1
|
Zhang H, Zheng L, Tang M, Guo F, Yang L, Liu S, Wang J, Chen J, Ye C, Shi Y, Li S, Xue W, Su J. Developing strategies "SATIA": How to manage dysphagia in older people? A Delphi panel consensus. Nurs Open 2023; 10:2376-2391. [PMID: 36440605 PMCID: PMC10006581 DOI: 10.1002/nop2.1493] [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: 12/21/2021] [Revised: 08/28/2022] [Accepted: 11/04/2022] [Indexed: 11/29/2022] Open
Abstract
AIM To develop a set of evidence-informed strategies to assist older people to improve swallowing functions and prevent further damage from complications. DESIGN A two-round Delphi survey. METHODS An initial set of dysphagia care strategies with 74 relevant items for older people was formed based on a literature review by seven researchers. An online survey was conducted by 21 panellists, and data of experts' opinions were collected and analysed by improved Delphi method. RESULTS The positive coefficients in the two rounds of expert consultation were 85.71% and 83.33%, respectively. Consensus was reached with 53 items included and was allocated into the following five sections: (1) screening, (2) assessment, (3) training, (4) interventions and (5) management. These strategies were named with the acronym of each section-"SATIA". The management strategy can be applied to guide the management of older people with dysphagia.
Collapse
Affiliation(s)
- Huafang Zhang
- Department of Nursing, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, China
| | - Li Zheng
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Mengling Tang
- Department of Epidemiology and Biostatistics, Zhejiang University School of Public Health, Hangzhou, China.,Department of Epidemiology and Biostatistics, and The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Fanjia Guo
- Department of Epidemiology and Biostatistics, Zhejiang University School of Public Health, Hangzhou, China
| | - Lili Yang
- Department of Nursing, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, China
| | - Suxiang Liu
- Department of Nursing, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, China
| | - Jinyun Wang
- Department of Nursing, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, China
| | - Jie Chen
- Department of Nursing, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, China
| | - Chenxi Ye
- Department of Nursing, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, China
| | - Yajun Shi
- Department of Nursing, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, China
| | - Sihan Li
- Faculty of Nursing, Zhejiang University School of Medicine, Hangzhou, China
| | - Wenfeng Xue
- Faculty of Nursing, Zhejiang University School of Medicine, Hangzhou, China
| | - Jie Su
- Faculty of Nursing, Zhejiang University School of Medicine, Hangzhou, China
| |
Collapse
|
2
|
Wu M, Yin X, Chen M, Liu Y, Zhang X, Li T, Long Y, Wu X, Pu L, Zhang M, Hu Z, Ye L. Effects of propofol on intracranial pressure and prognosis in patients with severe brain diseases undergoing endotracheal suctioning. BMC Neurol 2020; 20:394. [PMID: 33121474 PMCID: PMC7596952 DOI: 10.1186/s12883-020-01972-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 10/20/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND To investigate whether the administration of intravenous propofol before endotracheal suctioning (ES) in patients with severe brain disease can reduce the sputum suction response, improve prognosis, and accelerate recovery. METHODS A total of 208 severe brain disease patients after craniocerebral surgery were enrolled in the study. The subjects were randomly assigned to the experimental group (n = 104) and the control group (n = 104). The experimental group was given intravenous propofol (10 ml propofol with 1 ml 2% lidocaine), 0.5-1 mg/kg, before ES, while the control group was subjected to ES only. Changes in vital signs, sputum suction effect, the fluctuation range of intracranial pressure (ICP) before and after ES, choking cough response, short-term complications, length of stay, and hospitalization cost were evaluated. Additionally, the Glasgow Outcome Scale (GOS) prognosis score was obtained at 6 months after the operation. RESULTS At the baseline, the characteristics of the two groups were comparable (P > 0.05). The increase of systolic blood pressure after ES was higher in the control group than in the experimental group (P < 0.05). The average peak value of ICP in the experimental group during the suctioning (15.57 ± 12.31 mmHg) was lower than in the control group (18.24 ± 8.99 mmHg; P < 0.05). The percentage of patients experiencing cough reaction- during suctioning in the experimental group was lower than in the control group (P < 0.05), and the fluctuation range of ICP was increased (P < 0.0001). The effect of ES was achieved in both groups. The incidence of short-term complications in the two groups was comparable (P > 0.05). At 6 months after the surgery, the GOS scores were significantly higher in the experimental than in the control group (4-5 points, 51.54% vs. 32.64%; 1-3 points, 48.46% vs. 67.36%; P < 0.05). There was no significant difference in the length of stay and hospitalization cost between the two groups. CONCLUSIONS Propofol sedation before ES could reduce choking cough response and intracranial hypertension response. The use of propofol was safe and improved the long-term prognosis. The study was registered in the Chinese Clinical Trial Registry on May 16, 2015 (ChiCTR-IOR-15006441).
