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Viner Smith E, Lambell K, Tatucu-Babet OA, Ridley E, Chapple LA. Nutrition considerations for patients with persistent critical illness: A narrative review. JPEN J Parenter Enteral Nutr 2024; 48:658-666. [PMID: 38520657 DOI: 10.1002/jpen.2623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 02/28/2024] [Accepted: 02/28/2024] [Indexed: 03/25/2024]
Abstract
Critically ill patients experience high rates of malnutrition and significant muscle loss during their intensive care unit (ICU) admission, impacting recovery. Nutrition is likely to play an important role in mitigating the development and progression of malnutrition and muscle loss observed in ICU, yet definitive clinical trials of nutrition interventions in ICU have failed to show benefit. As improvements in the quality of medical care mean that sicker patients are able to survive the initial insult, combined with an aging and increasingly comorbid population, it is anticipated that ICU length of stay will continue to increase. This review aims to discuss nutrition considerations unique to critically ill patients who have persistent critical illness, defined as an ICU stay of >10 days. A discussion of nutrition concepts relevant to patients with persistent critical illness will include energy and protein metabolism, prescription, and delivery; monitoring of nutrition at the bedside; and the role of the healthcare team in optimizing nutrition support.
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Affiliation(s)
- Elizabeth Viner Smith
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Kate Lambell
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia
- Dietetics and Nutrition, Alfred Health, Melbourne, Australia
| | - Oana A Tatucu-Babet
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia
| | - Emma Ridley
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia
- Dietetics and Nutrition, Alfred Health, Melbourne, Australia
| | - Lee-Anne Chapple
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, South Australia, Australia
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Koyama Y, R A YM, Slp TO, Toyokura M, Mizuno K, Masakado Y. Bedside diagnosis of silent aspiration using mobile dynamic digital radiography: a preliminary study. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08785-9. [PMID: 38976064 DOI: 10.1007/s00405-024-08785-9] [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: 03/21/2024] [Accepted: 06/08/2024] [Indexed: 07/09/2024]
Abstract
PURPOSE This study aimed to assess reliable options for bedside diagnosis of silent aspiration in the intensive care unit by examining the use of default grayscale images (DGI) obtained using a mobile, general-purpose, radiography system capable of dynamic digital radiography (M-DDR) and inverted grayscale images (IGI) of DGI. METHODS This cohort study (exploratory and preliminary) involved 18 adult patients (mean age, 89.0 years) for whom a swallowing assessment request was received from their primary physicians. Fifty-six IGI videoclips were evaluated by three specialists using the penetration-aspiration scale (PAS), with the gold standard being the consensus reading of all three specialists. Another three speech-language pathologists (SLPs) assessed 56 DGI and IGI videoclips using the PAS. PAS scores 1 and 2 were classified as normal range, PAS scores 3-5 as pathological laryngeal penetration, and PAS scores 6-8 as aspiration. The correct rates with IGI and DGI were then determined, and the level of agreement of IGI and DGI evaluations was evaluated. RESULTS The correct rate of all evaluators was 100% for normal range, 80-100% for pathological laryngeal penetration, and 83-100% for aspiration with IGI and 100% for normal range, 90% for pathological laryngeal penetration, and 83% for aspiration with DGI. The kappa coefficient for IGI and DGI showed almost complete agreement for abnormal conditions. CONCLUSION Dynamic imaging of swallowing 2-5 ml of liquid using M-DDR performed for elderly patients at the bedside showed that aspiration assessments by SLPs obtained from DGI videos immediately after imaging are acceptable.
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Affiliation(s)
- Yuji Koyama
- Department of Rehabilitation Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan.
- Department of Rehabilitation Medicine, Tokai University Hachioji Hospital, 1838 Ishikawa-machi, Hachioji, Hachioji, Tokyo, 192-0032, Japan.
| | - Yukuo Morohoshi R A
- Department of Radiologic Technology, Tokai University Hospital, Isehara, Kanagawa, Japan
| | - Tetsuji Ohta Slp
- Department of Rehabilitation Technology, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan
| | - Minoru Toyokura
- Department of Rehabilitation Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Katsuhiro Mizuno
- Department of Rehabilitation Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Yoshihisa Masakado
- Department of Rehabilitation Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan
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Saconato M, Maselli-Schoueri JH, Malaque CMS, Marcusso RM, de Oliveira ACP, Batista LAN, Ultramari G, Lindoso JAL, Gonçalves MIR, Sztajnbok J. Postorotracheal intubation dysphagia in patients with COVID-19: A retrospective study. SAO PAULO MED J 2024; 142:e2022608. [PMID: 38808794 PMCID: PMC11126317 DOI: 10.1590/1516-3180.2022.0608.r3.14032024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 12/09/2023] [Accepted: 03/14/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND The cause of oropharyngeal dysphagia in patients with coronavirus disease (COVID-19) can be multifactorial and may underly limitations in swallowing rehabilitation. OBJECTIVE Analyze the factors related to dysphagia in patients with COVID-19 immediately after orotracheal extubation and the factors that influence swallowing rehabilitation. DESIGN AND SETTING A retrospective study. METHODS The presence of dysphagia was evaluated using the American Speech-Language Hearing Association National Outcome Measurement System (ASHA NOMS) scale and variables that influenced swallowing rehabilitation in 140 adult patients who required invasive mechanical ventilation for >48 h. RESULTS In total, 46.43% of the patients scored 1 or 2 on the ASHA NOMS (severe dysphagia) and 39.29% scored 4 (single consistency delivered orally) or 5 (exclusive oral diet with adaptations). Both the length of mechanical ventilation and the presence of neurological disorders were associated with lower ASHA NOMS scores (odds ratio [OR]: 0.80, 95% confidence interval [CI]: 0.74-0.87 P < 0.05; and OR: 0.13, 95% CI: 0.61-0.29; P < 0.05, respectively). Age and the presence of tracheostomy were negatively associated with speech rehabilitation (OR: 0.92; 95% CI: 0.87--0.96; OR: 0.24; 95% CI: 0.80--0.75), and acute post-COVID-19 kidney injury requiring dialysis and lower scores on the ASHA NOMS were associated with longer time for speech therapy outcomes (β: 1.62, 95% CI, 0.70-3.17, P < 0.001; β: -1.24, 95% CI: -1.55--0.92; P < 0.001). CONCLUSION Prolonged orotracheal intubation and post-COVID-19 neurological alterations increase the probability of dysphagia immediately after extubation. Increased age and tracheostomy limited rehabilitation.
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Affiliation(s)
- Mariana Saconato
- PhD. Speech therapist, Technical manager of the Speech Therapy team, Instituto de Infectologia Emílio Ribas (IIER), São Paulo (SP), Brazil
| | | | - Ceila Maria Sant’Ana Malaque
- PhD. Physician, Intensive Care Unit Physician, Instituto de Infectologia Emílio Ribas (IIER), São Paulo (SP), Brazil
| | - Rosa Maria Marcusso
- MSc. Statistician, Instituto de Infectologia Emílio Ribas (IIER), São Paulo (SP), Brazil
| | | | | | - Graziela Ultramari
- MSc. Physiotherapist, Head of the Diagnostic and Therapeutic Support Department, Instituto de Infectologia Emílio Ribas (IIER), São Paulo (SP), Brazil
| | - José Angelo Lauletta Lindoso
- PhD. Physician, Director of the Diagnostic and Therapeutic Support Department, Instituto de Infectologia Emílio Ribas (IIER), São Paulo (SP), Brazil
| | - Maria Inês Rebelo Gonçalves
- PhD. Speech therapist and Professor, Department of Speech Therapy, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil
| | - Jaques Sztajnbok
- MD. Physician, Head of the Intensive Care Unit, Instituto de Infectologia Emílio Ribas (IIER), São Paulo (SP), Brazil
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Bhat A, Dean J, Aboussouan LS. Perioperative Management in Neuromuscular Diseases: A Narrative Review. J Clin Med 2024; 13:2963. [PMID: 38792504 PMCID: PMC11122304 DOI: 10.3390/jcm13102963] [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: 03/31/2024] [Revised: 05/04/2024] [Accepted: 05/13/2024] [Indexed: 05/26/2024] Open
Abstract
Patients with neuromuscular diseases are particularly vulnerable in the perioperative period to the development of pulmonary and cardiac complications, or medication side effects. These risks could include hypoventilation, aspiration pneumonia, exacerbation of underlying cardiomyopathy, arrhythmias, adrenal insufficiency, prolonged neuromuscular blockade, issues related to thermoregulation, rhabdomyolysis, malignant hyperthermia, or prolonged mechanical ventilation. Interventions at each of the perioperative stages can be implemented to mitigate these risks. A careful pre-operative evaluation may help identify risk factors so that appropriate interventions are initiated, including cardiology consultation, pulmonary function tests, initiation of noninvasive ventilation, or implementation of preventive measures. Important intraoperative issues include positioning, airway and anesthetic management, and adequate ventilation. The postoperative period may require correction of electrolyte abnormalities, control of secretions with medications, manual or mechanical cough assistance, avoiding the risk of reintubation, judicious pain control, and appropriate medication management. The aim of this review is to increase awareness of the particular surgical challenges in this vulnerable population, and guide the clinician on the various evaluations and interventions that may result in a favorable surgical outcome.
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Affiliation(s)
| | | | - Loutfi S. Aboussouan
- Respiratory and Neurological Institutes, Cleveland Clinic, Cleveland, OH 44195, USA; (A.B.); (J.D.)
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Chapple LAS, Ridley EJ, Ainscough K, Ballantyne L, Burrell A, Campbell L, Dux C, Ferrie S, Fetterplace K, Fox V, Jamei M, King V, Serpa Neto A, Nichol A, Osland E, Paul E, Summers MJ, Marshall AP, Udy A. Nutrition delivery across hospitalisation in critically ill patients with COVID-19: An observational study of the Australian experience. Aust Crit Care 2024; 37:422-428. [PMID: 37316370 PMCID: PMC10176103 DOI: 10.1016/j.aucc.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 02/28/2023] [Accepted: 05/06/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Data on nutrition delivery over the whole hospital admission in critically ill patients with COVID-19 are scarce, particularly in the Australian setting. OBJECTIVES The objective of this study was to describe nutrition delivery in critically ill patients admitted to Australian intensive care units (ICUs) with coronavirus disease 2019 (COVID-19), with a focus on post-ICU nutrition practices. METHODS A multicentre observational study conducted at nine sites included adult patients with a positive COVID-19 diagnosis admitted to the ICU for >24 h and discharged to an acute ward over a 12-month recruitment period from 1 March 2020. Data were extracted on baseline characteristics and clinical outcomes. Nutrition practice data from the ICU and weekly in the post-ICU ward (up to week four) included route of feeding, presence of nutrition-impacting symptoms, and nutrition support received. RESULTS A total of 103 patients were included (71% male, age: 58 ± 14 years, body mass index: 30±7 kg/m2), of whom 41.7% (n = 43) received mechanical ventilation within 14 days of ICU admission. While oral nutrition was received by more patients at any time point in the ICU (n = 93, 91.2% of patients) than enteral nutrition (EN) (n = 43, 42.2%) or parenteral nutrition (PN) (n = 2, 2.0%), EN was delivered for a greater duration of time (69.6% feeding days) than oral and PN (29.7% and 0.7%, respectively). More patients received oral intake than the other modes in the post-ICU ward (n = 95, 95.0%), and 40.0% (n = 38/95) of patients were receiving oral nutrition supplements. In the week after ICU discharge, 51.0% of patients (n = 51) had at least one nutrition-impacting symptom, most commonly a reduced appetite (n = 25; 24.5%) or dysphagia (n = 16; 15.7%). CONCLUSION Critically ill patients during the COVID-19 pandemic in Australia were more likely to receive oral nutrition than artificial nutrition support at any time point both in the ICU and in the post-ICU ward, whereas EN was provided for a greater duration when it was prescribed. Nutrition-impacting symptoms were common.
