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Brates D, Peña-Chávez R. Noninstrumental Dysphagia Assessment and Screening: A Proposed Checklist. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024:1-8. [PMID: 39151049 DOI: 10.1044/2024_ajslp-22-00174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/18/2024]
Abstract
PURPOSE In the field of dysphagia research, there is a need to establish a framework for the critical appraisal of methodological reporting. A working group was formed to develop a tool to aid in such critical appraisal across various domains of dysphagia research (called the FRONTIERS [Framework for RigOr aNd Transparency In REseaRch on Swallowing] Framework). The goal of the current paper is to present and describe one domain of this tool: noninstrumental assessment and screening tools. METHOD Methods describing the development of the FRONTIERS Framework and the associated tool are detailed in the prologue of this series. RESULTS A set of questions specific to the critical appraisal of transparency and rigor of research involving noninstrumental screening and assessment tools was developed. This included 13 "yes/no" questions, each of which is presented with a rationale for its inclusion and an example of its implementation. CONCLUSIONS The use of this framework will serve researchers and those appraising the quality of research that uses noninstrumental dysphagia assessment and screening tools. More broadly, the FRONTIERS Framework will facilitate improved rigor and transparency across dysphagia research. Special considerations and future goals are discussed.
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Affiliation(s)
- Danielle Brates
- Department of Communicative Sciences and Disorders, New York University
- Swallowing and Salivary Bioscience Laboratory, Geriatric Research Education and Clinical Center (GRECC), University of Wisconsin-Madison
- Department of Communication and Sciences Disorders, University of Wisconsin-Madison
| | - Rodolfo Peña-Chávez
- Swallowing and Salivary Bioscience Laboratory, Geriatric Research Education and Clinical Center (GRECC), University of Wisconsin-Madison
- Department of Communication and Sciences Disorders, University of Wisconsin-Madison
- Departamento de Ciencias de la Rehabilitación en Salud, Facultad de Ciencias de la Salud y Alimentos, Universidad del Bío-Bío, Chile
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Dysphagic disorder in a cohort of COVID-19 patients: Evaluation and evolution. Ann Med Surg (Lond) 2021; 69:102837. [PMID: 34512968 PMCID: PMC8423675 DOI: 10.1016/j.amsu.2021.102837] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/06/2021] [Accepted: 09/06/2021] [Indexed: 01/08/2023] Open
Abstract
Background COVID-19 is a multisystem disease complicated by respiratory failure requiring sustanined mechanical ventilation (MV). Prolongued oro-tracheal intubation is associated to an increased risk of dysphagia and bronchial aspiration. Purpose of this study was to investigate swallowing disorders in critically ill COVID-19 patients. Material and methods This was a retrospective study analysing a consecutive cohort of COVID-19 patients admitted to the Intensive Care Unit (ICU) of our hospital. Data concerning dysphagia were collected according to the Gugging Swallowing Screen (GUSS) and related to demographic characteristics, clinical data, ICU Length-Of-Stay (LOS) and MV parameters. Results From March 2 to April 30, 2020, 31 consecutive critically ill COVID-19 patients admitted to ICU were evaluated by speech and language therapists (SLT). Twenty-five of them were on MV (61% through endotracheal tube and 19% through tracheostomy); median MV length was 11 days. Seventeen (54.8%) patients presented dysphagia; a correlation was found between first GUSS severity stratification and MV days (p < 0.001), ICU LOS (p < 0.001), age (p = 0.03) and tracheostomy (p = 0.042). No other correlations were found. At 16 days, 90% of patients had fully recovered; a significant improvement was registered especially during the first week (p < 0.001). Conclusion Compared to non-COVID-19 patiens, a higher rate of dysphagia was reported in COVID-19 patients, with a more rapid and complete recovery. A systematic early SLT evaluation of COVID-19 patients on MV may thus be useful to prevent dysphagia-related complications.
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Lee KS, Lee E, Choi B, Pyun SB. Automatic Pharyngeal Phase Recognition in Untrimmed Videofluoroscopic Swallowing Study Using Transfer Learning with Deep Convolutional Neural Networks. Diagnostics (Basel) 2021; 11:diagnostics11020300. [PMID: 33668528 PMCID: PMC7918932 DOI: 10.3390/diagnostics11020300] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/05/2021] [Accepted: 02/09/2021] [Indexed: 01/29/2023] Open
Abstract
Background: Video fluoroscopic swallowing study (VFSS) is considered as the gold standard diagnostic tool for evaluating dysphagia. However, it is time consuming and labor intensive for the clinician to manually search the recorded long video image frame by frame to identify the instantaneous swallowing abnormality in VFSS images. Therefore, this study aims to present a deep leaning-based approach using transfer learning with a convolutional neural network (CNN) that automatically annotates pharyngeal phase frames in untrimmed VFSS videos such that frames need not be searched manually. Methods: To determine whether the image frame in the VFSS video is in the pharyngeal phase, a single-frame baseline architecture based the deep CNN framework is used and a transfer learning technique with fine-tuning is applied. Results: Compared with all experimental CNN models, that fine-tuned with two blocks of the VGG-16 (VGG16-FT5) model achieved the highest performance in terms of recognizing the frame of pharyngeal phase, that is, the accuracy of 93.20 (±1.25)%, sensitivity of 84.57 (±5.19)%, specificity of 94.36 (±1.21)%, AUC of 0.8947 (±0.0269) and Kappa of 0.7093 (±0.0488). Conclusions: Using appropriate and fine-tuning techniques and explainable deep learning techniques such as grad CAM, this study shows that the proposed single-frame-baseline-architecture-based deep CNN framework can yield high performances in the full automation of VFSS video analysis.
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Affiliation(s)
- Ki-Sun Lee
- Medical Science Research Center, Ansan Hospital, Korea University College of Medicine, Ansan-si 15355, Korea
- Correspondence: (K.-S.L.); (S.-B.P.)
| | - Eunyoung Lee
- Department of Physical Medicine and Rehabilitation, Anam Hospital, Korea University College of Medicine, Seoul 02841, Korea; (E.L.); (B.C.)
- Department of Biomedical Sciences, Korea University College of Medicine, Seoul 02841, Korea
| | - Bareun Choi
- Department of Physical Medicine and Rehabilitation, Anam Hospital, Korea University College of Medicine, Seoul 02841, Korea; (E.L.); (B.C.)
| | - Sung-Bom Pyun
- Department of Physical Medicine and Rehabilitation, Anam Hospital, Korea University College of Medicine, Seoul 02841, Korea; (E.L.); (B.C.)