Collapse
Affiliation(s)
- Menghang Wu
- West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan Province, 610041, P. R. China
| | - Xiaorong Yin
- Department of Pain Management, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, P. R. China
| | - Maojun Chen
- West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan Province, 610041, P. R. China
| | - Yan Liu
- West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan Province, 610041, P. R. China
| | - Xia Zhang
- West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan Province, 610041, P. R. China
| | - Tingting Li
- West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan Province, 610041, P. R. China
| | - Yujuan Long
- West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan Province, 610041, P. R. China
| | - Xiaomei Wu
- West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan Province, 610041, P. R. China
| | - Lihui Pu
- West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan Province, 610041, P. R. China
| | - Maojie Zhang
- West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan Province, 610041, P. R. China
| | - Zhi Hu
- West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan Province, 610041, P. R. China
| | - Ling Ye
- Department of Pain Management, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, P. R. China.
| |
Collapse
|
3
|
Hannawi Y, Hannawi B, Rao CPV, Suarez JI, Bershad EM. Stroke-associated pneumonia: major advances and obstacles. Cerebrovasc Dis 2013; 35:430-43. [PMID: 23735757 DOI: 10.1159/000350199] [Citation(s) in RCA: 231] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Accepted: 02/14/2013] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Stroke-associated pneumonia (SAP) has been implicated in the morbidity, mortality and increased medical cost after acute ischemic stroke. The annual cost of SAP during hospitalization in the United States approaches USD 459 million. The incidence and prognosis of SAP among intensive care unit (ICU) patients have not been thoroughly investigated. We reviewed the pathophysiology, microbiology, incidence, risk factors, outcomes and prophylaxis of SAP with special attention to ICU studies. METHODS To determine the incidence, risk factors and prognosis of acute SAP, PubMed was searched using the terms 'pneumonia' AND 'neurology intensive unit' and the MeSH terms 'stroke' AND 'pneumonia'. Non-English literature, case reports and chronic SAP studies were excluded. Studies were classified into 5 categories according to the setting they were performed in: neurological intensive care units (NICUs), medical intensive care units (MICUs), stroke units, mixed studies combining more than one setting or when the settings were not specified and rehabilitation studies. RESULTS The incidences of SAP in the following settings were: NICUs 4.1-56.6%, MICUs 17-50%, stroke units 3.9-44%, mixed studies 3.9-23.8% and rehabilitation 3.2-11%. The majority of NICU and MICU studies were heterogeneous including different neurovascular diseases, which partly explains the wide range of SAP incidence. The higher incidence in the majority of ICU studies compared to stroke units or acute floor studies is likely explained by the presence of mechanical ventilation, higher stroke severity causing higher rates of aspiration and stroke-induced immunodepression among ICU patients. The short-term mortality of SAP was increased among the mixed and stroke unit studies ranging between 10.1 and 37.3%. SAP was associated with worse functional outcome in the majority of stroke unit and floor studies. Mortality was less consistent among NICU and MICU studies. This difference could be due to the heterogeneity of ICU studies and the effect of small sample size or other independent risk factors for mortality such as the larger neurological deficit, mechanical ventilation, and age, which may simultaneously increase the risk of SAP and mortality confounding the outcomes of SAP itself. The pathophysiology of SAP is likely explained by aspiration combined with stroke-induced immunodepression through complex humeral and neural pathways that include the hypothalamic-pituitary-adrenal axis, parasympathetic and sympathetic systems. CONCLUSIONS A unified definition of SAP, strict inclusion criteria, and the presence of a long-term follow-up need to be applied to the future prospective studies to better identify the incidence and prognosis of SAP, especially among ICU patients.