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Affiliation(s)
- Lee-Anne S Chapple
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia; Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia.
| | - Emma J Ridley
- The Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Nutrition Department, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Kate Ainscough
- University College Dublin Clinical Research Centre at St Vincents University Hospital, Dublin, Ireland
| | - Lauren Ballantyne
- Nutrition and Dietetic Department, Bendigo Health, Bendigo, Victoria, Australia
| | - Aidan Burrell
- The Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Intensive Care, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Lewis Campbell
- Intensive Care Unit, Royal Darwin Hospital, Darwin, Northern Territory, Australia; Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Claire Dux
- Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Herston, Australia; School of Human Movements and Nutrition Science, University of Queensland, Brisbane, Australia
| | - Suzie Ferrie
- Department of Nutrition & Dietetics, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; School of Medicine and Health, University of Sydney, New South Wales, Australia
| | - Kate Fetterplace
- Department of Allied Health (Clinical Nutrition), The Royal Melbourne Hospital, Melbourne, Victoria, Australia; The University of Melbourne, Department of Critical Care, Melbourne Medical School, Melbourne, Victoria, Australia
| | - Virginia Fox
- Nutrition and Dietetic Department, Bendigo Health, Bendigo, Victoria, Australia
| | - Matin Jamei
- Intensive Care Unit, Nepean Hospital, Sydney, New South Wales, Australia
| | - Victoria King
- The Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ary Serpa Neto
- The Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Alistair Nichol
- The Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; University College Dublin Clinical Research Centre at St Vincents University Hospital, Dublin, Ireland; Nutrition and Dietetic Department, Bendigo Health, Bendigo, Victoria, Australia; Department of Intensive Care, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Emma Osland
- Department of Intensive Care, The Alfred Hospital, Melbourne, Victoria, Australia; School of Human Movements and Nutrition Science, University of Queensland, Brisbane, Australia
| | - Eldho Paul
- The Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Matthew J Summers
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Andrea P Marshall
- Intensive Care Unit, Gold Coast University Hospital, Southport, Queensland, Australia; Menzies Health Institute, Griffith University, Southport, Queensland, Australia
| | - Andrew Udy
- The Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Intensive Care, The Alfred Hospital, Melbourne, Victoria, Australia
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Kuriyama A, Watanabe S, Katayama Y, Yasaka T, Ouchi A, Iida Y, Kasai F. Dysphagia Rehabilitation in Dysphagic Patients with Acute or Critical Illness: A Systematic Review and Meta-Analysis. Dysphagia 2024:10.1007/s00455-024-10700-7. [PMID: 38662217 DOI: 10.1007/s00455-024-10700-7] [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: 08/06/2023] [Accepted: 03/18/2024] [Indexed: 04/26/2024]
Abstract
Dysphagia or swallowing dysfunction is common in patients with acute or critical illness, and diverse methods of dysphagia rehabilitation are provided worldwide. We aimed to examine the efficacy of rehabilitation to treat dysphagia in patients with acute or critical illness. We searched PubMed, ICHUSHI, and Cochrane Central Register of Controlled Trials databases from inception to November 22, 2023 for relevant randomized controlled trials. We focused on dysphagic patients with acute or critical illness who were not orotracheally intubated. Our target intervention included conventional rehabilitation and nerve stimulation/neuromodulation techniques as dysphagia rehabilitation. Comparators were conventional or standard care or no dysphagia interventions. Primary outcomes included mortality, incidence of pneumonia during the study period, and health-related quality of life (HRQoL) scores within 90 days of hospital discharge. We pooled the data using a random-effects model, and classified the certainty of evidence based on the Grading of Recommendations, Assessment, Development, and Evaluation system. Nineteen randomized controlled trials involving 1,096 participants were included. Dysphagia rehabilitation was associated with a reduced incidence of pneumonia (risk ratio [RR], 0.66; 95% confidence interval [CI], 0.54-0.81; moderate certainty), but not with reduced mortality (RR, 0.92; 95% CI, 0.61-1.39; very low certainty) or improved HRQoL scores (mean difference, -0.20; 95% CI, -20.34 to 19.94; very low certainty). Based on the available moderate- or very low- quality evidence, while dysphagia rehabilitation had no impact on mortality or HRQoL, they might reduce the incidence of pneumonia in dysphagic patients with acute or critical illness.
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Affiliation(s)
- Akira Kuriyama
- Emergency and Critical Care Center, Kurashiki Central Hospital, Okayama, Japan.
| | - Shinichi Watanabe
- Department of Physical Therapy, Faculty of Rehabilitation, Gifu University of Health Science, Gifu, Japan
| | - Yukiko Katayama
- Department of Nursing, Sakakibara Heart Institute, Fuchū, Japan
| | - Taisuke Yasaka
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Bunkyō, Japan
| | - Akira Ouchi
- Department of Adult Health Nursing, College of Nursing, Ibaraki Christian University, Hitachi, Japan
| | - Yuki Iida
- Toyohashi Sozo University, Toyohashi, Japan
| | - Fumihito Kasai
- Department of Rehabilitation Medicine, Showa University School of Medicine, Shinagawa-Ku, Japan
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Gray R, Ryan MA, Mehta V. Volume and Practice-Setting Shift of Laryngology Procedures During the COVID-19 Pandemic: A Reg-ENT Database Analysis. OTO Open 2024; 8:e128. [PMID: 38590586 PMCID: PMC11000131 DOI: 10.1002/oto2.128] [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: 02/29/2024] [Accepted: 03/03/2024] [Indexed: 04/10/2024] Open
Abstract
Objective The onset of the coronavirus disease 2019 (COVID-19) pandemic changed practice patterns throughout medicine. The purpose of this study is to evaluate changes in the volume and location setting of laryngology procedures after the onset of COVID-19. Study Design Retrospective database cohort study. Setting Reg-ENT registry. Methods Retrospective review from 2017 to 2022 of patients who underwent a laryngology procedure identified by procedure code categorized by site of service code-"ambulatory surgical" versus "office" setting. Based on March 2020 as the cutoff point, the procedures were designated as pre-COVID versus COVID time period. Results A total of 5989 patients underwent laryngology procedures. Forty-two percent more procedures were performed in the COVID period (n = 3780) versus pre-COVID (n = 2209). Pre-COVID, the procedure distribution between office and ambulatory surgical setting was 70% (n = 1546) compared with 30% (663). This shifted to 77% (n = 2920) and 23% (n = 860) during COVID, P = .9. The most common diagnoses associated with laryngology procedures during the study period were vocal fold paralysis 47% (n = 2831), dysphonia 33% (n = 1392), and laryngotracheal stenosis 14% (n = 838). These trends remained in both pre-COVID and COVID time periods. After the start of the pandemic, among patients undergoing laryngology procedures, there was a 93% increase (n = 284-549) in the diagnosis of laryngotracheal stenosis, 70% increase (n = 520-882 patients) in dysphonia and 69% increase (n = 1054-1777) in vocal fold paralysis. Conclusion An increase in laryngology procedures performed after the onset of the COVID-19 pandemic was identified with an overall procedural shift to the office-setting.
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Affiliation(s)
- Raluca Gray
- Department of Otolaryngology–Head and Neck SurgeryUniversity of MinnesotaMinneapolisMinnesotaUSA
| | | | - Vikas Mehta
- Department of OtolaryngologyMontefiore Medical Center/Albert Einstein College of MedicineBronxNew YorkUSA
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Morris K, Taylor NF, Freeman-Sanderson A. Safety-related outcomes for patients with a tracheostomy and the use of flexible endoscopic evaluation of swallowing (FEES) for assessment and management of swallowing: A systematic review. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024:1-11. [PMID: 38462820 DOI: 10.1080/17549507.2023.2293633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
PURPOSE The purpose of this systematic review was to examine safety-related outcomes for patients with tracheostomy after flexible endoscopic evaluation of swallowing (FEES) to assess and manage their swallow, when compared to other non-instrumental swallow assessments such as clinical swallowing examination (CSE) and/or a modified Evans blue dye test (MEBDT). METHOD Three databases were searched for articles referring to safety-related outcome data for adults with a tracheostomy, who underwent FEES and CSE and/or MEBDT. Articles were screened using predefined inclusion/exclusion criteria. RESULT The search strategy identified 2097 articles; following abstract and full-text screening, seven were included for review. The summary of evidence found low to very low certainty that FEES was associated with improved outcomes across swallow safety, physiological outcomes, tracheostomy cannulation duration, functional outcomes, and detection of upper airway pathologies. CONCLUSION This systematic review demonstrated low to very low certainty evidence from seven heterogeneous studies with low sample sizes that incorporating FEES may be associated with improved safety-related outcomes. There is less evidence supporting the accuracy of other swallow assessments conducted at the point of care (i.e. CSE and MEBDT). Future research requires studies with larger sample sizes and routine reporting of safety-related outcomes with use of FEES.
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Affiliation(s)
- Katherine Morris
- Speech Pathology Department, Eastern Health, Melbourne, Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Nicholas F Taylor
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia
| | - Amy Freeman-Sanderson
- Graduate School of Health, University of Technology Sydney, Sydney, Australia
- Speech Pathology Department, Royal Prince Alfred Hospital, Sydney, 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, Melbourne, Australia
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Krisciunas GP, Scheel R, Slavin M. Implementing Dysphagia Outcome Assessments into Clinical Settings: Leveraging Principles of Implementation, Dissemination, and Psychometrics. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:707-715. [PMID: 38284938 DOI: 10.1044/2023_ajslp-23-00227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
PURPOSE Myriad dysphagia assessment tools have been designed, but their application is variable. This is partly due to a lack of implementation and dissemination strategy as well as to limited guidance regarding which instruments are optimally designed and best used for clinical and research applications. METHOD This tutorial provides a high-level overview of implementation and dissemination, their interaction with psychometrics and knowledge coproduction, and how these concepts relate to proper development and widespread application of contextually relevant, psychometrically optimized, evidence-based dysphagia assessment instruments. RESULTS A review of the literature identified two dysphagia assessment instruments that purposefully integrated implementation and dissemination processes after measurement development. Application of knowledge coproduction was not identified in any papers reporting development and testing of dysphagia assessment instruments. A better understanding of coproduction and psychometrics when developing measures, while simultaneously applying implementation science and dissemination strategies, can result in the development of optimal dysphagia assessment tools that are more consistently adopted into clinical practice. CONCLUSIONS Clinicians and researchers should promote the development of psychometrically sound measures, and employ principles of implementation science and effective dissemination strategies to advocate for, and promote the use of, well-designed instruments within their appropriate clinical contexts. Support from governing bodies and funding agencies could enhance future efforts to develop, and encourage widespread uptake of, optimally developed dysphagia assessment tools.
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Affiliation(s)
- Gintas P Krisciunas
- Department of Otolaryngology, Boston University Chobanian & Avedisian School of Medicine, MA
- Department of Otolaryngology, Boston Medical Center, MA
- Department of Health Law, Policy & Management, Boston University School of Public Health, MA
| | - Rebecca Scheel
- Department of Otolaryngology, Lahey Hospital & Medical Center, Beth Israel Lahey Health, Burlington, MA
| | - Mary Slavin
- Department of Health Law, Policy & Management, Boston University School of Public Health, MA
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10
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Yogo N, Abe T, Kano K, Muto Y, Kiyonaga S, Hirai K. Post-extubation dysphagia in pediatric trauma patients: a single-center case-series study. Sci Rep 2024; 14:3475. [PMID: 38347152 PMCID: PMC10861439 DOI: 10.1038/s41598-024-54247-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 02/10/2024] [Indexed: 02/15/2024] Open
Abstract
We aimed to investigate whether ventilator support time influences the occurrence of dysphagia in pediatric trauma patients. This case-series study was conducted in a single pediatric emergency and critical care center from April 2012 to March 2022. Trauma patients aged < 16 years who underwent tracheal intubation were divided into two groups based on the occurrence of dysphagia within 72 h after extubation, and their data were analyzed. Tracheal intubation was performed in 75 pediatric trauma patients, and 53 of them were included in the analysis. A total of 22 patients had post-extubation dysphagia and head trauma. The dysphagia group tended to have more severe head injuries (Abbreviated Injury Scale (AIS) 4 [4-5] vs. 4 [0-4]; p < 0.05), a longer ventilator support time (7 days [4-11] vs. 1 day [1-2.5]; p < 0.05), and a longer length of hospital stay (27 days [18.0-40.3] vs. 11 days [10.0-21.0]; p < 0.05). Severe head trauma and a long duration of tracheal intubation may be risk factors for dysphagia in pediatric trauma patients. Therefore, early recognition of these risk factors could assist in treatment planning for speech-language pathologist intervention and nutritional routes of administration.