- Department of Biomedical Sciences, Korea University College of Medicine, Seoul 02841, Korea
- Brain Convergence Research Center, Korea University College of Medicine, Seoul 02841, Korea
- Correspondence: (K.-S.L.); (S.-B.P.)
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Lima MSD, Sassi FC, Medeiros GCD, Jayanthi SK, Andrade CRFD. Diagnostic precision for bronchopulmonary aspiration in a heterogeneous population. Codas 2020; 32:e20190166. [PMID: 33053090 DOI: 10.1590/2317-1782/20202019166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 10/27/2019] [Indexed: 11/21/2022] Open
Abstract
PURPOSE The purpose of the present study was to assess the validity of a simple instrument for screening dysphagia used in a large public hospital in Brazil with heterogeneous adult population. METHOD The Dysphagia Risk Evaluation Protocol (DREP) - screening version contains four items (altered cervical auscultation, altered vocal quality, coughing and choking before / during / after swallowing) that were previously indicated as independent risk factors associated to the presence of dysphagia in the swallowing test with water. Trained speech therapists administered and scored DREP - screening version to consecutive patients referred by hospital's medical team to perform Video Fluoroscopic for Swallowing Study (VFSS). RESULTS 211 patients received the swallowing screen (DREP): 99 failed and 112 passed. One in every five patients was randomized to receive a VFSS. The DREP screening version demonstrated excellent validity with sensitivity at 92.9%, specificity at 75.0%, negative predictive values at 95.5% and an accuracy of 80.9%. CONCLUSION The DREP - screening version is a simple and accurate tool to identify the risk for penetration and / or aspiration in patients who are not tube-fed, who have a good level of alertness, have no history of recurrent pneumonia, are not on pneumonia, and that do not use a tracheostomy cannula.
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Affiliation(s)
- Maíra Santilli de Lima
- Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo - USP - São Paulo (SP), Brasil
| | - Fernanda Chiarion Sassi
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina da Universidade de São Paulo - USP - São Paulo (SP), Brasil
| | - Gisele Chagas de Medeiros
- Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo - USP - São Paulo (SP), Brasil
| | - Shri Krishna Jayanthi
- Instituto de Radiologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo - USP - São Paulo (SP), Brasil
| | - Claudia Regina Furquim de Andrade
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina da Universidade de São Paulo - USP - São Paulo (SP), Brasil
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Suiter DM, Daniels SK, Barkmeier-Kraemer JM, Silverman AH. Swallowing Screening: Purposefully Different From an Assessment Sensitivity and Specificity Related to Clinical Yield, Interprofessional Roles, and Patient Selection. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:979-991. [PMID: 32650661 DOI: 10.1044/2020_ajslp-19-00140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose The purpose of this clinical focus article is to summarize the goal and process by which identification of individuals at risk for having feeding problems or dysphagia is clinically screened across the life span by speech-language pathologists (SLPs). The topic of this clinical focus article was presented at the Charleston Swallowing Conference in Chicago, Illinois, in July 2018. The contents of this clinical focus article offer an expanded summary of information discussed at this meeting with focus on critical considerations to guide clinical decisions by SLPs regarding the optimal feeding and dysphagia screening approach and process. Conclusion Screening is a critical first step in the identification of individuals at risk for feeding problems and dysphagia across the life span. Understanding the difference between screening and assessment objectives as well as having the knowledge, skills, and clinical competency to implement psychometrically sound screening approaches is a recommended clinical practice standard for SLPs working with these clinical populations. This clinical focus article summarizes critical considerations for identifying individuals at risk for feeding problems and dysphagia across the life span to guide clinicians working with dysphagia populations.
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Affiliation(s)
- Debra M Suiter
- Department of Communication Sciences and Disorders, University of Kentucky, Lexington
| | - Stephanie K Daniels
- Department of Communication Sciences and Disorders, University of Houston, TX
| | | | - Alan H Silverman
- Section of Gastroenterology, Hepatology, and Nutrition, Medical College of Wisconsin, Milwaukee
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McRae J, Montgomery E, Garstang Z, Cleary E. The role of speech and language therapists in the intensive care unit. J Intensive Care Soc 2019; 21:344-348. [PMID: 34093737 DOI: 10.1177/1751143719875687] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
National guidance recommends the involvement of speech and language therapists in intensive care particularly for those requiring tracheostomy and ventilation. However, the role of speech and language therapists is poorly understood especially in the context of critical care. This article aims to increase awareness of the background training and skills development of speech and language therapists working in this context to demonstrate their range of specialist abilities. Speech and language therapists support and enhance the process of laryngeal weaning alongside the rehabilitation of speech and swallowing as part of the multidisciplinary team. Examples are provided of the types of interventions that are used and technological innovations that may enhance rehabilitation of oropharyngeal impairments.
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Affiliation(s)
- Jackie McRae
- Speech and Language Therapy Department, St George's University Hospitals NHS Foundation Trust, London, UK.,School of Allied Health, Midwifery and Social Care, Faculty of Health, Social Care and Education, Kingston University and St George's, University of London, London, UK
| | - Elizabeth Montgomery
- Speech and Language Therapy Department, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Zoë Garstang
- Speech and Language Therapy Department, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Eibhlin Cleary
- Speech and Language Therapy Department, St George's University Hospitals NHS Foundation Trust, London, UK
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Hoffmeister J, Zaborek N, Thibeault SL. Postextubation Dysphagia in Pediatric Populations: Incidence, Risk Factors, and Outcomes. J Pediatr 2019; 211:126-133.e1. [PMID: 30954246 DOI: 10.1016/j.jpeds.2019.02.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 01/22/2019] [Accepted: 02/13/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To assess incidence, risk factors for, and impact on outcomes of postextubation dysphagia. We hypothesized that the incidence of postextubation dysphagia in pediatric patients would approximate or exceed that in adults, that age and duration of intubation would increase odds for postextubation dysphagia, and that the presence of postextubation dysphagia would negatively impact patient outcomes. STUDY DESIGN We performed a retrospective, observational cohort study of patients aged 0-16 years admitted between 2011 and 2017. Patients were included if they were extubated in the intensive care unit and fed orally within 72 hours. Records were reviewed to determine dysphagia status and assess the impact of patient factors on odds of postextubation dysphagia. The impact of postextubation dysphagia on patient outcomes was then assessed. RESULTS Following application of inclusion and exclusion criteria, the sample size was 372 patients. Postextubation dysphagia was observed in 29% of patients. For every hour of intubation, odds of postextubation dysphagia increased by 1.7% (P < .0001). Age of <25 months increased odds of postextubation dysphagia more than 2-fold (P < .05). When we controlled for age, diagnosis, number of complex chronic conditions, and dysphagia status, patients with dysphagia had an increase in total length of stay of 10.95 days (P < .0001). Postextubation dysphagia increased odds of gastrostomy or nasogastric tube at time of discharge (aOR 22.22, P < .0001). CONCLUSIONS This study found that postextubation dysphagia is associated with increased time between extubation and discharge and with odds of gastrostomy or nasogastric tube at time of discharge.