Collapse
Affiliation(s)
- Yousef Hannawi
- Department of Neurology, Baylor College of Medicine, Houston, TX, USA. yousefhannawi @ yahoo.com
| | | | | | | | | |
Collapse
|
4
|
Drozdz DRC, Costa CC, Jesus PRDO, Trindade MS, Weiss G, Neto ABM, da Silva AMT, Mancopes R. Pharyngeal swallowing phase and chronic cough. Int Arch Otorhinolaryngol 2012; 16:502-8. [PMID: 25991980 PMCID: PMC4399588 DOI: 10.7162/s1809-97772012000400012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2012] [Accepted: 08/26/2012] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION The act of swallowing depends on a complex and dynamic process which uses common structures to the act of breathing; respiratory problems can cause swallowing difficulties. AIM To assess the swallowing pharyngeal phase in patients with chronic cough. METHOD Retrospective study with 15 patients of both genders, patients with chronic cough and risk factors for aspiration defined by the pneumologic diagnosis. The patients were submitted to anamnesis on complaints related to swallowing, chewing and breathing, or related to food and to videofluoroscopic examination. RESULTS It was observed that 33.3% had normal and functional swallowing, being the last one of most prevalence. The mild dysphagia was observed in 20% of the patients, the mild to moderate dysphagia in 6.7% of them. In relation to the Rosenbek scale, 73.3% of patients presented degree 1, 6.7% presented degrees 2 and 3, and 13.3% presented degree 8. The most found pathology was the chronic cough with 40%, followed by asthma with 20%; 69.2% of patients presented stasis and of these, five used protection maneuvers, of these, seven were effective and only three were used in the presence of stasis. The most used maneuver was the multiple swallowing, being effective in 100%. CONCLUSION There are peculiarities in the patients' swallowing with chronic cough that, although not presenting complaints relating to swallowing, it presents an important aspiration risk due to the presence of changes in breathing pattern that can intervene in the coordination between breathing and swallowing, which is essential to protect the lower airway.
Collapse
Affiliation(s)
- Daniela Rejane Constantino Drozdz
- Speech Language Pathologist, Specialist in Oral Motricity approach with hospital. Master student of the Post-graduation Program in Human Communication Disorders, Federal University of Santa Maria (UFSM), Santa Maria, Rio Grande do Sul
| | - Cintia Conceição Costa
- Speech Language Pathologist post-graduation. Master student of the Post-graduation Program in Human Communication Disorders, Federal University of Santa Maria Santa Maria (UFSM), Santa Maria, Rio Grande do Sul, Brazil
| | - Paulo Roberto de Oliveira Jesus
- Radiologist Doctor. Chief of the Radiology service of the Academic Hospital of Santa Maria (HUSM), Santa Maria, Rio Grande do Sul, Brazil
| | | | - Guilherme Weiss
- Physical Specialist in Radiology Diagnostic by the ABFM. Physical specialist in radiology diagnostic by the ABFM
| | | | - Ana Maria T da Silva
- Speech Language Pathologist (SLP); Associate Professor of the Phonoaudiology Department of the Federal University of Santa Maria (UFSM), Santa Maria, Rio Grande do Sul, Brazil, PhD
| | - Renata Mancopes
- Speech Language Pathologist (SLP), Adjunct Professor of the Post-Graduation Program in Human Communication Disorders, Santa Maria (UFSM), Santa Maria, Rio Grande do Sul, Brazil, PhD
| |
Collapse
|
5
|
Silva ACVD, Dantas RO, Fabio SRC. Clinical and scintigraphic swallowing evaluation of post-stroke patients. ACTA ACUST UNITED AC 2011; 22:317-24. [PMID: 21103725 DOI: 10.1590/s0104-56872010000300027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Accepted: 08/18/2010] [Indexed: 11/21/2022]
Abstract
BACKGROUND deglutition of post-stroke patients. AIM to study the swallowing of post-stroke patients through clinical and scintigraphic evaluations. METHOD participants were 26 patients, who had suffered their first stroke within the last two months. The control group was composed by 15 healthy volunteers. Both groups were submitted to a clinical and scintigraphic evaluation of swallowing; using 5 ml of liquid (water) and 5 ml of paste bolus. Clinical evaluation was composed by an interview, an assessment of the oral structures (without food) and by a functional assessment (with food). RESULTS during the clinical evaluation, one individual of the control group presented inefficient larynx elevation and clinical signs of aspiration. As for the group of post-stroke patients, 27% presented inefficient prepare of the liquid bolus and 42% presented inefficient prepare of the paste bolus, in the oral phase. Considering the pharyngeal phase, 12% presented cough and choked. In the scintigraphy evaluation, three post-stroke patients were excluded from this analysis for the following reasons: two did not swallow during the exam acquisition time and one swallowed before the instruction given by the researcher. The group of post-stroke patients presented more oral residues and shorter pharyngeal transit with the paste bolus when compared to the control group. CONCLUSION clinical and objective swallowing evaluations of post-stroke patients are necessary and important to determine therapy intervention and possible outcomes. Patients who have suffered stroke have more residues and shorter pharyngeal transit than healthy individuals. The scintigraphic method should be used more often as a research instrument to quantify the residue, transit time and clearance in each of the swallowing phases.
Collapse
Affiliation(s)
- Ana Cristina Viana da Silva
- Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Faculdade de Medicina de Ribeirão Preto, Uiversidade de São Paulo, Brazil.
| | | | | |
Collapse
|