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Affiliation(s)
- Naoki Yogo
- Department of Pediatric Emergency and Critical Care Medicine, Japanese Red Cross Kumamoto Hospital, 2-1-1 Ngamineminami Higashi-ku, Kumamoto, 861-8520, Japan.
| | - Takeru Abe
- Department of Quality and Safety in Healthcare, Yokohama City University Medical Center, 4-57 Urafunecho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan
| | - Kyoko Kano
- Department of Pediatric Emergency and Critical Care Medicine, Japanese Red Cross Kumamoto Hospital, 2-1-1 Ngamineminami Higashi-ku, Kumamoto, 861-8520, Japan
| | - Yuichiro Muto
- Department of Pediatric Emergency and Critical Care Medicine, Japanese Red Cross Kumamoto Hospital, 2-1-1 Ngamineminami Higashi-ku, Kumamoto, 861-8520, Japan
| | - Sachi Kiyonaga
- Department of Rehabilitation, Japanese Red Cross Kumamoto Hospital, 2-1-1 Ngamineminami, Higashi-ku, Kumamoto, 861-8520, Japan
| | - Katsuki Hirai
- Department of Pediatric Emergency and Critical Care Medicine, Japanese Red Cross Kumamoto Hospital, 2-1-1 Ngamineminami Higashi-ku, Kumamoto, 861-8520, Japan
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Likar R, Aroyo I, Bangert K, Degen B, Dziewas R, Galvan O, Grundschober MT, Köstenberger M, Muhle P, Schefold JC, Zuercher P. Management of swallowing disorders in ICU patients - A multinational expert opinion. J Crit Care 2024; 79:154447. [PMID: 37924574 DOI: 10.1016/j.jcrc.2023.154447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 09/19/2023] [Accepted: 10/10/2023] [Indexed: 11/06/2023]
Abstract
BACKGROUND Dysphagia is common in intensive care unit (ICU) patients, yet it remains underrecognized and often unmanaged despite being associated with life-threatening complications, prolonged ICU stays and hospitalization. PURPOSE To propose an expert opinion for the diagnosis and management of dysphagia developed from evidence-based clinical recommendations and practitioner insights. METHODS A multinational group of dysphagia and critical care experts conducted a literature review using a modified ACCORD methodology. Based on a fusion of the available evidence and the panel's clinical experience, an expert opinion on best practice management was developed. RESULTS The panel recommends adopting clinical algorithms intended to promote standardized, high-quality care that triggers timely systematic dysphagia screening, assessment, and treatment of extubated and tracheostomized patients in the ICU. CONCLUSIONS Given the lack of robust scientific evidence, two clinical management algorithms are proposed for use by multidisciplinary teams to improve early systematic detection and effective management of dysphagia in ICU patients. Additionally, emerging therapeutic options such as neurostimulation have the potential to improve the quality of ICU dysphagia care.
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Affiliation(s)
- Rudolf Likar
- Department for Anaesthesiology and Intensive Medicine, Klinikum Klagenfurt am Wörthersee, Austria
| | - Ilia Aroyo
- Department of Neurology and Neurointensive Care Medicine, Klinikum Darmstadt, Germany
| | - Katrin Bangert
- Clinic for Intensive Care Medicine, University Hospital Hamburg, Germany
| | - Björn Degen
- Clinic for Intensive Medicine, Dysphagia Centre, Vienna, Austria
| | - Rainer Dziewas
- Department of Neurology and Neurological Rehabilitation, Klinikum Osnabrück, Osnabrück, Germany
| | - Oliver Galvan
- Department for Hearing, Speech and Voice Disorders, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Markus Köstenberger
- Department for Anaesthesiology and Intensive Medicine, Klinikum Klagenfurt am Wörthersee, Austria; Department for Anaesthesiology and Intensive Care Medicine, Medical University Graz, Graz, Austria.
| | - Paul Muhle
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Germany
| | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Patrick Zuercher
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
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12
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Wang Y, Zhu K, Wang N, Chen X, Cai C, Zhu Y, Shi C. Development and Validation of a Risk Prediction Model to Predict Postextubation Dysphagia in Elderly Patients After Endotracheal Intubation Under General Anesthesia: A Single-Center Cross-Sectional Study. Dysphagia 2024; 39:63-76. [PMID: 37272948 DOI: 10.1007/s00455-023-10594-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 05/17/2023] [Indexed: 06/06/2023]
Abstract
At present, the incidence and risk factors for dysphagia after extubation in elderly inpatients are still unclear, and we aimed to develop and validate a risk prediction model that prospectively identifies high-risk patients to reduce the occurrence rate of dysphagia. The 469 patients recruited were randomly divided into modeling and validation groups in a 7:3 ratio. In the modeling group, the postextubation dysphagia (PED) risk factors were analyzed, and a risk prediction model was established. In the validation group, the model was validated and evaluated. The model was constructed based on the risk factors determined by a binary logistic regression analysis. The discrimination ability of the model was evaluated by the receiver operating characteristic (ROC) curve. The calibration curve and Hosmer‒Lemeshow test were performed to evaluate the model's calibration ability. The clinical utility of the risk prediction model was analyzed by decision curve analysis (DCA). The results showed that the incidence of PED was 15.99%, and age, duration of indwelling gastric tube, difficult endotracheal intubation, atomization after extubation, anesthesia risk level and frailty assessment were identified as important risk factors. The model was validated to have favorable discrimination, calibration ability and clinical utility. It has a certain extension value and clinical applicability, providing a feasible reference for preventing the occurrence of PED.
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Affiliation(s)
- Yixin Wang
- Institute of Nursing Research, Hubei Province Key Laboratory of Occupational Hazard Identification and Control, School of Medicine, Wuhan University of Science and Technology, Wuhan, Hubei, 430065, China
| | - Kaimei Zhu
- Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Nan Wang
- Institute of Nursing Research, Hubei Province Key Laboratory of Occupational Hazard Identification and Control, School of Medicine, Wuhan University of Science and Technology, Wuhan, Hubei, 430065, China
| | - Xiangrong Chen
- General Hospital of PLA Central Theater Command, Wuhan, Hubei, China
| | - Chan Cai
- Institute of Nursing Research, Hubei Province Key Laboratory of Occupational Hazard Identification and Control, School of Medicine, Wuhan University of Science and Technology, Wuhan, Hubei, 430065, China
| | - Yuxin Zhu
- Institute of Nursing Research, Hubei Province Key Laboratory of Occupational Hazard Identification and Control, School of Medicine, Wuhan University of Science and Technology, Wuhan, Hubei, 430065, China
| | - Chongqing Shi
- Institute of Nursing Research, Hubei Province Key Laboratory of Occupational Hazard Identification and Control, School of Medicine, Wuhan University of Science and Technology, Wuhan, Hubei, 430065, China.
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13
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Chen J, Lu G, Wang Z, Zhang J, Ding J, Zeng Q, Chai L, Zhao L, Yu H, Li Y. Prediction Models for Dysphagia in Intensive Care Unit after Mechanical Ventilation: A Systematic Review and Meta-analysis. Laryngoscope 2024; 134:517-525. [PMID: 37543979 DOI: 10.1002/lary.30931] [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: 04/19/2023] [Revised: 06/16/2023] [Accepted: 07/13/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVE Dysphagia is a common condition that can independently lead to death in patients in the intensive care unit (ICU), particularly those who require mechanical ventilation. Despite extensive research on the predictors of dysphagia development, consistency across these studies is lacking. Therefore, this study aimed to identify predictors and summarize existing prediction models for dysphagia in ICU patients undergoing invasive mechanical ventilation. METHODS We searched five databases: PubMed, EMBASE, Web of Science, Cochrane Library, and the China National Knowledge Infrastructure. Studies that developed a post-extubation dysphagia risk prediction model in ICU were included. A meta-analysis of individual predictor variables was performed with mixed-effects models. The risk of bias was assessed using the prediction model risk of bias assessment tool (PROBAST). RESULTS After screening 1,923 references, we ultimately included nine studies in our analysis. The most commonly identified risk predictors included in the final risk prediction model were the length of indwelling endotracheal tube ≥72 h, Acute Physiology and Chronic Health Evaluation (APACHE) II score ≥15, age ≥65 years, and duration of gastric tube ≥72 h. However, PROBAST analysis revealed a high risk of bias in the performance of these prediction models, mainly because of the lack of external validation, inadequate pre-screening of variables, and improper treatment of continuous and categorical predictors. CONCLUSIONS These models are particularly susceptible to bias because of numerous limitations in their development and inadequate external validation. Future research should focus on externally validating the existing model in ICU patients with varying characteristics. Moreover, assessing the acceptance and effectiveness of the model in clinical practice is needed. LEVEL OF EVIDENCE NA Laryngoscope, 134:517-525, 2024.
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Affiliation(s)
- Juan Chen
- School of Nursing and Public Health, Yangzhou University, Yangzhou, China
| | - Guangyu Lu
- Institute of Public Health, Medical College of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Zhiyao Wang
- Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou, China
- Neuro Intensive Care Unit, Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Jingyue Zhang
- School of Nursing and Public Health, Yangzhou University, Yangzhou, China
| | - Jiali Ding
- School of Nursing and Public Health, Yangzhou University, Yangzhou, China
| | - Qingping Zeng
- School of Nursing and Public Health, Yangzhou University, Yangzhou, China
| | - Liying Chai
- School of Nursing and Public Health, Yangzhou University, Yangzhou, China
- Institute of Public Health, Medical College of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Li Zhao
- School of Nursing and Public Health, Yangzhou University, Yangzhou, China
- Institute of Public Health, Medical College of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Hailong Yu
- Neuro Intensive Care Unit, Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou, China
- Department of Neurology, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Yuping Li
- Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou, China
- Neuro Intensive Care Unit, Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou, China
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14
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Beumeler LFE, Visser E, Buter H, Navis GJ, Boerma EC, van Zutphen T. Protein and energy intake in intensive care unit survivors during the first year of recovery: A descriptive cohort study. JPEN J Parenter Enteral Nutr 2024; 48:93-99. [PMID: 37886877 DOI: 10.1002/jpen.2572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 10/19/2023] [Accepted: 10/25/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND Many intensive care unit (ICU) survivors suffer long-term health issues that affect their quality of life. Nutrition inadequacy can limit their rehabilitation potential. This study investigates nutrition intake and support during ICU admission and recovery. METHODS In this prospective cohort study, 81 adult ICU patients with stays ≥48 h were included. Data on dietary intake, feeding strategies, baseline and ICU characteristics, and 1-year outcomes (physical health and readmission rates) were collected. The number of patients achieving 1.2 gram per kilogram per day of protein and 25 kilocalories per kilogram per day at 3 months, 6 months, and 12 months after ICU admission was recorded. The impact of dietary supplementation during the year was assessed. Baseline characteristics, intake barriers, and rehabilitation's influence on nutrition intake at 12 months were evaluated, along with the effect of inadequate intake on outcomes. RESULTS After 12 months, only 10% of 60 patients achieved 1.2 g/kg/day protein intake, whereas 28% reached the advised 25 kcal/kg/day energy target. Supplementary feeding significantly increased protein intake at 3, 6, and 12 months (P = 0.003, P = 0.012, and P = 0.033, respectively) and energy intake at 3 months (P = 0.003). A positive relation was found between female sex and energy intake at 12 months after ICU admission (β = 4.145; P = 0.043) and taste issues were independently associated with higher protein intake (β = 0.363; P = 0.036). However, achieving upper-quartile protein or energy intake did not translate into improved physical health outcomes. CONCLUSION Continuous and improved nutrition care is urgently needed to support patients in reaching nutrition adequacy.
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Affiliation(s)
- Lise F E Beumeler
- Department of Intensive Care, Medical Center Leeuwarden, Leeuwarden, the Netherlands
- Department of Sustainable Health, Faculty Campus Fryslân, Groningen, the Netherlands
| | - Edith Visser
- Department of Sustainable Health, Faculty Campus Fryslân, Groningen, the Netherlands
- Department of Epidemiology, Medical Center Leeuwarden, Leeuwarden, the Netherlands
| | - Hanneke Buter
- Department of Intensive Care, Medical Center Leeuwarden, Leeuwarden, the Netherlands
| | - Gerjan J Navis
- Department of Internal Medicine, University Medical Center Groningen, Groningen, the Netherlands
| | - E Christiaan Boerma
- Department of Intensive Care, Medical Center Leeuwarden, Leeuwarden, the Netherlands
- Department of Sustainable Health, Faculty Campus Fryslân, Groningen, the Netherlands
| | - Tim van Zutphen
- Department of Sustainable Health, Faculty Campus Fryslân, Groningen, the Netherlands
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15
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Clayton NA, Ward EC, Norman E, Ryan H, Kol MR. Speech pathology assessment of dysphagia post endotracheal extubation: A service-model evaluation. Aust Crit Care 2024; 37:144-150. [PMID: 37709658 DOI: 10.1016/j.aucc.2023.07.041] [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: 06/02/2023] [Accepted: 07/25/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND As postextubation dysphagia (PED) is correlated with pneumonia, feeding-tube placement, and in-hospital mortality, early identification is paramount. Endotracheal intubation duration of ≥48 h is independently predictive for PED. Therefore, a blanket intensive care unit (ICU) referral protocol was implemented to conduct PED assessment of patients intubated for ≥48 h. OBJECTIVES The objective of this study was to review outcomes of an established blanket referral model for PED assessment in patients intubated for ≥48 h. Outcomes of the model were examined over a 2-year period (June 2015-June 2017) for (i) numbers and clinical characteristics of patients meeting criteria and referred for speech pathology (SP) assessment; (ii) frequency identified with PED on clinical swallow examination; (iii) severity and duration of PED; and (iv) SP management within the ICU. RESULTS There was 96% adherence to the pathway with 108 participants (68% male) assessed. Median intubation duration was 142 h (mode = 61; interquartile range [IQR] = 131.75), and median ICU admission was 9 days (mode = 8; IQR = 6.75). SP referral occurred at a median of 19.5 h (mode = 4; IQR = 18.75) after extubation. Dysphagia assessment occurred at a median of 22 h (mode = 4; IQR = 19), with 34% assessed on the same day and 77% within 24 h of extubation. PED was observed in 89%, with 26% exhibiting profound PED. Dysphagia recovery occurred at a median of 7 days (mode = 2; IQR = 11). Dysphagia severity was associated with duration to swallow recovery (p = 0.001). A median of two occasions of service and 90 min clinical time was spent by the speech pathologist in the ICU. CONCLUSION The blanket referral model enabled timely triage and assessment of dysphagia in a patient cohort at high risk of PED in our facility.