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Affiliation(s)
- Jesse Hoffmeister
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery; Department of Communication Sciences and Disorders
| | - Nicholas Zaborek
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, Wisconsin
| | - Susan L Thibeault
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery; Department of Communication Sciences and Disorders.
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Leite KKDA, Sassi FC, Medeiros GCD, Comerlatti LR, Andrade CRFD. Clinical swallowing prognostic indicators in patients with acute ischemic stroke. ARQUIVOS DE NEURO-PSIQUIATRIA 2019; 77:501-508. [PMID: 31365642 DOI: 10.1590/0004-282x20190080] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 04/16/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE A swallowing disorder is present in more than 50% of patients with acute stroke. To identify clinical prognostic indicators of the swallowing function in a population with acute ischemic stroke and to determine prioritization indicators for swallowing rehabilitation. METHODS Participants were adults admitted to the emergency room who were diagnosed with acute ischemic stroke. Data gathering involved a swallowing assessment to determine the functional level of swallowing (American Speech-Language-Hearing Association National Outcome Measurement System - ASHA NOMS) and the verification of demographic and clinical variables. RESULTS The study sample included 295 patients. For analysis purposes, patients were grouped as follows: ASHA NOMS levels 1 and 2 - ASHA1 (n = 51); levels 3, 4 and 5 - ASHA2 (n = 96); levels 6 and 7 - ASHA3 (n = 148). Statistical analyses indicated that patients who presented a poorer swallowing function (ASHA1) were older (age ≥ 70 years); had anterior circulation infarct; had lower scores on the Glasgow Coma Scale (GCS ≤ 14 points); took longer to initiate swallowing rehabilitation; had longer hospital stays; made more use of alternative feeding methods; needed more sessions of swallowing rehabilitation to remove alternate feeding methods; took longer to return to oral feeding and had poorer outcomes (fewer individuals discharged from swallowing rehabilitation sessions and increased mortality). CONCLUSION Patients with acute ischemic stroke, admitted to the emergency room, aged ≥ 70 years, score on the GCS ≤ 14, anterior circulation infarct and dementia should be prioritized for swallowing assessment and rehabilitation.
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Affiliation(s)
- Karoline Kussik de Almeida Leite
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Divisão de Fonoaudiologia do Instituto Central, São Paulo SP, Brasil
| | - Fernanda Chiarion Sassi
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, São Paulo SP, Brasil
| | - Gisele Chagas de Medeiros
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Divisão de Fonoaudiologia do Instituto Central, São Paulo SP, Brasil
| | - Luiz Roberto Comerlatti
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Divisão de Clínica Neurológica, Serviço de Neurologia de Emergência, São Paulo SP, Brasil
| | - Claudia Regina Furquim de Andrade
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, São Paulo SP, Brasil
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Seehra G, Solomon B, Ryan E, Steward AM, Roshan Lal T, Tanima Y, Lopez G, Sidransky E. Five-parameter evaluation of dysphagia: A novel prognostic scale for assessing neurological decline in Gaucher disease type 2. Mol Genet Metab 2019; 127:191-199. [PMID: 31256856 PMCID: PMC6727642 DOI: 10.1016/j.ymgme.2019.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 06/07/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Gaucher disease type 2 (GD2) is defined by acute neurological decline, failure to thrive, and early demise. Currently, there is no clear standard for evaluating, staging, and counseling regarding neurological decline in GD2. Due to the high prevalence of progressive dysphagia secondary to acute neurological involvement, we aimed to identify key components of swallow function which could serve as markers of disease progression in GD2. METHODS A post-hoc analysis of modified barium swallow studies was performed. Six parameters of swallowing were scored in a retrospective chart review of eleven infants with GD2. Mixed effects regression, principal component analysis (PCA), and a transition analysis were used to evaluate swallow function and model disease progression. RESULTS All patients exhibited impaired swallow function. There was no association between any of the swallow parameters and age, indicating non-linear disease progression. PCA and transition analysis identified five parameters capturing multiple dimensions of swallowing which defined two distinct disease states. CONCLUSION A five-parameter swallow evaluation was sufficient to identify distinct states of GD2 and model prospective outcomes. This multi-dimensional evaluation could be a useful efficacy parameter for future therapeutic trials in GD2 and other neurodegenerative disorders of infancy.
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Affiliation(s)
- Gurpreet Seehra
- Section on Molecular Neurogenetics, Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, United States of America
| | - Beth Solomon
- Speech and Language Pathology Section, Rehabilitation Medicine Department, Mark O. Hatfield Clinical Research Center, NIH, DHHS, Bethesda, MD, United States of America
| | - Emory Ryan
- Section on Molecular Neurogenetics, Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, United States of America
| | - Alta M Steward
- Section on Molecular Neurogenetics, Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, United States of America
| | - Tamanna Roshan Lal
- Section on Molecular Neurogenetics, Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, United States of America
| | - Yuichiro Tanima
- Section on Molecular Neurogenetics, Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, United States of America
| | - Grisel Lopez
- Section on Molecular Neurogenetics, Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, United States of America
| | - Ellen Sidransky
- Section on Molecular Neurogenetics, Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, United States of America.
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Ferrucci JL, Sassi FC, Medeiros GCD, Andrade CRFD. Comparison between the functional aspects of swallowing and clinical markers in ICU patients with Traumatic Brain Injury (TBI). Codas 2019; 31:e20170278. [PMID: 30942285 DOI: 10.1590/2317-1782/20182017278] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 09/19/2018] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To characterize and compare the functional aspects of swallowing and clinical markers in intensive care patients with traumatic brain injury (TBI) in Intensive Care Unit (ICU). METHODS Participants of this study were 113 adults diagnosed with TBI. Data collection stage involved: clinical assessment of the risk for bronchoaspiration performed by a speech-language therapist; assessment of the functional level of swallowing (American Speech-Language-Hearing Association National Outcome Measurement System - ASHA NOMS ); assessment of the patient' health status (Sequential Organ Failure Assessment - SOFA). RESULTS After the inclusion criteria were applied, patients were grouped according to their swallowing functional level: levels 1 and 2 - ASHA1 (n=25); levels 3, 4 and 5 - ASHA2 (n=37); levels 6 and 7 - ASHA3 (n=51). The statistical analyses indicated the following significant results: the ASHA3 group presented lower severity levels of TBI at the clinical assessment of bronchoaspiration, remained less time intubated (approximately um third less than the more severe group), remained fewer days in hospital and needed less therapy sessions to return to safe oral feeding. The clinical predictor signs for bronchoaspiration that best characterized the groups were the presence of altered auscultation and the presence of coughing after swallowing. Patients in the ASHA3 group presented these signs less frequently. CONCLUSION The score obtained on the SOFA and the time of orotracheal intubation were identified as the prognostic indicators of functional swallowing. The presence of altered cervical auscultation and coughing were clinical predictors of dysphagia.
