für Logopädie, Universitätsklinikum Münster, Kardinal-von-Galen-Ring 10, 48149, Münster, Germany
| | | | - Jörg Glahn
- Universitätsklinik für Neurologie und Neurogeriatrie, Johannes Wesling Klinikum Minden, Hans-Nolte Strasse 1, 32429, Minden, Germany
| | - Hans-Jürgen Heppner
- Private Universität Witten/Herdecke gGmbH, Alfred-Herrhausen-Straße 50, 58448, Witten, Germany
| | - Karl Hörmann
- University Medical Centre Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Christian Ledl
- Abteilung Sprach-, Sprech- und Schlucktherapie, Schön Klinik Bad Aibling SE & Co. KG, Kolbermoorer Str. 72, 83043, Bad Aibling, Germany
| | - Christoph Lücking
- Schön Klinik München Schwabing, Parzivalplatz 4, 80804, München, Germany
| | - Peter Pokieser
- Medizinische Universität Wien, Teaching Center / Unified Patient Program, AKH Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - Joerg C Schefold
- Universitätsklinik für Intensivmedizin, Inselspital, Universitätsspital Bern, 3010, Bern, Schweiz
| | | | - Kathi Schweikert
- REHAB Basel, Klinik für Neurorehabilitation und Paraplegiologie, Im Burgfelderhof 40, 4012, Basel, Schweiz
| | - Roland Sparing
- VAMED Klinik Hattingen GmbH, Rehabilitationszentrum für Neurologie, Neurochirurgie, Neuropädiatrie, Am Hagen 20, 45527, Hattingen, Germany
| | - Michaela Trapl-Grundschober
- Klinische Abteilung für Neurologie, Therapeutischer Dienst, Universitätsklinikum Tulln, Karl Landsteiner Privatuniversität für Gesundheitswissenschaften, Alter Ziegelweg 10, 3430, Tulln an der Donau, Österreich
| | - Claus Wallesch
- BDH-Klinik Elzach gGmbH, Am Tannwald 1, 79215, Elzach, Germany
| | - Tobias Warnecke
- Klinik für Neurologie, Universitätsklinik Münster, 48149 Münster, Germany
| | - Cornelius J Werner
- Sektion Interdisziplinäre Geriatrie, Klinik für Neurologie, Medizinische Fakultät, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Johannes Weßling
- Zentrum für Radiologie, Neuroradiologie und Nuklearmedizin, Clemenskrankenhaus Münster, Düesbergweg 124, 48153, Münster, Germany
| | - Rainer Wirth
- Klinik für Altersmedizin und Frührehabilitation, Marien Hospital Herne, Universitätsklinikum der Ruhr-Universität Bochum, Katholische Kliniken Rhein-Ruhr, Hölkeskampring 40, 44625, Herne, Germany
| | - Christina Pflug
- Klinik und Poliklinik für Hör-, Stimm- und Sprachheilkunde, Universitäres Dysphagiezentrum Hamburg, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
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18
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SEREL ARSLAN S, DEMIR N, KARADUMAN AA. Deglutition disorders from the perspective of healthcare professionals in Turkey. CLINICAL AND EXPERIMENTAL HEALTH SCIENCES 2021. [DOI: 10.33808/clinexphealthsci.812290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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19
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Prevalence, Pathophysiology, Diagnostic Modalities, and Treatment Options for Dysphagia in Critically Ill Patients. Am J Phys Med Rehabil 2020; 99:1164-1170. [PMID: 32304381 DOI: 10.1097/phm.0000000000001440] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Postextubation dysphagia may impose a substantial burden on intensive care unit patients and healthcare systems. Approximately 517,000 patients survive mechanical ventilation during critical care annually. Reports of postextubation dysphagia prevalence are highly variable ranging between 3% and 93%. Of great concern is aspiration leading to the development of aspiration pneumonia when patients resume oral feeding. Screening for aspiration with a water swallow test has been reported to be positive for 12% of patients in the intensive care unit after extubation. This review aims to increase awareness of postextubation dysphagia and provide an updated overview of the current knowledge regarding prevalence, pathophysiology, diagnostic modalities, and treatment options.
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20
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Nielsen AH, Gow ND, Svenningsen H. Translation and adaption of the Yale Swallow Protocol for a Danish intensive care setting. Scand J Caring Sci 2020; 35:1290-1300. [PMID: 33368484 DOI: 10.1111/scs.12950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 10/27/2020] [Accepted: 11/29/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Dysphagia related to intubation affects almost one in five patients in the intensive care unit; it may vary due to fluctuations in cerebral status and fatigue and lead to pneumonia, re-intubation and increased mortality. Taking care of patients' nutritional needs is an integral part of nursing and nurses must therefore be able to assess risk of dysphagia at all hours. However, Danish validated methods for use in the critically ill patient population are lacking. AIM To translate and adapt the Yale Swallow Protocol method for implementation in a Danish intensive care unit setting. METHODS Translation and adaption followed WHO's recommendations for translation and adaption of instruments. Face validity of the Danish version was evaluated in four group interviews. These were digitally recorded, transcribed and analysed using deductive content analysis. All interviewees gave informed consent. FINDINGS The translated version of the Yale Swallow Protocol was easy to understand, although nurses needed to have the method explained and needed training in using the method. In addition, the Yale Swallow Protocol must be adapted to local practice in terms of identifying patients at risk of dysphagia and deciding where to document results of the screening. CONCLUSION The translated version of the Yale Swallow Protocol proved conceptually and culturally sound and acceptable to intensive care unit nurses. Implementation should be followed by theoretical and practical training to build a nursing vocabulary relating to dysphagia and strengthen nurses' sensitivity to clinical manifestations consistent with dysphagia.