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Affiliation(s)
- Nicola A Clayton
- Speech Pathology Department, Concord Repatriation General Hospital, NSW Australia; Intensive Care Unit, Concord Repatriation General Hospital, NSW Australia; School of Health and Rehabilitation Sciences, University of Queensland, QLD Australia; Faculty of Medical and Health Sciences, University of Sydney, NSW Australia.
| | - Elizabeth C Ward
- School of Health and Rehabilitation Sciences, University of Queensland, QLD Australia; Centre for Functioning and Health Research, Metro South Health, Queensland Health, QLD Australia
| | - Eva Norman
- Speech Pathology Department, Concord Repatriation General Hospital, NSW Australia; Intensive Care Unit, Concord Repatriation General Hospital, NSW Australia
| | - Helen Ryan
- Speech Pathology Department, Concord Repatriation General Hospital, NSW Australia
| | - Mark R Kol
- Intensive Care Unit, Concord Repatriation General Hospital, NSW Australia
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16
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Iguchi T, Mita J, Iseda N, Sasaki S, Harada N, Ninomiya M, Sugimachi K, Honboh T, Sadanaga N, Matsuura H. Development of predictive score for postoperative dysphagia after emergency abdominal surgery in patients of advanced age. Ann Gastroenterol Surg 2024; 8:172-181. [PMID: 38250679 PMCID: PMC10797835 DOI: 10.1002/ags3.12716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/10/2023] [Accepted: 07/03/2023] [Indexed: 01/23/2024] Open
Abstract
Aim Postoperative dysphagia after emergency abdominal surgery (EAS) in patients of advanced age has become problematic, and appropriate dysphagia management is needed. This study was performed to identify predictive factors of dysphagia after EAS and to explore the usefulness of swallowing screening tools (SSTs). Methods This retrospective study included 267 patients of advanced age who underwent EAS from 2012 to 2022. They were assigned to a dysphagia group and non-dysphagia group using the Food Intake Level Scale (FILS) (dysphagia was defined as a FILS level of <7 on postoperative day 10). From 2018, original SSTs including a modified water swallowing test were performed by nurses. Results The incidence of postoperative dysphagia was 22.8% (61/267). Patients were significantly older in the dysphagia than non-dysphagia group. The proportions of patients who had poor nutrition, cerebrovascular disorder, Parkinson's disease, dementia, nursing-care service, high intramuscular adipose tissue content (IMAC), and postoperative ventilator management were much higher in the dysphagia than non-dysphagia group. Using logistic regression analysis, high IMAC, postoperative ventilator management, cerebrovascular disorder, and dementia were correlated with postoperative dysphagia and were assigned 10, 4, 3, and 3 points, respectively, according to each odds ratio. The optimal cut-off value was 7 according to a receiver operating characteristics curve. Using 1:1 propensity score matching for high-risk patients, the incidence of postoperative dysphagia was reduced by SSTs. Conclusions The new prediction score obtained from this study can identify older patients at high risk for dysphagia after EAS, and SSTs may improve these patients' short-term outcomes.
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Affiliation(s)
- Tomohiro Iguchi
- Department of SurgerySaiseikai Fukuoka General HospitalFukuokaJapan
| | - Junya Mita
- Department of SurgeryOita Red Cross HospitalOitaJapan
| | - Norifumi Iseda
- Department of SurgerySaiseikai Fukuoka General HospitalFukuokaJapan
| | - Shun Sasaki
- Department of SurgerySaiseikai Fukuoka General HospitalFukuokaJapan
| | - Noboru Harada
- Department of Surgery and Science, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | | | - Keishi Sugimachi
- Department of Hepato‐Biliary Pancreatic SurgeryNational Hospital Organization Kyushu Cancer CenterFukuokaJapan
| | - Takuya Honboh
- Department of SurgerySaiseikai Fukuoka General HospitalFukuokaJapan
| | - Noriaki Sadanaga
- Department of SurgerySaiseikai Fukuoka General HospitalFukuokaJapan
| | - Hiroshi Matsuura
- Department of SurgerySaiseikai Fukuoka General HospitalFukuokaJapan
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17
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Unoki T, Hayashida K, Kawai Y, Taito S, Ando M, Iida Y, Kasai F, Kawasaki T, Kozu R, Kondo Y, Saitoh M, Sakuramoto H, Sasaki N, Saura R, Nakamura K, Ouchi A, Okamoto S, Okamura M, Kuribara T, Kuriyama A, Matsuishi Y, Yamamoto N, Yoshihiro S, Yasaka T, Abe R, Iitsuka T, Inoue H, Uchiyama Y, Endo S, Okura K, Ota K, Otsuka T, Okada D, Obata K, Katayama Y, Kaneda N, Kitayama M, Kina S, Kusaba R, Kuwabara M, Sasanuma N, Takahashi M, Takayama C, Tashiro N, Tatsuno J, Tamura T, Tamoto M, Tsuchiya A, Tsutsumi Y, Nagato T, Narita C, Nawa T, Nonoyama T, Hanada M, Hirakawa K, Makino A, Masaki H, Matsuki R, Matsushima S, Matsuda W, Miyagishima S, Moromizato M, Yanagi N, Yamauchi K, Yamashita Y, Yamamoto N, Liu K, Wakabayashi Y, Watanabe S, Yonekura H, Nakanishi N, Takahashi T, Nishida O. Japanese Clinical Practice Guidelines for Rehabilitation in Critically Ill Patients 2023 (J-ReCIP 2023). J Intensive Care 2023; 11:47. [PMID: 37932849 PMCID: PMC10629099 DOI: 10.1186/s40560-023-00697-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 10/24/2023] [Indexed: 11/08/2023] Open
Abstract
Providing standardized, high-quality rehabilitation for critically ill patients is a crucial issue. In 2017, the Japanese Society of Intensive Care Medicine (JSICM) promulgated the "Evidence-Based Expert Consensus for Early Rehabilitation in the Intensive Care Unit" to advocate for the early initiation of rehabilitations in Japanese intensive care settings. Building upon this seminal work, JSICM has recently conducted a rigorous systematic review utilizing the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. This endeavor resulted in the formulation of Clinical Practice Guidelines (CPGs), designed to elucidate best practices in early ICU rehabilitation. The primary objective of this guideline is to augment clinical understanding and thereby facilitate evidence-based decision-making, ultimately contributing to the enhancement of patient outcomes in critical care settings. No previous CPGs in the world has focused specifically on rehabilitation of critically ill patients, using the GRADE approach. Multidisciplinary collaboration is extremely important in rehabilitation. Thus, the CPGs were developed by 73 members of a Guideline Development Group consisting of a working group, a systematic review group, and an academic guideline promotion group, with the Committee for the Clinical Practice Guidelines of Early Mobilization and Rehabilitation in Intensive Care of the JSICM at its core. Many members contributed to the development of the guideline, including physicians and healthcare professionals with multiple and diverse specialties, as well as a person who had been patients in ICU. Based on discussions among the group members, eight important clinical areas of focus for this CPG were identified. Fourteen important clinical questions (CQs) were then developed for each area. The public was invited to comment twice, and the answers to the CQs were presented in the form of 10 GRADE recommendations and commentary on the four background questions. In addition, information for each CQ has been created as a visual clinical flow to ensure that the positioning of each CQ can be easily understood. We hope that the CPGs will be a useful tool in the rehabilitation of critically ill patients for multiple professions.
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Affiliation(s)
- Takeshi Unoki
- Department Acute and Critical Care Nursing, School of Nursing, Sapporo City University, Sapporo, Japan.
| | - Kei Hayashida
- Department of Emergency Medicine, South Shore University Hospital, Northwell Health, Bay Shore, NY, USA
| | - Yusuke Kawai
- Department of Nursing, Fujita Health University Hospital, Toyoake, Japan
| | - Shunsuke Taito
- Department of Clinical Practice and Support, Hiroshima University Hospital, Hiroshima, Japan
| | - Morihide Ando
- Department of Pulmonary Medicine, Ogaki Municipal Hospital, Ogaki, Japan
| | - Yuki Iida
- Faculty of Physical Therapy, School of Health Sciences, Toyohashi Sozo University, Toyohashi, Japan
| | - Fumihito Kasai
- Department of Rehabilitation Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Tatsuya Kawasaki
- Department of Pediatric Critical Care, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Ryo Kozu
- Department of Rehabilitation Medicine, Nagasaki University Hospital, Nagasaki, Japan
- Department of Physical Therapy Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yutaka Kondo
- Department of Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital, Urayasu, Japan
| | - Masakazu Saitoh
- Department of Physical Therapy, Faculty of Health Science, Juntendo University, Tokyo, Japan
| | - Hideaki Sakuramoto
- Department of Critical Care and Disaster Nursing, Japanese Red Cross Kyushu International College of Nursing, Munakata, Japan
| | - Nobuyuki Sasaki
- Department of Rehabilitation Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Ryuichi Saura
- Department of Rehabilitation Medicine, Division of Comprehensive Medicine, Osaka Medical and Pharmaceutical University School of Medicine, Takatsuki, Japan
| | - Kensuke Nakamura
- Department of Critical Care Medicine, Yokohama City University Hospital, Yokohama, Japan
| | - Akira Ouchi
- Department of Adult Health Nursing, College of Nursing, Ibaraki Christian University, Hitachi, Japan
| | - Saiko Okamoto
- Department of Nursing, Hitachi General Hospital, Hitachi, Japan
| | - Masatsugu Okamura
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Tomoki Kuribara
- Department Acute and Critical Care Nursing, School of Nursing, Sapporo City University, Sapporo, Japan
| | - Akira Kuriyama
- Department of Primary Care and Emergency Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yujiro Matsuishi
- School of Nursing, St. Luke's International University, Tokyo, Japan
| | - Norimasa Yamamoto
- Department of Nursing, Toyama Prefectural Central Hospital, Toyama, Japan
| | - Shodai Yoshihiro
- Department of Pharmaceutical Services, Hiroshima University Hospital, Hiroshima, Japan
| | - Taisuke Yasaka
- Global Nursing Research Center, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Ryo Abe
- Department of Rehabilitation, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Takahito Iitsuka
- Department of Rehabilitation, Amagasaki Daimotsu Rehabilitation Hospital, Amagasaki, Japan
| | - Hiroyasu Inoue
- Department of Rehabilitation, Showa University School of Nursing and Rehabilitation Sciences, Yokohama, Japan
| | - Yuki Uchiyama
- Department of Rehabilitation Medicine, School of Medicine, Hyogo Medical University, Nishinomiya, Japan
| | - Satoshi Endo
- Rehabilitation Center, Amayama Hospital, Matsuyama, Japan
| | - Kazuki Okura
- Division of Rehabilitation, Akita University Hospital, Akita, Japan
| | - Kohei Ota
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Takahisa Otsuka
- Department of Rehabilitation Medicine, Okayama University Hospital, Okayama, Japan
| | - Daisuke Okada
- Department of Rehabilitation, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Kengo Obata
- Department of Rehabilitation, Japanese Red Cross Okayama Hospital, Okayama, Japan
| | - Yukiko Katayama
- Department of Nursing, Sakakibara Heart Institute, Fuchu, Japan
| | - Naoki Kaneda
- Rehabilitation Division, Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo, Japan
| | - Mio Kitayama
- Nursing Department, Kanazawa Medical University Hospital, Uchinada, Japan
| | - Shunsuke Kina
- Department of Rehabilitation, Nakagami Hospital, Okinawa, Japan
| | - Ryuichi Kusaba
- Department of Rehabilitation Medicine, Kyushu University Hospital, Fukuoka, Japan
| | | | - Naoki Sasanuma
- Department of Rehabilitation, Hyogo Medical University Hospital, Nishinomiya, Japan
| | | | | | - Naonori Tashiro
- Rehabilitation Center, Showa University Hospital, Tokyo, Japan
| | - Junko Tatsuno
- Department of Nursing, Kokura Memorial Hospital, Kitakyusyu, Japan
| | - Takahiko Tamura
- Department of Anesthesiology and Intensive Care Medicine, Kochi Medical School, Nankoku, Japan
| | - Mitsuhiro Tamoto
- Department of Nursing, Kyoto University Hospital, Kyoto, Kyoto, Japan
| | - Asuka Tsuchiya
- Department of Emergency and Critical Care Medicine, Tokai University School of Medicine, Kanagawa, Japan
| | - Yusuke Tsutsumi
- Department of Emergency Medicine, National Hospital Organization Mito Medical Center, Mito, Japan
| | - Tadashi Nagato
- Department of Respiratory Medicine and Infectious Diseases, JCHO Tokyo Yamate Medical Center, Tokyo, Japan
| | - Chihiro Narita
- Department of Emergency Medicine, Shizuoka General Hospital, Shizuoka, Japan
| | - Tomohiro Nawa
- Department of Pediatric Cardiology, Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo, Japan
| | - Tadayoshi Nonoyama
- Department of Rehabilitation, University of Fukui Hospital, Fukui, Japan