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Affiliation(s)
- Juliana Lopes Ferrucci
- Divisão de Fonoaudiologia, Instituto Central, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - USP - São Paulo (SP), Brasil
| | - Fernanda Chiarion Sassi
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina, Universidade de São Paulo - USP - São Paulo (SP), Brasil
| | - Gisele Chagas de Medeiros
- Divisão de Fonoaudiologia, Instituto Central, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - USP - São Paulo (SP), Brasil
| | - Claudia Regina Furquim de Andrade
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina, Universidade de São Paulo - USP - São Paulo (SP), Brasil
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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: 163] [Impact Index Per Article: 32.6] [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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Santos ECBD, Diniz DDSTJ, Correia ARC, Assis RB. Voice and swallowing implications in patients with tumors in their mediastinum. REVISTA CEFAC 2018. [DOI: 10.1590/1982-021620182068918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Purpose: to verify voice and swallowing implications in patients diagnosed with tumors in the mediastinum. Methods: the study was carried out with 21 individuals aged between 18 and 60 years, with a diagnosis of tumors in their mediastinum. Data collection was performed at Oncology, OncoHematology and Thoracic Oncology Surgery ambulatory, and in the wards of the aforementioned clinics at an oncology reference hospital. The data was obtained by applying a questionnaire, and by evaluating voice and swallowing, using CAPE-V and O'Neil protocols, respectively. Results: there was a higher prevalence of females with mean age at 40 years. A higher prevalence of tumors in the anterior region of the mediastinum and non-Hodgkin's lymphomas was found, however, Hodgkin's lymphomas presented worse results in all the parameters of the voice evaluation. Fourteen subjects presented some degree of dysphagia, ranging from mild to moderate. Conclusion: patients with tumors in the mediastinum have significant impairments in voice and swallowing functions, especially when they are located in the anterior mediastinal region and Hodgkin lymphomas.
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Abstract
OBJECTIVES Postextubation dysphagia is common and associated with worse outcomes in the PICU. Although there has been an increased participation of speech-language pathologists in its treatment, there is limited evidence to support speech-language pathologists as core PICU team member. We aimed to assess the impact of speech-language pathologists interventions on the treatment of postextubation dysphagia. DESIGN A quasi-experimental prospective study. In the historical group (controls), patients received a standard care management for dysphagia whereas the intervention group was routinely treated by speech-language pathologists. SETTING PICU of a tertiary hospital. PATIENTS Children who were endotracheally intubated for a period greater than 24 hours with greater oral intake limitation as defined by a Functional Oral Intake Scale less than or equal to 3. INTERVENTION Routine speech-language pathologist assessment. MEASUREMENTS AND MAIN RESULTS A total of 74 patients were enrolled to receive intervention (January 2015 to December 2016) and 41 patients to the historical group (January 2014 to December 2014). There were no differences in the demographic and clinical characteristics. The historical group had both longer time to initiate oral intake (7 vs 4 d; p = 0.0002; hazard ratio, 2.33) and to reach full oral intake compared with intervention group (9 vs 13 d; p < 0.001; hazard ratio, 2.51). A total of 32 controls (78%) and 74 intervention patients (100%) were on total oral intake at discharge (p ≤ 0.001). Three of nine control patients were feeding tube dependent at hospital discharge. Also, controls had a longer length of hospital stay (25 vs 20 d) and a higher rate of reintubation when compared with those patients of intervention group (10% vs 2%). CONCLUSIONS Incorporating speech-language pathologists in the routine management of postextubation dysphagia can result in faster functional improvement and favorable patient outcomes. Yet, further and larger studies in pediatric dysphagia are required to support the related interventions and strategies to guide clinical practice.
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Sassi FC, Medeiros GCD, Zambon LS, Zilberstein B, Andrade CRFD. Evaluation and classification of post-extubation dysphagia in critically ill patients. ACTA ACUST UNITED AC 2018; 45:e1687. [PMID: 30043826 DOI: 10.1590/0100-6991e-20181687] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 04/26/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVE to identify factors associated with dysphagia in patients undergoing prolonged orotracheal intubation (pOTI) and the post-extubation consequences. METHODS 150 patients undergoing pOTI participated in the study, evaluated according to the deglutition functional level (American Speech Language - Hearing Association National Outcome Measurement System - ASHA NOMS), severity determination (The Simplified Acute Physiology Score - SOFA) and submitted to collection of variables age, mortality, days of orotracheal intubation, number of sessions to introduce oral diet, and days to hospital discharge. We grouped patients according to ASHA classification: 1 (levels 1 and 2), 2 (levels 3, 4 and 5) and 3 (levels 6 and 7). RESULTS the variables associated with impaired deglutition functionality were age (p<0.001), mortality (p<0.003), OTI days (p=0.001), number of sessions to introduce oral diet (p<0.001) and days to hospital discharge (p=0.018). Multiple comparisons indicated significant difference between ASHA1 and ASHA2 groups in relation to ASHA3 group. ASHA1 and ASHA2 groups had a lower SOFA score when compared with the ASHA3 group (p=0.004). Only 20% of ASHA1 patients and 32% of ASHA2 patients presented safe deglutition levels before discharge. CONCLUSION factors associated with dysphagia in patients submitted to pOTI were age over 55 years and orotracheal intubation time (greater in the cases with worse deglutition functionality). The post-extubation consequences were increased mortality and length of hospital stay in the presence of dysphagia.