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Affiliation(s)
- Anne Højager Nielsen
- Department of Anesthesiology, NIDO, Danmark, Gødstrup Hospital, Herning, Denmark
| | - Neil Duncan Gow
- Department of Anesthesiology, NIDO, Danmark, Gødstrup Hospital, Herning, Denmark
| | - Helle Svenningsen
- Research Centre for Health and Welfare Technology, VIA University College, Aarhus N, Denmark
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21
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Schefold JC, Wollersheim T, Grunow JJ, Luedi MM, Z'Graggen WJ, Weber-Carstens S. Muscular weakness and muscle wasting in the critically ill. J Cachexia Sarcopenia Muscle 2020; 11:1399-1412. [PMID: 32893974 PMCID: PMC7749542 DOI: 10.1002/jcsm.12620] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 08/10/2020] [Accepted: 08/23/2020] [Indexed: 12/17/2022] Open
Affiliation(s)
- Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Tobias Wollersheim
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Julius J Grunow
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Markus M Luedi
- Department of Anaesthesiology and Pain Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Werner J Z'Graggen
- Department of Neurology and Neurosurgery, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Steffen Weber-Carstens
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
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22
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Cardinal LA, Freeman-Sanderson A, Togher L. The speech pathology workforce in intensive care units: Results from a national survey. Aust Crit Care 2020; 33:250-258. [PMID: 32386794 DOI: 10.1016/j.aucc.2020.02.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 02/24/2020] [Accepted: 02/25/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Admission to the intensive care unit (ICU) with mechanical ventilation can lead to patients experiencing impaired swallowing and communication function. This can negatively affect patient experiences and outcomes. There is increasing research supporting early intervention for swallowing and communication; however, there are no published ICU workforce data to determine patient access. PURPOSE The purpose of this study was to describe national ICU access to speech pathology (SP) services and to describe the nature of this workforce. METHODS Prospective audit of Australian ICUs with a focussed workforce survey of SP service including workforce demographics, clinical practices, team environments, and training was conducted. Data are described as percentage (%, n) and as median (interquartile range). Qualitative data were analysed using thematic frameworks. RESULTS SP services were available at 99% (n = 165) of the sites; 62 sites provided workforce data (45% response rate). Seventy-one percent of respondents serviced the ICU ≤10 h per week, with 23% reporting dedicated funding. Almost a third (32%) reported not participating in ICU team activities, and more than half of the sites (56%) did not provide ICU-specific training with resulting varied clinical confidence ratings. Facilitator and barriers both highlighted team working relationships. Facilitator themes were building working relationships, understanding the SP role in the multidisciplinary team, physical presence in the unit, and access to resources. Barrier themes were the multidisciplinary team's understanding of SP roles and lack of presence of SP services in the ICU. CONCLUSIONS SP services are not standard across Australian ICUs, with variations in confidence, funding, training, and team environments. Further research into the impact of these variations on patient outcomes is needed.
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Affiliation(s)
- Lara Anne Cardinal
- The University of Sydney, 75 East Street, Lidcombe, NSW, 2141, Australia.
| | - Amy Freeman-Sanderson
- University of Technology Sydney, PO Box 123 Broadway, Ultimo, NSW, 2007, Australia; The University of Sydney, 75 East Street, Lidcombe, NSW, 2141, Australia.
| | - Leanne Togher
- The University of Sydney, 75 East Street, Lidcombe, NSW, 2141, Australia.
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23
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Zuercher P, Moret CS, Dziewas R, Schefold JC. Dysphagia in the intensive care unit: epidemiology, mechanisms, and clinical management. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2019; 23:103. [PMID: 30922363 PMCID: PMC6438038 DOI: 10.1186/s13054-019-2400-2] [Citation(s) in RCA: 166] [Impact Index Per Article: 33.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 03/18/2019] [Indexed: 12/14/2022]
Abstract
Dysphagia may present in all critically ill patients and large-scale clinical data show that e.g. post-extubation dysphagia (PED) is commonly observed in intensive care unit (ICU) patients. Recent data demonstrate that dysphagia is mostly persisting and that its presence is independently associated with adverse patient-centered clinical outcomes. Although several risk factors possibly contributing to dysphagia development were proposed, the underlying exact mechanisms in ICU patients remain incompletely understood and no current consensus exists on how to best approach ICU patients at risk.From a clinical perspective, dysphagia is well-known to be associated with an increased risk of aspiration and aspiration-induced pneumonia, delayed resumption of oral intake/malnutrition, decreased quality of life, prolonged ICU and hospital length of stay, and increased morbidity and mortality. Moreover, the economic burden on public health care systems is high.In light of high mortality rates associated with the presence of dysphagia and the observation that dysphagia is not systematically screened for on most ICUs, this review describes epidemiology, terminology, and potential mechanisms of dysphagia on the ICU. Furthermore, the impact of dysphagia on affected individuals, health care systems, and society is discussed in addition to current and future potential therapeutic approaches.
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Affiliation(s)
- Patrick Zuercher
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, CH, Switzerland.
| | - Céline S Moret
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, CH, Switzerland
| | - Rainer Dziewas
- Department of Neurology, University Hospital Münster, Münster, Germany
| | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, CH, Switzerland
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