| | - Masatoshi Hanada
- Department of Rehabilitation Medicine, Nagasaki University Hospital, Nagasaki, Japan
| | - Kotaro Hirakawa
- Department of Rehabilitation, Sakakibara Heart Institute, Fuchu, Japan
| | - Akiko Makino
- School of Nursing, St. Luke's International University, Tokyo, Japan
| | - Hirotaka Masaki
- Department of Nursing, Nagoya University Hospital, Nagoya, Japan
| | - Ryosuke Matsuki
- Department of Rehabilitation, Kansai Electric Power Hospital, Osaka, Japan
| | | | - Wataru Matsuda
- Department of Emergency Medicine & Critical Care, Center Hospital of the National Center for Global Health and Medicine, Shinjuku, Japan
| | - Saori Miyagishima
- Division of Rehabilitation, Sapporo Medical University Hospital, Hokkaido, Japan
| | - Masaru Moromizato
- Department of Nursing, Chubu Tokushukai Hospital, Kitanakagusuku, Japan
| | - Naoya Yanagi
- Department of Rehabilitation, Kitasato University Medical Center, Kitamoto, Japan
| | - Kota Yamauchi
- Department of Rehabilitation, Steel Memorial Yawata Hospital, Kitakyushu, Japan
| | - Yuhei Yamashita
- Division of Rehabilitation Medicine, Gunma Prefectural Cardiovascular Center, Maebashi, Japan
| | - Natsuhiro Yamamoto
- Department of Anesthesiology and Critical Care Medicine, Yokohama City University School of Medicine, Yokohama, Japan
| | - Keibun Liu
- Critical Care Research Group, The Prince Charles Hospital, Chermside, QLD, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Non-Profit Organization ICU Collaboration Network (ICON), Tokyo, Japan
| | - Yuki Wakabayashi
- Department of Nursing, Kobe City Center General Hospital, Kobe, Japan
| | - Shinichi Watanabe
- Department of Physical Therapy, Faculty of Rehabilitation, Gifu University of Health Science, Gifu, Japan
| | - Hiroshi Yonekura
- Department of Anesthesiology and Pain Medicine, Fujita Health University Bantane Hospital, Nagoya, Japan
| | - Nobuto Nakanishi
- Department of Disaster and Emergency Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Tetsuya Takahashi
- Department of Physical Therapy, Faculty of Health Science, Juntendo University, Tokyo, Japan
| | - Osamu Nishida
- Department of Anesthesiology and Critical Care Medicine, School of Medicine, Fujita Health University, Toyoake, Japan
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18
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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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19
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Barth I, Beumeler LFE, Nahar-van Venrooij L, van Dijk O, Buter H, Boerma EC. The effect of protein provision and exercise therapy on patient-reported and clinical outcomes in intensive care unit survivors: A systematic review. J Hum Nutr Diet 2023; 36:1727-1740. [PMID: 37211649 DOI: 10.1111/jhn.13188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 05/18/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Intensive care unit (ICU) survivors deal with long-term health problems, which negatively affect their quality of life (QoL). Nutritional and exercise intervention could prevent the decline of muscle mass and physical functioning which occurs during critical illness. Despite the growing amount of research, robust evidence is lacking. METHODS For this systematic review, Embase, PubMed and Cochrane Central Register of Controlled Trials databases were searched. The effect of protein provision (PP) or combined protein and exercise therapy (CPE) during or after ICU admission on QoL, physical functioning, muscle health, protein/energy intake and mortality was assessed compared to standard care. RESULTS Four thousand nine hundred and fifty-seven records were identified. After screening, data were extracted for 15 articles (9 randomised controlled trials and 6 non-randomised studies). Two studies reported improvements in muscle mass, of which one found higher independency in activities of daily living. No significant effect was found on QoL. Overall, protein targets were seldom met and often below recommendations. CONCLUSION Evidence for the effect of PP or CPE on patient-reported outcomes in ICU survivors is limited due to study heterogeneity and lack of high-quality studies. Future research and clinical practice should focus on adequate protein delivery with exercise interventions to improve long-term outcomes.
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Affiliation(s)
- Iris Barth
- Department of Dietetics, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - Lise F E Beumeler
- Campus Fryslân, University of Groningen, Leeuwarden, The Netherlands
- Department of Intensive Care, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - Lenny Nahar-van Venrooij
- Department of Data Science and Epidemiology, University Medical Centre Amsterdam and University of Amsterdam, Amsterdam, The Netherlands
- Jeroen Bosch Academy Research, Jeroen Bosch Hospital, Hertogenbosch, The Netherlands
| | - Olga van Dijk
- Knowledge and Information Centre, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - Hanneke Buter
- Department of Data Science and Epidemiology, University Medical Centre Amsterdam and University of Amsterdam, Amsterdam, The Netherlands
| | - E Christiaan Boerma
- Department of Intensive Care, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
- Department of Data Science and Epidemiology, University Medical Centre Amsterdam and University of Amsterdam, Amsterdam, The Netherlands
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20
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Kelly E, Hirschwald J, Clemens J, Regan J. Persistent Features of Laryngeal Injury Following Endotracheal Intubation: A Systematic Review. Dysphagia 2023; 38:1333-1341. [PMID: 36774422 PMCID: PMC9922098 DOI: 10.1007/s00455-023-10559-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 01/27/2023] [Indexed: 02/13/2023]
Abstract
This systematic review examined (i) prevalence, severity, and impact of persistent post-extubation laryngeal injury beyond hospital discharge and (ii) differences in persistent laryngeal injury between COVID-19 and non-COVID-19 populations. The review was completed following PRISMA-2020 guidelines. Four databases (PubMed, CINHAL complete, EMBASE, Web of Science) were searched (inception to March 2021). Screening, full text review and data extraction were completed by two reviewers. Primary outcomes were swallow, voice and cough and airway measures obtained after hospital discharge. Quality assessment was measured using Downs & Black Tool and Johanna Briggs Institute Checklist for Cohort Studies. Meta-analysis was not completed due to study heterogeneity. Six cohort studies were included. Total number of participants across the included studies was 436. ICU admission diagnoses included respiratory disease 46% (COVID-19 and non-COVID-19), sepsis 14%, non-sepsis-related organ dysfunction 9%, general medical 11%, general surgical 10%, trauma 2%, ENT 0.6% and other not specified by authors 7%. Outcomes were obtained between 2 and 60 months post hospital discharge. Assessment methods included endoscopic evaluation, clinician ratings and patient-reported outcomes. Persistent features of laryngeal injury identified were airway abnormalities (18.9-27%), dysphonia (13.2-60%) and dysphagia (23-33%). Persistent laryngeal injury was associated with ICU length of stay, respiratory diagnosis and tracheostomy. Study quality ranged from poor-good. This is the first systematic review to examine post-extubation laryngeal injury beyond hospital discharge. Significant gaps in the literature were identified. Given the impact on clinical and patient outcomes, large scale, well-designed research is needed to guide post-ICU service delivery.
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Affiliation(s)
- Eileen Kelly
- Department of Clinical Speech & Language Studies, Trinity College Dublin, Dublin, Ireland.
- Highly Specialist Speech & Language Therapist, Adult Critical Care Unit, Royal London Hospital, London, UK.
| | - Julia Hirschwald
- Department of Clinical Speech & Language Studies, Trinity College Dublin, Dublin, Ireland
| | | | - Julie Regan
- Department of Clinical Speech & Language Studies, Trinity College Dublin, Dublin, Ireland
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21
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Kazemian E, Solinski M, Wozniak A, Charous S. Dysphagia After Prolonged Intubation in SARS-CoV-19 Patients: A Single Institution Retrospective Review. Cureus 2023; 15:e41544. [PMID: 37554611 PMCID: PMC10404913 DOI: 10.7759/cureus.41544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2023] [Indexed: 08/10/2023] Open
Abstract
To determine the impact of various factors on swallowing in SARS-CoV-19 patients after prolonged intubation. Methods: A retrospective chart review of SARS-CoV-19 patients intubated between February 2020 and March 2021 was performed. Independent variables, including duration and factors of intubation, and patient demographic characteristics were analyzed. Formal swallow studies were performed for patients who failed a screening swallow evaluation. Results: Seventy-three individuals of 308 patients reviewed had a dysphagia score of ≤5. A total of 49% of patients' dysphagia resolved prior to discharge, with a median of eight days between extubation and the last evaluation. The median duration of intubation was 11 days. Increasing age, congestive heart failure, cerebrovascular disease, and hypertension were associated with dysphagia at the first and/or last evaluation. Hispanic ethnicity was associated with a decreased risk of dysphagia (all p<0.05). Conclusions: Although various patient factors including age and congestive heart failure were associated with the development of dysphagia after prolonged intubation, the length of intubation was not.
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Affiliation(s)
- Elycia Kazemian
- Otolaryngology - Head and Neck Surgery, Loyola University Medical Center, Maywood, USA
| | - Mark Solinski
- Otolaryngology - Head and Neck Surgery, Loyola University Medical Center, Maywood, USA
| | - Amy Wozniak
- Statistics, Loyola University Chicago Health Sciences Division Center for Translational Research and Education, Maywood, USA
| | - Steven Charous
- Otolaryngology - Head and Neck Surgery, Loyola University Medical Center, Maywood, USA
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22
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Dawson C, Clunie G, Evison F, Duncan S, Whitney J, Houchen-Wolloff L, Bolton CE, Leavy OC, Richardson M, Omer E, McAuley H, Shikotra A, Singapuri A, Sereno M, Saunders RM, Harris VC, Greening NJ, Nolan CM, Wootton DG, Daynes E, Donaldson G, Sargent J, Scott J, Pimm J, Bishop L, McNarry M, Hart N, Evans RA, Singh S, Yates T, Chalder T, Man W, Harrison E, Docherty A, Lone NI, Quint JK, Chalmers J, Ho LP, Horsley AR, Marks M, Poinasamy K, Raman B, Wain LV, Brightling C, Sharma N, Coffey M, Kulkarni A, Wallace S. Prevalence of swallow, communication, voice and cognitive compromise following hospitalisation for COVID-19: the PHOSP-COVID analysis. BMJ Open Respir Res 2023; 10:e001647. [PMID: 37495260 PMCID: PMC10360430 DOI: 10.1136/bmjresp-2023-001647] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 06/30/2023] [Indexed: 07/28/2023] Open
Abstract
OBJECTIVE Identify prevalence of self-reported swallow, communication, voice and cognitive compromise following hospitalisation for COVID-19. DESIGN Multicentre prospective observational cohort study using questionnaire data at visit 1 (2-7 months post discharge) and visit 2 (10-14 months post discharge) from hospitalised patients in the UK. Lasso logistic regression analysis was undertaken to identify associations. SETTING 64 UK acute hospital Trusts. PARTICIPANTS Adults aged >18 years, discharged from an admissions unit or ward at a UK hospital with COVID-19. MAIN OUTCOME MEASURES Self-reported swallow, communication, voice and cognitive compromise. RESULTS Compromised swallowing post intensive care unit (post-ICU) admission was reported in 20% (188/955); 60% with swallow problems received invasive mechanical ventilation and were more likely to have undergone proning (p=0.039). Voice problems were reported in 34% (319/946) post-ICU admission who were more likely to have received invasive (p<0.001) or non-invasive ventilation (p=0.001) and to have been proned (p<0.001). Communication compromise was reported in 23% (527/2275) univariable analysis identified associations with younger age (p<0.001), female sex (p<0.001), social deprivation (p<0.001) and being a healthcare worker (p=0.010). Cognitive issues were reported by 70% (1598/2275), consistent at both visits, at visit 1 respondents were more likely to have higher baseline comorbidities and at visit 2 were associated with greater social deprivation (p<0.001). CONCLUSION Swallow, communication, voice and cognitive problems were prevalent post hospitalisation for COVID-19, alongside whole system compromise including reduced mobility and overall health scores. Research and testing of rehabilitation interventions are required at pace to explore these issues.