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Affiliation(s)
- Fernanda Chiarion Sassi
- Faculdade de Medicina da Universidade de São Paulo, Departamento de Fonoaudiologia, Fisioterapia e Terapia Ocupacional, São Paulo, SP, Brasil
| | - Gisele Chagas de Medeiros
- Hospital das Clínicas da Universidade de São Paulo, Divisão de Fonoaudiologia, São Paulo, SP, Brasil
| | - Lucas Santos Zambon
- Faculdade de Medicina da Universidade de São Paulo, Departamento de Clínica Médica, São Paulo, SP, Brasil
| | - Bruno Zilberstein
- Faculdade de Medicina da Universidade de São Paulo, Departamento de Gastroenterologia, São Paulo, SP, Brasil
| | - Claudia Regina Furquim de Andrade
- Faculdade de Medicina da Universidade de São Paulo, Departamento de Fonoaudiologia, Fisioterapia e Terapia Ocupacional, São Paulo, SP, Brasil
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Saito Y, Takeuchi H, Fukuda K, Suda K, Nakamura R, Wada N, Kawakubo H, Kitagawa Y. Size of recurrent laryngeal nerve as a new risk factor for postoperative vocal cord paralysis. Dis Esophagus 2018; 31:4986869. [PMID: 29701761 DOI: 10.1093/dote/dox162] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Recurrent laryngeal nerve paralysis (RLNP) is a frequent and serious complication following esophageal cancer surgery. Therefore, this study aims to evaluate the correlation between recurrent laryngeal nerve (RLN) size and RLNP. This was a retrospective study of esophageal cancer patients who underwent thoracoscopic esophagectomy from January 2012 to December 2014. Eighty-four patients were included in the primary analysis. Diameter of the RLN was measured using the digital video recording of surgical procedures by the ratio between scissor and RLN. For evaluation of vocal cord paralysis or paresis, indirect laryngoscopy was performed. Because RLNP more frequently occurs on the left side than the right, we evaluated the correlation between size of the left RLN and left RLNP. The median size of the left RLN was 1.51 mm. We found that the incidence of postoperative left RLNP (Clavien-Dindo classification ≥1) was significantly higher (71% vs. 24%; P < 0.001) in thin RLNs (≤1.5 mm) than in thick RLNs (>1.5 mm). Thin RLN (P < 0.001), female sex (P = 0.025), and being overweight (P = 0.034) were identified as significant independent risk factors for postoperative RLNP. RLNP more easily occurred when the RLN was thin. It is difficult to confirm occurrence of postoperative RLNP before and at extubation. Therefore, it is helpful to know its risk factors including size of RLN.
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Affiliation(s)
- Y Saito
- Department of Surgery, School of Medicine, Keio University, Shinjuku-ku, Tokyo
| | - H Takeuchi
- Department of Surgery, School of Medicine, Keio University, Shinjuku-ku, Tokyo.,Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - K Fukuda
- Department of Surgery, School of Medicine, Keio University, Shinjuku-ku, Tokyo
| | - K Suda
- Department of Surgery, School of Medicine, Keio University, Shinjuku-ku, Tokyo
| | - R Nakamura
- Department of Surgery, School of Medicine, Keio University, Shinjuku-ku, Tokyo
| | - N Wada
- Department of Surgery, School of Medicine, Keio University, Shinjuku-ku, Tokyo
| | - H Kawakubo
- Department of Surgery, School of Medicine, Keio University, Shinjuku-ku, Tokyo
| | - Y Kitagawa
- Department of Surgery, School of Medicine, Keio University, Shinjuku-ku, Tokyo
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Christensen M, Trapl M. Development of a modified swallowing screening tool to manage post-extubation dysphagia. Nurs Crit Care 2017; 23:102-107. [PMID: 29285846 DOI: 10.1111/nicc.12333] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 11/07/2017] [Accepted: 11/14/2017] [Indexed: 11/28/2022]
Abstract
Post-extubation dysphagia is a condition that is becoming a growing concern. The condition occurs in 3-62% of extubated patients and can be related to mixed aetiologies, such as neuromuscular impairment, critical illness and laryngeal damage. The risk factors for developing dysphagia in critically ill patients are under-diagnosed and perhaps underestimated. Recent studies recommend the implementation of a standardized swallowing screen to prevent aspiration and decrease pneumonia rate and mortality. The aim of this quality improvement initiative was the development of a bedside swallowing screening tool to assess effective swallowing post-endotracheal extubation. Post-extubation dysphagia can result in a delay in re-feeding, with the potential for malnutrition as well as overt and covert aspiration if swallowing is not effectively screened. It is apparent that ICU nurses commence the initial screen for swallowing in the absence of an evidence base of care. A review of current local and international practice guidelines excludes the process of an effective swallowing screen of the extubated patient. Previously, a referral to speech and language therapists would be required to assess swallowing only after an initial review by the ICU medical team. This often leads to delays if the referral is made outside normal working practice, such as weekends or evenings. The initial development of a swallowing screening tool is the first step to promoting a nurse-led/-initiated bedside swallow screening tool that will enhance patient care and patient safety. There is growing body of evidence regarding the incidence of post-extubation dysphagia. Currently, there are very few recognized bedside swallowing screening tools to identify patients at risk. The most serious complication associated with post-extubation dysphagia is aspiration pneumonia, which is the leading cause of nosocomial infection in the critically ill patient.
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Affiliation(s)
- Martin Christensen
- School of Nursing, Queensland University of Technology, Caboolture, Queensland, Australia
| | - Michaela Trapl
- Department of Neurology, University Clinic, Tulln, Austria
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Dysphagia in Mechanically Ventilated ICU Patients (DYnAMICS): A Prospective Observational Trial. Crit Care Med 2017; 45:2061-2069. [PMID: 29023260 DOI: 10.1097/ccm.0000000000002765] [Citation(s) in RCA: 134] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Swallowing disorders may be associated with adverse clinical outcomes in patients following invasive mechanical ventilation. We investigated the incidence of dysphagia, its time course, and association with clinically relevant outcomes in extubated critically ill patients. DESIGN Prospective observational trial with systematic dysphagia screening and follow-up until 90 days or death. SETTINGS ICU of a tertiary care academic center. PATIENTS One thousand three-hundred four admissions of mixed adult ICU patients (median age, 66.0 yr [interquartile range, 54.0-74.0]; Acute Physiology and Chronic Health Evaluation-II score, 19.0 [interquartile range, 14.0-24.0]) were screened for postextubation dysphagia. Primary ICU admissions (n = 933) were analyzed and followed up until 90 days or death. Patients from an independent academic center served as confirmatory cohort (n = 220). INTERVENTIONS Bedside screening for dysphagia was performed within 3 hours after extubation by trained ICU nurses. Positive screening triggered confirmatory specialist bedside swallowing examinations and follow-up until hospital discharge. MEASUREMENTS AND MAIN RESULTS Dysphagia screening was positive in 12.4% (n = 116/933) after extubation (18.3% of emergency and 4.9% of elective patients) and confirmed by specialists within 24 hours from positive screening in 87.3% (n = 96/110, n = 6 missing data). The dysphagia incidence at ICU discharge was 10.3% (n = 96/933) of which 60.4% (n = 58/96) remained positive until hospital discharge. Days on feeding tube, length of mechanical ventilation and ICU/hospital stay, and hospital mortality were higher in patients with dysphagia (all p < 0.001). The univariate hazard ratio for 90-day mortality for dysphagia was 3.74 (95% CI, 2.01-6.95; p < 0.001). After adjustment for disease severity and length of mechanical ventilation, dysphagia remained an independent predictor for 28-day and 90-day mortality (excess 90-d mortality 9.2%). CONCLUSIONS Dysphagia after extubation was common in ICU patients, sustained until hospital discharge in the majority of affected patients, and was an independent predictor of death. Dysphagia after mechanical ventilation may be an overlooked problem. Studies on underlying causes and therapeutic interventions seem warranted.