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Affiliation(s)
- Camilla Dawson
- Department of Speech and Language Therapy, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Gemma Clunie
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Felicity Evison
- Department of Informatics, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Sallyanne Duncan
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - Julie Whitney
- King's College London Faculty of Life Sciences and Medicine, London, UK
| | - Linzy Houchen-Wolloff
- Department of Pulmonary Rehabilitation, University Hospitals of Leicester, Leicester, UK
| | - Charlotte E Bolton
- Respiratory Medicine, NIHR Nottingham Biomedical Research Centre Respiratory Theme, University of Nottingham, Nottingham, UK
| | - Olivia C Leavy
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Matthew Richardson
- Leicester Respiratory Biomedical Research Unit, National Institute for Health Research, Leicester, UK
| | - Elneima Omer
- Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | | | - Aarti Shikotra
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Amisha Singapuri
- Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Marco Sereno
- Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Ruth M Saunders
- Department of Infection, Immunity and Inflammation, Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Victoria C Harris
- Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Neil J Greening
- Respiratory Sciences, University of Leicester, Leicester, UK
- Respiratory Medicine, Institute for Lung Health, UK
| | | | | | - Enya Daynes
- CERS, NIHR Leicester Biomedical Research Centre, Leicester, UK
| | | | - Jack Sargent
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | - John Pimm
- Healthy Minds, The Buckinghamshire IAPT Service, Oxford Health NHS Foundation Trust, Oxford, UK
| | | | | | - Nicholas Hart
- Lane Fox Respiratory Service, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | | | - Sally Singh
- Cardiac/Pulmonary Rehabilitation, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Tom Yates
- University of Leicester, Leicester, UK
| | | | | | - Ewen Harrison
- Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Annemarie Docherty
- Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Nazir I Lone
- Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Jennifer K Quint
- Imperial College London, London, UK
- NHLI, Imperial College London, London, UK
| | - James Chalmers
- Tayside Respiratory Research Group, University of Dundee, Dundee, UK
| | - Ling-Pei Ho
- MRC Human Immunology Unit, Weatherall Institute of Molecular Medicine, Oxford, UK
- Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, UK
| | - Alex Robert Horsley
- Respiratory Medicine, Manchester Adult Cystic Fibrosis Centre, Manchester, UK
| | - Michael Marks
- London School of Hygiene & Tropical Medicine, London, UK
| | | | - Betty Raman
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxfordshire, UK
- University of Oxford, Oxford, UK
| | - Louise V Wain
- Biomedical Research Centre-Respiratory, National Institute for Health Research, Leicester, UK
- Genetic Epidemiology Group, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Chris Brightling
- Institute of Lung Health, University of Leicester, Leicester, UK
| | - Neil Sharma
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Otolaryngology, Head and Neck Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Amit Kulkarni
- Royal College of Speech and Language Therapists, London, UK
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23
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Wang K, Hu Y, Duan Z, Fu H, Hu X, Zhao Y, Wen R, Li L, Xie F. Severe Community-Acquired Pneumonia Caused by Methicillin-Sensitive Staphylococcus aureus: Successfully Treated with Contezolid - A Case Report and Literature Review. Infect Drug Resist 2023; 16:3233-3242. [PMID: 37249965 PMCID: PMC10224678 DOI: 10.2147/idr.s406799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 04/24/2023] [Indexed: 05/31/2023] Open
Abstract
Background Staphylococcus aureus has been well recognized as an important cause of community-acquired pneumonia (CAP), with non-specific characteristics and poor prognosis. In severe CAP (SCAP) guidelines, β-lactam combined with macrolides or fluoroquinolones therapy was recommended, but the efficacy is not satisfactory due to the continued spread of antimicrobial resistance. Contezolid is a new representative of oxazolidinones in clinical development, but no relevant reports have been reported for the treatment of SCAP. This was the first report of a patient with Staphylococcus aureus SCAP who was successfully treated with contezolid combined with other antibiotics and rehabilitation exercise. Case Presentation A 44-year-old woman with high blood pressure and diabetes was admitted to our hospital owing to cough, sputum, wheezing for 2 weeks, and aggravation for 2 days. The bronchoscopic alveolar lavage and microorganism-Rapid On Site Evaluation (BAL-mROSE) was used to get pathological data, which were positive for Staphylococcus aureus, in line with blood cultures. During hospitalization, the patient received endotracheal intubation for assisted breathing and anti-infective therapy, including meropenem, linezolid, teicoplanin and tazocin successively. Finally, contezolid obtained excellent result, with platelet recovery to normal levels and significant improvement in pulmonary imaging. Meanwhile, the patient's swallowing disorder improved after continuous rehabilitation exercise. After discharge, she received contezolid consolidation therapy for 1 week and was free of complaints during the 30-day follow-up without any special treatment for SCAP. Discussion Treatment with contezolid combined with other antibiotics and rehabilitation exercise for SCAP has shown remarkable efficacy and good safety; hence, this regimen is a promising treatment strategy for this fatal disease.
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Affiliation(s)
- Kaifei Wang
- College of Pulmonary and Critical Care Medicine, Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Ye Hu
- College of Pulmonary and Critical Care Medicine, Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Zhimei Duan
- College of Pulmonary and Critical Care Medicine, Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Han Fu
- College of Pulmonary and Critical Care Medicine, Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Xingshuo Hu
- College of Pulmonary and Critical Care Medicine, Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Ying Zhao
- College of Pulmonary and Critical Care Medicine, Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Ruoxuan Wen
- College of Pulmonary and Critical Care Medicine, Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Lina Li
- College of Pulmonary and Critical Care Medicine, Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Fei Xie
- College of Pulmonary and Critical Care Medicine, Chinese PLA General Hospital, Beijing, People’s Republic of China
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24
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Lijo M, Hamilton A, Russell ME, Wren N. Acute inpatient rehabilitation for COVID-19 survivors: A retrospective case series. Physiother Theory Pract 2023:1-10. [PMID: 37184416 DOI: 10.1080/09593985.2023.2213773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND Patients with Coronavirus Disease 2019 (COVID-19) who required mechanical ventilation and had prolonged hospital stay present with medical instability and functional impairments after the acute hospitalization. OBJECTIVE To present the rehabilitation outcome of three patients with COVID-19 admitted to an inpatient rehabilitation unit using a case series method. METHODS Subjects included three consecutive male patients admitted to the rehabilitation unit with a diagnosis of deconditioning and critical illness myopathy. On admission, patients were evaluated by a multidisciplinary team using outcome measures such as 6-min walk test (6 MWT), 10-m walk test (10 MWT), berg balance scale (BBS), and dynamometry. Each patient received daily therapy with a minimum of 900 min per week during their rehabilitation stay. Treatment strategies included fatigue management, training of mobility and activities for daily living tasks, muscle strengthening, and cognitive retraining. RESULTS All patients showed significant improvements across all the outcome measures, specifically, the 6MWT (minimal clinically identifiable difference (MCID) range: 14-30.5 m) and the 10MWT (MCID range: 0.10-0.20 m/s) which exceeded the MCID for all three patients. The BBS also demonstrated significant improvement, surpassing the minimum detectable change of 5-7 points. Of the three patients, two were able to be discharged at an independent level, while one required supervision for safety. CONCLUSION Patients with COVID-19, who experienced prolonged hospital stay present with severe impairments in muscle strength, functional mobility, and participation in daily living tasks. Inpatient rehabilitation may have the potential to reduce impairments and accelerate the recovery process while managing ongoing medical issues.
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Affiliation(s)
- Mithu Lijo
- Rehabilitation Services, John H. Stroger Jr. Hospital of Cook County, Chicago, IL, USA
| | - Ashley Hamilton
- Rehabilitation Services, TIRR Inpatient Rehabilitation, The Woodlands, TX, USA
| | - Mary E Russell
- Rehabilitation Services, TIRR Inpatient Rehabilitation, The Woodlands, TX, USA
| | - Nicole Wren
- Rehabilitation Services, TIRR Inpatient Rehabilitation, The Woodlands, TX, USA
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25
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Reedy EL, Simpson AN, O'Rourke AK, Bonilha HS. Characterizing Swallowing Impairment in a Post-Lung Transplant Population. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:1236-1251. [PMID: 37000923 DOI: 10.1044/2023_ajslp-22-00266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
BACKGROUND Lung transplant recipients carry significant pre- and post-lung transplant dysphagia risk factors related to altered respiratory-swallow coordination as well as acute injury and decompensation resulting in the acute post-lung transplant recovery period. However, we are only beginning to understand the potential physiological contributors to altered swallowing in this population. METHOD A retrospective, cross-sectional, cohort study of post-lung transplant patients was performed. All participants received a modified barium swallow study (MBSS) as part of standard care during their acute hospitalization using the Modified Barium Swallow Impairment Profile (MBSImP) protocol and scoring metric. A combination of MBSImP scores, Penetration-Aspiration Scale (PAS) scores, Functional Oral Intake Scale (FOIS) scores, International Dysphagia Diet Standardization Initiative (IDDSI) scale levels, and the time from lung transplant to MBSS was collected, as well as measures of swallowing impairment and swallowing-related outcomes. Differences in swallowing physiology and swallowing-related outcomes between participants with typical versus atypical PAS were explored. RESULTS Forty-two participants met our prespecified inclusion criteria. We identified atypical laryngeal penetration and/or aspiration in 52.4% of our post-lung transplant cohort. Silent aspiration occurred in 75% of those patients who aspirated. Comparing typical versus atypical PAS scores, we found statistically significant associations with laryngeal elevation (Component 8), p < .0001; anterior hyoid excursion (Component 9), p = .0046; epiglottic movement (Component 10), p = .0031; laryngeal vestibule closure (Component 11), p < .0001; pharyngeal stripping (Component 12), p = .0058; pharyngeal total scores, p = .0001; FOIS scores, p = .00264; and IDDSI liquid levels, p = .0009. CONCLUSIONS Swallowing impairment resulting in abnormal bolus invasion is prevalent in post-lung transplant patients. Airway invasion in this cohort was related to pharyngeal swallow impairment and resulted in modified oral intake. Our findings help expand upon prior literature, which only reported the incidence of aspiration and pathological laryngeal penetration. Our results suggest that the potential for aerodigestive system impairment and negative sequela should not be underestimated in the post-lung transplant population.