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Sassi FC, Medeiros GC, Zilberstein B, Jayanthi SK, de Andrade CR. Screening protocol for dysphagia in adults: comparison with videofluoroscopic findings. Clinics (Sao Paulo) 2017; 72:718-722. [PMID: 29319716 PMCID: PMC5738561 DOI: 10.6061/clinics/2017(12)01] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 08/15/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To compare the videofluoroscopic findings of patients with suspected oropharyngeal dysphagia with the results of a clinical screening protocol. METHODS A retrospective observational cohort study was conducted on all consecutive patients with suspected oropharyngeal dysphagia between March 2015 and February 2016 who were assigned to receive a videofluoroscopic assessment of swallowing. All patients were first submitted to videofluoroscopy and then to the clinical assessment of swallowing. The clinical assessment was performed within the first 24 hours after videofluoroscopy. The videofluoroscopy results were analyzed regarding penetration/aspiration using an 8-point multidimensional perceptual scale. The accuracy of the clinical protocol was analyzed using the sensitivity, specificity, likelihood ratios and predictive values. RESULTS The selected sample consisted of 50 patients. The clinical protocol presented a sensitivity of 50% and specificity of 95%, with an accuracy of 88%. "Cough" and "wet-hoarse" vocal quality after/during swallowing were clinical indicators that appeared to correctly identify the presence of penetration/aspiration risk. CONCLUSION The clinical protocol used in the present study is a simple, rapid and reliable clinical assessment. Despite the absence of a completely satisfactory result, especially in terms of the sensitivity and positive predictive values, we suggest that lower rates of pneumonia can be achieved using a formal dysphagia screening method.
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Affiliation(s)
- Fernanda C. Sassi
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina (FMUSP), Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Gisele C. Medeiros
- Divisão de Fonoaudiologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Bruno Zilberstein
- Divisao de Cirurgia Digestiva, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Shri Krishna Jayanthi
- Instituto de Radiologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Claudia R.F. de Andrade
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina (FMUSP), Universidade de Sao Paulo, Sao Paulo, SP, BR
- *Corresponding author. E-mail:
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Borges MDSD, Mangilli LD, Ferreira MC, Celeste LC. Apresentação de um Protocolo Assistencial para Pacientes com Distúrbios da Deglutição. Codas 2017; 29:e20160222. [DOI: 10.1590/2317-1782/20172016222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 05/15/2017] [Indexed: 11/21/2022] Open
Abstract
RESUMO Objetivo Descrever o processo de implantação de Protocolo Assistencial para os Distúrbios da Deglutição em unidade hospitalar pública de alta densidade tecnológica no Distrito Federal. Método Trata-se de um estudo descritivo do tipo Relato de Experiência com descrição do processo de implantação de Protocolo Assistencial para os Distúrbios da Deglutição em unidade hospitalar pública de alta densidade tecnológica no Distrito Federal. Resultados A implantação do Protocolo consistiu em três etapas de trabalho: Etapa 1 - busca na literatura sobre os procedimentos que caracterizariam as melhores práticas propedêuticas e terapêuticas; Etapa 2 - discussão com equipe multidisciplinar para ajustes necessários à execução da proposta de implantação de um Protocolo Assistencial para os Distúrbios da Deglutição; e Etapa 3 - proposta final do Protocolo Assistencial para os Distúrbios da Deglutição considerando as particularidades do serviço. Conclusão A proposta final do Protocolo Assistencial para os Distúrbios da Deglutição (PADD) apresenta um método sistematizado pré-definido para acompanhar os pacientes com alteração da deglutição de unidades de saúde de alta densidade tecnológica. O PADD propõe-se a favorecer a detecção precoce do distúrbio, a tomada de decisões terapêuticas uniformes, a utilização de métodos propedêuticos e terapêuticos de baixo custo e a auxiliar gestores no processo de avaliar a qualidade do serviço ofertado através da mensuração de indicadores.
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Dietsch AM, Rowley CB, Solomon NP, Pearson WG. Swallowing Mechanics Associated With Artificial Airways, Bolus Properties, and Penetration-Aspiration Status in Trauma Patients. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2017; 60:2442-2451. [PMID: 28810268 DOI: 10.1044/2017_jslhr-s-16-0431] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 04/11/2017] [Indexed: 06/07/2023]
Abstract
PURPOSE Artificial airway procedures such as intubation and tracheotomy are common in the treatment of traumatic injuries, and bolus modifications may be implemented to help manage swallowing disorders. This study assessed artificial airway status, bolus properties (volume and viscosity), and the occurrence of laryngeal penetration and/or aspiration in relation to mechanical features of swallowing. METHOD Coordinates of anatomical landmarks were extracted at minimum and maximum hyolaryngeal excursion from 228 videofluoroscopic swallowing studies representing 69 traumatically injured U.S. military service members with dysphagia. Morphometric canonical variate and regression analyses examined associations between swallowing mechanics and bolus properties based on artificial airway and penetration-aspiration status. RESULTS Significant differences in swallowing mechanics were detected between extubated versus tracheotomized (D = 1.32, p < .0001), extubated versus decannulated (D = 1.74, p < .0001), and decannulated versus tracheotomized (D = 1.24, p < .0001) groups per post hoc discriminant function analysis. Tracheotomy-in-situ and decannulated subgroups exhibited increased head/neck extension and posterior relocation of the larynx. Swallowing mechanics associated with (a) penetration-aspiration status and (b) bolus properties were moderately related for extubated and decannulated subgroups, but not the tracheotomized subgroup, per morphometric regression analysis. CONCLUSION Specific differences in swallowing mechanics associated with artificial airway status and certain bolus properties may guide therapeutic intervention in trauma-based dysphagia.
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Affiliation(s)
- Angela M Dietsch
- Walter Reed National Military Medical Center, National Military Audiology & Speech Pathology Center, Bethesda, MD
- University of Nebraska-Lincoln, Department of Special Education & Communication Disorders
| | | | - Nancy Pearl Solomon
- Walter Reed National Military Medical Center, National Military Audiology & Speech Pathology Center, Bethesda, MD
| | - William G Pearson
- Department of Cellular Biology & Anatomy, Medical College of Georgia, Augusta University
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Medeiros GCD, Sassi FC, Zambom LS, Andrade CRFD. Correlation between the severity of critically ill patients and clinical predictors of bronchial aspiration. J Bras Pneumol 2017; 42:114-20. [PMID: 27167432 PMCID: PMC4853064 DOI: 10.1590/s1806-37562015000000192] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 01/27/2016] [Indexed: 11/22/2022] Open
Abstract
Objective: To determine whether the severity of non-neurological critically ill patients correlates with clinical predictors of bronchial aspiration. Methods: We evaluated adults undergoing prolonged orotracheal intubation (> 48 h) and bedside swallowing assessment within the first 48 h after extubation. We collected data regarding the risk of bronchial aspiration performed by a speech-language pathologist, whereas data regarding the functional level of swallowing were collected with the American Speech-Language-Hearing Association National Outcome Measurement System (ASHA NOMS) scale and those regarding health status were collected with the Sequential Organ Failure Assessment (SOFA). Results: The study sample comprised 150 patients. For statistical analyses, the patients were grouped by ASHA NOMS score: ASHA1 (levels 1 and 2), ASHA2 (levels 3 to 5); and ASHA3 (levels 6 and 7). In comparison with the other patients, those in the ASHA3 group were significantly younger, remained intubated for fewer days, and less severe overall clinical health status (SOFA score). The clinical predictors of bronchial aspiration that best characterized the groups were abnormal cervical auscultation findings and cough after swallowing. None of the patients in the ASHA 3 group presented with either of those signs. Conclusions: Critically ill patients 55 years of age or older who undergo prolonged orotracheal intubation (≥ 6 days), have a SOFA score ≥ 5, have a Glasgow Coma Scale score ≤ 14, and present with abnormal cervical auscultation findings or cough after swallowing should be prioritized for a full speech pathology assessment.
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Werle RW, Steidl EMDS, Mancopes R. Fatores relacionados à disfagia orofaríngea no pós-operatório de cirurgia cardíaca: revisão sistemática. Codas 2016; 28:646-652. [DOI: 10.1590/2317-1782/20162015199] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 10/08/2015] [Indexed: 11/21/2022] Open
Abstract
RESUMO Objetivo Identificar os principais fatores relacionados à disfagia orofaríngea no pós-operatório de cirurgia cardíaca, por meio de uma revisão sistemática de literatura. Método Foi realizada pesquisa bibliográfica nas bases PubMed e ScienceDirect, utilizando os termos cardiac surgery, deglutition disorders e dysphagia. Critérios de seleção Foram selecionados artigos sem limitação de ano escritos em português, inglês ou espanhol e que referissem disfagia orofaríngea no pós-operatório de cirurgia cardíaca. Apenas os estudos disponíveis na íntegra foram incluídos. Análise dos dados Cada artigo passou pela análise de títulos e resumos, sendo posteriormente submetido à avaliação na íntegra por dois juízes cegados. Os seguintes dados foram extraídos: autores/ano, desenho do estudo, amostra, variáveis avaliadas e principais resultados. Resultados Os principais fatores relacionados à disfagia orofaríngea no pós-operatório de cirurgia cardíaca foram: idade avançada, presença de comorbidades e outras doenças associadas, tempo de intubação e condições cirúrgicas. Conclusão Os estudos foram bastante heterogêneos, demonstrando que sujeitos submetidos a procedimentos cirúrgicos cardíacos, em especial idosos, apresentam diversos fatores relacionados à disfagia orofaríngea no pós-operatório, como o uso de circulação extracorpórea e ecocardiografia transesofágica, comorbidades associadas, desenvolvimento de sepse pós-operatória e condições cardíacas prévias.
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Tsai MH, Ku SC, Wang TG, Hsiao TY, Lee JJ, Chan DC, Huang GH, Chen CCH. Swallowing dysfunction following endotracheal intubation: Age matters. Medicine (Baltimore) 2016; 95:e3871. [PMID: 27310972 PMCID: PMC4998458 DOI: 10.1097/md.0000000000003871] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
To evaluate postextubation swallowing dysfunction (PSD) 21 days after endotracheal extubation and to examine whether PSD is time-limited and whether age matters.For this prospective cohort study, we evaluated 151 adult critical care patients (≥20 years) who were intubated for at least 48 hours and had no pre-existing neuromuscular disease or swallowing dysfunction. Participants were assessed for time (days) to pass bedside swallow evaluations (swallow 50 mL of water without difficulty) and to resume total oral intake. Outcomes were compared between younger (20-64 years) and older participants (≥65 years).PSD, defined as inability to swallow 50 mL of water within 48 hours after extubation, affected 92 participants (61.7% of our sample). At 21 days postextubation, 17 participants (15.5%) still failed to resume total oral intake and were feeding-tube dependent. We found that older participants had higher PSD rates at 7, 14, and 21 days postextubation, and took significantly longer to pass the bedside swallow evaluations (5.0 vs 3.0 days; P = 0.006) and to resume total oral intake (5.0 vs 3.0 days; P = 0.003) than their younger counterparts. Older participants also had significantly higher rates of subsequent feeding-tube dependence than younger patients (24.1 vs 5.8%; P = 0.008).Excluding patients with pre-existing neuromuscular dysfunction, PSD is common and prolonged. Age matters in the time needed to recover. Swallowing and oral intake should be monitored and interventions made, if needed, in the first 7 to 14 days postextubation, particularly for older patients.