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Affiliation(s)
- Erin L Reedy
- Health Sciences and Research, The Medical University of South Carolina, Charleston
| | - Annie N Simpson
- Health Sciences and Research, The Medical University of South Carolina, Charleston
- Department of Otolaryngology-Head & Neck Surgery, The Medical University of South Carolina, Charleston
| | - Ashli K O'Rourke
- Department of Otolaryngology-Head & Neck Surgery, The Medical University of South Carolina, Charleston
| | - Heather Shaw Bonilha
- Health Sciences and Research, The Medical University of South Carolina, Charleston
- Department of Otolaryngology-Head & Neck Surgery, The Medical University of South Carolina, Charleston
- Department of Rehabilitation Medicine, Emory University, Atlanta, GA
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26
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Briggs MS, Kolbus ES, Patterson KM, Harmon-Matthews LE, McGrath SL, Quatman-Yates CC, Meirelles C, Salsberry MJ. How oral intake, mobility, and activity measures can inform discharge recommendations: A retrospective analysis of hospitalized inmate and non-inmate COVID-19 patients. JMIR Rehabil Assist Technol 2023. [PMID: 37224276 DOI: 10.2196/43250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Patients who were incarcerated were disproportionately impacted by COVID-19 compared to the general public. Further, the impact of multidisciplinary rehabilitation assessments and interventions on the outcomes of patients admitted to the hospital with COVID-19 is limited. OBJECTIVE To compare functional outcomes of oral intake, mobility, and activity between inmates and non-inmates who were diagnosed with COVID-19 and examine the relationships among these functional measures and discharge destination. METHODS A retrospective analysis was performed on patients admitted to the hospital for COVID-19 at a large academic medical center. Scores on functional measures including Functional Oral Intake Scale (FOIS) and Activity Measure for Post-Acute Care (AM-PAC) were collected and compared between inmates and non-inmates. Binary logistic regression models were used to evaluate the odds of 1) whether patients were discharged to the same place they were admitted and 2) patients being discharged with a total oral diet with no restrictions. Independent variables were considered significant if the 95% CIs of the odds ratios (ORs) did not include 1.0. RESULTS A total of 83 patients (inmates, n=38; non-inmates, n=45) were included in the final analysis. There were no differences between inmates and non-inmates on initial (P=.39) and final FOIS scores (P=.35) or on initial, final, or change scores (P>.05) on the AM-PAC. When examining separate regression models using AM-PAC mobility or AM-PAC activity scores as independent variables, greater age upon admission decreased the odds (OR=0.922; 95%CI=0.875 to 0.972 and OR=0.918; 95%CI=0.871 to 0.968) of patients being discharged with a total oral diet with no restrictions. The following factors increased the odds of patients being discharged to the same place they were admitted from: being an inmate (OR=5.285; 95%CI= 1.334 to 20.931) and (OR=6.083; 95%CI=1.548 to 23.912); "Other" race (OR=7.596; 95%CI=1.203 to 47.968) and (OR=8.515; 95%CI=1.311 to 55.291); and female sex (OR=4.671; 95%CI=1.086 to 20.092) and (OR=4.977; 95%CI=1.146 to 21.615). CONCLUSIONS Results from this study provide an opportunity to learn how functional measures may be used to better understand discharge outcomes in both inmate and non-inmate patients admitted to the hospital with COVID-19 during the initial period of the pandemic. CLINICALTRIAL
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Affiliation(s)
- Matthew Scott Briggs
- Rehabilitation Services, The Ohio State University Wexner Medical Center, 410 W 10th Ave., Columbus, US
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, US
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, US
- School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, US
| | - Erin Shevawn Kolbus
- Rehabilitation Services, The Ohio State University Wexner Medical Center, 410 W 10th Ave., Columbus, US
| | - Kevin Michael Patterson
- Rehabilitation Services, The Ohio State University Wexner Medical Center, 410 W 10th Ave., Columbus, US
| | | | - Shana Lee McGrath
- Rehabilitation Services, The Ohio State University Wexner Medical Center, 410 W 10th Ave., Columbus, US
| | - Catherine Celeste Quatman-Yates
- School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, US
- Rehabilitation Services, The Ohio State University Wexner Medical Center, 410 W 10th Ave., Columbus, US
| | - Cristiane Meirelles
- School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, US
- Rehabilitation Services, The Ohio State University Wexner Medical Center, 410 W 10th Ave., Columbus, US
| | - Marka Jean Salsberry
- School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, US
- Rehabilitation Services, The Ohio State University Wexner Medical Center, 410 W 10th Ave., Columbus, US
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Hou L, Li Y, Wang J, Wang Y, Wang J, Hu G, Ding XR. Risk factors for post-extubation dysphagia in ICU: A systematic review and meta-analysis. Medicine (Baltimore) 2023; 102:e33153. [PMID: 36897733 PMCID: PMC9997834 DOI: 10.1097/md.0000000000033153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 02/10/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Post-extubation dysphagia is high in critically ill patients and is not easily recognized. This study aimed to identify risk factors for acquired swallowing disorders in the intensive care unit (ICU). METHODS We have retrieved all relevant research published before August 2022 from PubMed, Embase, Web of Science, and the Cochrane Library electronic databases. The studies were selected using inclusion and exclusion criteria. Two reviewers screened studies, extracted data, and independently evaluated the risk of bias. The quality of the study was assessed with the Newcastle-Ottawa Scale, and a meta-analysis was carried out with Cochrane Collaboration's Revman 5.3 software. RESULTS A total of 15 studies were included. Age (odds ratio [OR] = 1.04), tracheal intubation time (OR = 1.61), APACHE II (OR = 1.04), and tracheostomy (OR = 3.75) were significant risk factors that contributed to post-extubation dysphagia in ICU. CONCLUSION This study provides preliminary evidence that post-extraction dysphagia in ICU is associated with factors such as age, tracheal intubation time, APACHE II, and tracheostomy. The results of this research may improve clinician awareness, risk stratification, and prevention of post-extraction dysphagia in the ICU.
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Affiliation(s)
- Lingyu Hou
- Nursing Department, Peking University Shenzhen Hospital, Shenzhen, People’s Republic of China
| | - Ying Li
- College of Nursing, Weifang Institute of Science and Technology, Shandong, Weifang, People’s Republic of China
| | - Jianhua Wang
- College of Nursing, Weifang Institute of Science and Technology, Shandong, Weifang, People’s Republic of China
| | - Yuqi Wang
- College of Nursing, Weifang Institute of Science and Technology, Shandong, Weifang, People’s Republic of China
| | - Jingchao Wang
- College of Nursing, Weifang Institute of Science and Technology, Shandong, Weifang, People’s Republic of China
| | - GuoJing Hu
- College of Nursing, Weifang Institute of Science and Technology, Shandong, Weifang, People’s Republic of China
| | - Xiao Rong Ding
- Nursing Department, Peking University Shenzhen Hospital, Shenzhen, People’s Republic of China
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Bouldin E, Sandeep S, Gillespie A, Tkaczuk A. Otolaryngologic Symptom Severity Post SARS-CoV-2 Infection. J Voice 2023:S0892-1997(23)00080-2. [PMID: 37068983 PMCID: PMC9977624 DOI: 10.1016/j.jvoice.2023.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 02/19/2023] [Accepted: 02/20/2023] [Indexed: 03/06/2023]
Abstract
Objective(s) To assess laryngologic symptomatology following SARS-CoV-2 infection and determine whether symptom severity correlates with disease severity. Methods Single-institution survey study in participants with documented SARS-CoV-2 infection between March 2020 and February 2021. Data acquired included demographic, infection severity characteristics, comorbidities, and current upper aerodigestive symptoms via validated patient reported outcome measures. Primary outcomes of interest were scores of symptom severity questionnaires. COVID-19 severity was defined by hospitalization status. Descriptive subgroup analyses were performed to investigate differences in demographics, comorbidities, and symptom severity in hospitalized participants stratified by ICU status. Multivariate logistical regression was used to evaluate significant differences in symptom severity scores by hospitalization status. Results Surveys were distributed to 5300 individuals with upper respiratory infections. Ultimately, 470 participants with COVID-19 were included where 352 were hospitalized and 118 were not hospitalized. Those not hospitalized were younger (45.87 vs. 56.28 years), more likely female (74.17 vs. 58.92%), and less likely white (44.17 vs. 52.41%). Severity of dysphonia, dyspnea, cough, and dysphagia was significantly worse in hospitalized patients overall and remained worse at all time points. Cough severity paradoxically worsened in hospitalized respondents over time. Dyspnea scores remained abnormally elevated in respondents even 12 months after resolution of infection. Conclusion Results indicate that laryngologic symptoms are expected to be worse in patients hospitalized with COVID-19. Dyspnea and cough symptoms can be expected to persist or even worsen by one-year post infection in those who were hospitalized. Dysphagia and dysphonia symptoms were mild. Non-hospitalized participants tended to have minimal residual symptoms by one year after infection.
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Affiliation(s)
- Emerson Bouldin
- Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA 30322
| | - Shelly Sandeep
- Emory University Hospital Midtown, Medical Office Tower, 9th Floor Voice Center, 550 Peachtree St. NE, Atlanta, GA 30308
| | - Amanda Gillespie
- Emory University Hospital Midtown, Medical Office Tower, 9th Floor Voice Center, 550 Peachtree St. NE, Atlanta, GA 30308
| | - Andrew Tkaczuk
- Emory University Hospital Midtown, Medical Office Tower, 9th Floor Voice Center, 550 Peachtree St. NE, Atlanta, GA 30308,Corresponding Author: Andrew T. Tkaczuk, Emory University School of Medicine, Division of Laryngology, Department of Otolaryngology-Head & Neck Surgery, Emory University Hospital Midtown, Medical Office Tower, 9th Floor Voice Center, 550 Peachtree St. NE, Atlanta, GA 30308, Tell: 404-778-3381, Fax: 404-686-4699
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Molfenter SM, Amin MR, Balou M, Herzberg EG, Frempong-Boadu A. A scoping review of the methods used to capture dysphagia after anterior cervical discectomy and fusion: the need for a paradigm shift. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:969-976. [PMID: 36625955 PMCID: PMC10805127 DOI: 10.1007/s00586-022-07515-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 12/02/2022] [Accepted: 12/20/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Dysphagia is the most commonly reported complication of annterior cervical discectomy and fusion (ACDF) surgery. However, the incidence of dysphagia post-ACDF varies widely-partly attributable to differing outcome measures used to capture dysphagia. Our objective was to conduct a scoping review of the literature to quantify which dysphagia outcome measures have been employed post-ACDF and examine trends by study design, year, and location. METHODS After removing duplicates, 2396 abstracts were screened for inclusion. A total of 480 studies were eligible for full-text review. After applying exclusion criteria, data was extracted from 280 studies. We extracted the dysphagia outcome measure(s), study design (prospective vs retrospective), year, and location (country). Approximately 10% of studies were repeated for intra-rater agreement. RESULTS In total, 317 dysphagia outcome measures were reported in 280 studies (primarily retrospective-63%). The largest proportion of outcome measures were categorized as "unvalidated patient-reported outcome measures" (46%), largely driven by use of the popular Bazaz scale. The next most common categories were "insufficient detail" and "validated patient-reported outcome measures" (both 16%) followed by "chart review/database" (13%) and instrumental assessment (7%). Studies examining dysphagia post-ACDF steadily increased over the years and the use of validated measures increased in the past 10 years. CONCLUSIONS This scoping review of the literature highlights that nearly half of the ACDF dysphagia literature relies on unvalidated patient-reported outcome measures. The current understanding of the mechanism, timeline, and presentation of dysphagia post-ACDF are likely limited due to the metrics that are most commonly reported in the literature.
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Affiliation(s)
- Sonja M Molfenter
- Department of Communicative Sciences and Disorders, NYU Steinhardt, 665 Broadway, Room 622, New York, NY, 10012, USA.
- Rusk Rehabilitation, NYU Langone Health, New York, NY, USA.
| | - Milan R Amin
- Department of Otolaryngology, Head & Neck Surgery, NYU Langone Health, New York, NY, USA
| | - Matina Balou
- Department of Otolaryngology, Head & Neck Surgery, NYU Langone Health, New York, NY, USA
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Clinical profile and recovery pattern of dysphagia in the COVID-19 patient: A prospective observational cohort within NSW. Aust Crit Care 2023; 36:262-268. [PMID: 35177342 PMCID: PMC8758281 DOI: 10.1016/j.aucc.2022.01.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 12/22/2021] [Accepted: 01/04/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The impact of COVID-19 on swallowing function is not well understood. Despite low hospital admission rates in Australia, the virus and subsequent treatment affects swallow function in those requiring intensive care unit (ICU) treatment. As such, the current pandemic provides a unique opportunity to describe swallowing function and outline dysphagia characteristics and trajectory of recovery for a series of cases across NSW. AIM The aims of this study were to describe (i) physiological characteristics of swallowing dysfunction and (ii) pattern of swallowing recovery and outcomes, in ICU patients with COVID-19. METHODS All patients admitted to 17 participating NSW Health ICU sites over a 12-month period (March 2020-March 2021), diagnosed with COVID-19, treated with the aim for survival, and seen by a speech pathologist for clinical swallowing examination during hospital admission were considered for inclusion. Demographic, critical care airway management, speech pathology treatment, and swallowing outcome data were collected. RESULTS Twenty-seven patients (22 male; 5 female) with a median age of 65 years (interquartile range [IQR] = 15.5) were recruited. All required mechanical ventilation. Almost 90% of the total cohort had pre-existing comorbidities, with the two most frequently observed being diabetes (63%, 95% confidence interval = 44%-78%) and cardiac disease (59%, 95% confidence interval = 40%-75%) in origin. Prevalence of dysphagia was 93%, with the majority (44%) exhibiting profound dysphagia at the initial assessment. Median duration to initiate oral feeding was 38.5 days (IQR = 31.25) from ICU admission, and 33% received dysphagia rehabilitation. Dysphagia recovery was observed in 81% with a median duration of 44 days (IQR = 29). Positive linear associations were identified between duration of intubation, mechanical ventilation, hospital and ICU length of stay, and the duration to speech pathology assessment (p < 0.005), dysphagia severity (p < 0.002), commencing oral intake (p < 0.02), dysphagia recovery (p < 0.004), and enteral feeding (p < 0.024). CONCLUSION COVID-19 considerably impacted swallowing function in the current study. Although many patients recovered within an acceptable timeframe, some experienced persistent severe dysphagia and a protracted recovery with dependence on enteral nutrition.