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Affiliation(s)
- Min-Hsuan Tsai
- Department of Nursing, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Shih-Chi Ku
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Tyng-Guey Wang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Tzu-Yu Hsiao
- Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jang-Jaer Lee
- Department of Dentistry, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ding-Cheng Chan
- Department of Geriatrics and Gerontology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- National Taiwan University Hospital Zhu-dong Branch, Hsinchu, Taiwan
| | - Guan-Hua Huang
- Institute of Statistics, National Chiao Tung University, Hsinchu, Taiwan
| | - Cheryl Chia-Hui Chen
- Department of Nursing, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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Scheel R, Pisegna JM, McNally E, Noordzij JP, Langmore SE. Endoscopic Assessment of Swallowing After Prolonged Intubation in the ICU Setting. Ann Otol Rhinol Laryngol 2015. [PMID: 26215724 DOI: 10.1177/0003489415596755] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The purpose of this study was to identify the frequency of swallowing dysfunction after extubation in a sample of patients with no preexisting dysphagia. METHODS Mechanically ventilated patients in the ICU with no prior history of dysphagia received a flexible endoscopic evaluation of swallowing (FEES) exam within 72 hours after extubation. The FEES was then analyzed for variables related to swallowing patterns and laryngeal pathology. Univariate analyses were performed to identify relationships between variables. RESULTS Fifty-nine patients were included in this study. After extubation, 21 (35.6%) penetrated and 13 (22.0%) aspirated. The mean days intubated was 9.4 ± 6.1. Various forms of laryngeal injury were associated with worse swallowing scores, and delayed onset of the swallow was a common finding in all patients post extubation. Of the 44 participants evaluated ≤ 24 hours post extubation, 56.8% penetrated/aspirated. Of the 15 patients evaluated >24 hours post extubation, 60.0% penetrated/aspirated. CONCLUSIONS This study found a high frequency of dysphagia after prolonged intubation in patients with no preexisting dysphagia. Important variables leading to dysphagia are often overlooked, such as swallowing delay and laryngeal pathology. The timing of swallowing assessments did not reveal any difference in dysphagia frequency, suggesting that it might not be necessary to wait to perform dysphagia screens or evaluations.
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Affiliation(s)
- Rebecca Scheel
- Boston University Medical Center, Otolaryngology, Boston, Massachusetts, USA
| | - Jessica M Pisegna
- Boston University Medical Center, Otolaryngology, Boston, Massachusetts, USA Boston University, Sargent College, College of Health and Rehabilitation Sciences, Boston, Massachusetts, USA
| | - Edel McNally
- Boston University Medical Center, Otolaryngology, Boston, Massachusetts, USA
| | | | - Susan E Langmore
- Boston University, Sargent College, College of Health and Rehabilitation Sciences, Boston, Massachusetts, USA Boston University School of Medicine, Otolaryngology, Boston, Massachusetts, USA
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Postextubation dysphagia in critically ill trauma patients. Are necessary new screening methods? Some practical comments. Am J Surg 2014; 208:868-869. [DOI: 10.1016/j.amjsurg.2014.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 02/24/2014] [Indexed: 11/21/2022]
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Zielske J, Bohne S, Brunkhorst FM, Axer H, Guntinas-Lichius O. Acute and long-term dysphagia in critically ill patients with severe sepsis: results of a prospective controlled observational study. Eur Arch Otorhinolaryngol 2014; 271:3085-93. [PMID: 24970291 DOI: 10.1007/s00405-014-3148-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 06/10/2014] [Indexed: 02/07/2023]
Abstract
Dysphagia is a major risk factor for morbidity and mortality in critically ill patients treated in intensive care units (ICUs). Structured otorhinolaryngological data on dysphagia in ICU survivors with severe sepsis are missing. In a prospective study, 30 ICU patients with severe sepsis and thirty without sepsis as control group were examined using bedside fiberoptic endoscopic evaluation of swallowing after 14 days in the ICU (T1) and 4 months after onset of critical illness (T2). Swallowing dysfunction was assessed using the Penetration-Aspiration Scale (PAS). The Functional Oral Intake Scale was applied to evaluate the diet needed. Primary endpoint was the burden of dysphagia defined as PAS score >5. At T1, 19 of 30 severe sepsis patients showed aspiration with a PAS score >5, compared to 7 of 30 in critically ill patients without severe sepsis (p = 0.002). Severe sepsis and tracheostomy were independent risk factors for severe dysphagia with aspiration (PAS > 5) at T1 (p = 0.042 and 0.006, respectively). 4-month mortality (T2) was 57 % in severe sepsis patients compared to 20 % in patients without severe sepsis (p = 0.006). At T2, more severe sepsis survivors were tracheostomy-dependent and needed more often tube or parenteral feeding (p = 0.014 and p = 0.040, respectively). Multivariate analysis revealed tracheostomy at T1 as independent risk factor for severe dysphagia at T2 (p = 0.030). Severe sepsis appears to be a relevant risk factor for long-term dysphagia. An otorhinolaryngological evaluation of dysphagia at ICU discharge is mandatory for survivors of severe critical illness to plan specific swallowing rehabilitation programs.
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Affiliation(s)
- Joerg Zielske
- Department of Otorhinolaryngology, Jena University Hospital, Lessingstrasse 2, 07740, Jena, Germany
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Garuti G, Reverberi C, Briganti A, Massobrio M, Lombardi F, Lusuardi M. Swallowing disorders in tracheostomised patients: a multidisciplinary/multiprofessional approach in decannulation protocols. Multidiscip Respir Med 2014; 9:36. [PMID: 25006457 PMCID: PMC4086992 DOI: 10.1186/2049-6958-9-36] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 06/02/2014] [Indexed: 11/10/2022] Open
Abstract
Safe removal of tracheal cannula is a major goal in the rehabilitation of tracheostomised patients to achieve progressive independence from mechanical support and reduce the risk of respiratory complications. A tracheal cannula may also cause significant discomfort to the patient, making verbal communication difficult. Particularly when cuffed, tracheal cannula reduces the normal movement of the larynx which can further compromise the basic swallowing defect. A close connection between respiratory, phonating, swallowing and feeding abilities to be recovered, implies a strict integration among different professionals of the rehabilitation team. An appropriate management of tracheostomy cannula is closely connected with assessment and treatment of swallowing disorders in order to limit the development of severe pulmonary and nutritional complications, but at present there are no uniform protocols in the scientific literature. Furthermore, several studies report as an essential criterion for decannulation the presence of good patient consciousness, which is often altered in patients with tracheostomy, but a general agreement is lacking.
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Affiliation(s)
- Giancarlo Garuti
- Respiratory Rehabilitation, S. Sebastiano Hospital, AUSL Reggio Emilia, I-42015 Correggio, RE, Italy
| | - Cristina Reverberi
- Neurological Rehabilitation, S. Sebastiano Hospital, AUSL Reggio Emilia, Correggio, RE, Italy
| | - Angelo Briganti
- Neurological Rehabilitation, S. Sebastiano Hospital, AUSL Reggio Emilia, Correggio, RE, Italy
| | - Monica Massobrio
- Respiratory Rehabilitation, S. Sebastiano Hospital, AUSL Reggio Emilia, I-42015 Correggio, RE, Italy
| | - Francesco Lombardi
- Respiratory Rehabilitation, S. Sebastiano Hospital, AUSL Reggio Emilia, I-42015 Correggio, RE, Italy
| | - Mirco Lusuardi
- Respiratory Rehabilitation, S. Sebastiano Hospital, AUSL Reggio Emilia, I-42015 Correggio, RE, Italy
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