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Lin CW, Chiang TY, Chen WC, Chiu LW, Su YC, Lin HC, Chang CT. Is Postextubation Dysphagia Underestimated in the Era of COVID-19? A Systematic Review and Meta-Analysis. Otolaryngol Head Neck Surg 2023; 168:935-943. [PMID: 36842159 DOI: 10.1002/ohn.168] [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: 07/21/2022] [Revised: 09/01/2022] [Accepted: 09/04/2022] [Indexed: 02/27/2023]
Abstract
OBJECTIVE To investigate the incidence rate of postextubation dysphagia (PED) in patients with COVID-19, as well as relative factors potentially influencing the clinical course of dysphagia. DATA SOURCES Six databases including PubMed, MEDLINE, Embase, ScienceDirect, the Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science were searched with no restriction on the language. REVIEW METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Data were extracted and cross-examined among 3 of the authors. The random-effects model was adopted for the statistical synthesis. The percentage and 95% confidence interval (CI) were adopted as the effect measurements of the PED incidence rate. Subgroup analyses, sensitivity analyses, and metaregression were also performed to identify the heterogeneity among the studies. RESULTS A total of 594 patients were enrolled and analyzed from the 10 eligible studies. The weighted incidence of PED in patients with COVID-19 was 66.5% (95% CI: 49.7%-79.9%). Age was the potential factor influencing the incidence rate after heterogeneity was adjusted by the metaregression analysis. CONCLUSION Compared to the current evidence reporting only 41% of the non-COVID patients experienced PED, our study further disclosed that a higher 66.5% of COVID-19 patients suffered from PED, which deserves global physicians' attention. With the association between COVID-19 and dysphagia having been more clearly understood, future clinicians are suggested to identify intubated patients' risk factors earlier to strengthen PED care programs in the era of COVID-19.
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Affiliation(s)
- Chung-Wei Lin
- Department of Education, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Ting-Yi Chiang
- Department of Education, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Wen-Ching Chen
- Department of General Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Li-Wen Chiu
- Department of Education, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Yung-Chung Su
- Department of General Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsin-Ching Lin
- Department of Otolaryngology, Division of Laryngology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Business Management and Institute of Biomedical Science, Institute of Healthcare Management, National Sun Yat-sen University, Kaohsiung, Taiwan.,Sleep Center, Robotic Surgery Center and Center for Quality Management, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chun-Tuan Chang
- Department of Business Management and Institute of Biomedical Science, Institute of Healthcare Management, National Sun Yat-sen University, Kaohsiung, Taiwan
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Abstract
Coronavirus (COVID-19) infection usually causes mild symptoms in children. However, serious complications may occur as a result of both acute infection or in association with the multisystem inflammatory syndrome (MIS-C). Dysphagia may develop as a sequela of COVID-19. We review the limited data on dysphagia associated with COVID-19 infection in children. Children can develop acute respiratory distress syndrome (ARDS) due to severe COVID-19 infection leading to endotracheal intubation and mechanical ventilation. These children can possibly develop post-intubation dysphagia. Screening for the presence of dysphagia, in an effort to minimize aspiration, in children with active COVID-19 infection must be done carefully to reduce the risk of transmission of the virus. Those children diagnosed with persistent dysphagia after COVID-19 infection has resolved will need further evaluation and management by pediatric subspecialists experienced in treating children with this condition. We recommend, this evaluation and treatment be done by a pediatric aerodigestive team.
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Affiliation(s)
- James D Tutor
- Program in Pediatric Pulmonary Medicine, Division of Pulmonology, Department of Pediatrics, University of Tennessee Health Science Center, LeBonheur Children's Hospital, Faculty Office Building, Room 224, 49 North Dunlap Street, Memphis, TN, 38105, USA.
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Xia C, Ji J. The Characteristics and Predicators of Post-extubation Dysphagia in ICU Patients with Endotracheal Intubation. Dysphagia 2023; 38:253-259. [PMID: 35729419 DOI: 10.1007/s00455-022-10462-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 11/22/2021] [Indexed: 01/27/2023]
Abstract
The current status and characteristics of post-extubation dysphagia in intensive care unit (ICU) patients with endotracheal intubation remain unclear, we aimed to evaluate the characteristics and identify the predicators for post-extubation dysphagia, to provide reliable reference to the clinical management and nursing care of dysphagia. Patients who underwent tracheal intubation for mechanical ventilation in the ICU of our hospital from January 1, 2020-May 31, 2021 were selected. The characteristics of patients with and without post-extubation dysphagia were analyzed. Univarinate and binary logistic regression analysis were used to screen the risk factors of dysphagia after extubation, and we established the risk prediction model according to the regression coefficients of each risk factor. 316 ICU patients with endotracheal intubation were included, the incidence of post-extubation dysphagia was 27.85%. Logistic regression analysis showed that age ≥ 65 years (OR 2.368, 95%CI 1.633 ~ 3.946), APACHE II score ≥ 15 (OR 3.727, 95%CI 3.312 ~ 4.202), length of tracheal intubation indwelling ≥ 72 h (OR 2.495, 95%CI 1.824 ~ 3.715), length of gastric tube stay ≥ 72 h (OR 1.923, 95%CI 1.452 ~ 2.882) were the risk factors of post-extubation dysphagia in ICU patients with endotracheal intubation(all p < 0.05). Six score was used as the cuff value of the model with good sensitivity and specificity. The area under the ROC curve and 95% confidence interval was 0.822 (0.746, 0.872). There are many risks of post-extubation dysphagia in ICU patients with endotracheal intubation. For high-risk patients with a score ≥ 6, early nursing care and interventions should be given as soon as possible to reduce the post-extubation dysphagia.
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Affiliation(s)
- Chenyun Xia
- Department of Emergency, The Second Affiliated Hospital of Nantong University, Nantong, China
| | - Jianhong Ji
- Intensive Care Unit, The Second Affiliated Hospital of Nantong University, No. 6 of Haierxiang North Road, Chongchuan District, Nantong, China.
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Royals WJ, Gillis RJ, Campbell JL. A Decision Guide for Assessing the Recently Extubated Patient's Readiness for Safe Oral Intake. Crit Care Nurse 2023; 43:42-51. [PMID: 36720280 DOI: 10.4037/ccn2023722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Postextubation dysphagia is a known consequence of endotracheal intubation. Several risk factors for postextubation dysphagia have been identified that could be used to help determine which patients should undergo swallowing assessment by an appropriate professional. LOCAL PROBLEM At the authors' institution, critical care nurses, health care providers, and speech-language pathology professionals lacked a clear process for referring patients for swallowing assessment after extubation, resulting in inefficiency and confusion. Information to guide their decision-making in this area was needed. To address this need, a multidisciplinary group convened and developed a guide with specific indicators. METHODS A review of the literature on postextubation dysphagia was conducted to determine the most appropriate indicators for the guide, which was piloted in the medical intensive care unit. The utilization rate was calculated. Referrals to speech-language pathology professionals were tabulated before and after the project. RESULTS During the 11 months before implementation of the project, there were 994 speech-language pathology consultations for postextubation evaluation of swallowing. During the 11 months after implementation, there were 831 consultations, representing a 16.4% reduction. The decline in consultations resulted in cost savings in addition to preventing unnecessary testing before patients' resumption of oral intake. The utilization rate for the guide during the project was 58%. CONCLUSION The decision guide was an effective tool to help nurses and health care providers determine which patients should be referred to speech-language pathology professionals for swallowing assessment after extubation, facilitating the appropriate use of limited health care resources.
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Affiliation(s)
- Waverlyn J Royals
- Waverlyn J. Royals is a speech-language pathology clinical specialist and student education coordinator for Rehabilitation Services, ECU Health Medical Center, Greenville, North Carolina
| | - Rita J Gillis
- Rita J. Gillis is a retired speech-language pathologist. At the time this project was initiated, she was Director of Performance Improvement and Professional Practice for Rehabilitation Services, ECU Health Medical Center
| | - Jarvis L Campbell
- Jarvis L. Campbell is an assistant nurse manager for the medical intensive care unit and the Continuous Renal Replacement Therapy program, ECU Health Medical Center
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Martínez de Lagrán Zurbano I, Laguna LB, Soria CV, Guisasola CP, Marcos-Neira P. Utility of the modified Volume-Viscosity Swallow Test for bedside screening of dysphagia in critically ill patients. Clin Nutr ESPEN 2023; 53:214-223. [PMID: 36657916 DOI: 10.1016/j.clnesp.2022.12.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 12/19/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND AIM Aspiration and dysphagia are frequent in critically ill patients, and evidence of the validity of bedside screening tests is lacking. This study evaluated the modified Volume-Viscosity Swallow Test (mV-VST) as a screening tool for aspiration and dysphagia in intensive care unit patients. METHODS An observational, prospective longitudinal cohort single-center study included patients older than 18 years old, on mechanical ventilation for at least 48 h, conscious and cooperative. Patients had been admitted in intensive care between March 2016 and August 2019 at a university hospital in Spain. Data from the mV-VST and the flexible endoscopic evaluation of swallowing (FEES) test in extubated and tracheostomized patients were collected; the ROC curve was obtained for each group, and the sensitivity (Se), specificity (Sp), positive (pPV) and negative (nPV) predictive values of mV-VST were calculated and compared with the FEES results. We calculated percentages and 95% confidence intervals (CI) for qualitative variables and means or medians for quantitative variables according to the Shapiro-Wilk test. A univariate analysis identified dysphagia risk factors in each group. RESULTS The study included 87 patients: 44 extubated and 43 tracheostomized with similar age, body mass index, Sequential Organ Failure Assessment, Charlson comorbidity index, type and reason for admission. Aspiration with FEES was significantly higher in extubated patients than in tracheostomized patients, 43.2% vs. 23.2%, respectively, p = 0.04. With the mV-VST, aspiration was detected in 54.5% of extubated patients and in 39.5% of tracheostomized patients. In the extubated group, the Se of mV-VST to detect aspiration was 89.5%, Sp was 72%, and nPV was 90%. In the tracheostomized group, Se was 100%, Sp was 78.8%, and nPV was 100%. The ROC curve showed that mV-VST similarly identifies aspiration in extubated and tracheostomized patients. CONCLUSIONS Dysphagia and aspiration are frequent amongst patients in intensive care after mechanical ventilation. The mV-VST is a valid screening tool to detect aspiration and dysphagia in extubated and tracheostomized patients.
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Affiliation(s)
- Itziar Martínez de Lagrán Zurbano
- Department of Intensive Care Medicine, Germans Trias i Pujol University Hospital, Badalona, Spain; Doctoral Programme in Surgery and Morphological Sciences of the Univ Autonoma of Barcelona, Passeig de la Vall D'hebrón 119-129, 08035 Barcelona, Spain.
| | - Luisa Bordejé Laguna
- Department of Intensive Care Medicine, Germans Trias i Pujol University Hospital, Badalona, Spain.
| | - Constanza Viña Soria
- Department of Otorhinolaryngology, Germans Trias i Pujol University Hospital, Badalona, Spain.
| | - Carlos Pollán Guisasola
- Department of Otorhinolaryngology, Germans Trias i Pujol University Hospital, Badalona, Spain.
| | - Pilar Marcos-Neira
- Department of Intensive Care Medicine, Germans Trias i Pujol University Hospital, Badalona, Spain.
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Heidler MD. [Dysphagia in Tracheostomized Patients after Long-Term Mechanical Ventilation - Become Sensitive to Reduced Pharyngo-Laryngeal Sensitivity]. Laryngorhinootologie 2023; 102:27-31. [PMID: 36580929 DOI: 10.1055/a-1076-9686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Independent of the type of critical illness, tracheostomized patients have a high risk of developing a dysphagia. This is potentially life-threatening as it can lead to aspiration and pneumonia. It is therefore essential to perform swallowing diagnostics by means of a bolus dyeing test and/or FEES before oral feeding. Since a physiological airflow through the larynx and adequate subglottic pressure are key components of an effective swallowing act, oralisation should be avoided as far as possible with a blocked tracheal cannula.
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Affiliation(s)
- M-D Heidler
- Neurologisches Rehabilitationszentrum (N1), Brandenburg-Klinik, Bernau
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A Predictive Model for Dysphagia after Ventilator Liberation in Severe Pneumonia Patients Receiving Tracheostomy: A Single-Center, Observational Study. J Clin Med 2022; 11:jcm11247391. [PMID: 36556007 PMCID: PMC9785512 DOI: 10.3390/jcm11247391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/08/2022] [Accepted: 12/12/2022] [Indexed: 12/15/2022] Open
Abstract
The main purpose of this study was to develop a model predictive of dysphagia in hospital survivors with severe pneumonia who underwent tracheostomy during their hospital stay. The present study included 175 patients (72% male; mean age, 71.3 years) over 5 years. None of these patients had a history of deglutition disorder before hospital admission. Binary logistic regression analysis was performed to identify factors predicting dysphagia at hospital discharge. Dysphagia scores were calculated from β-coefficients and by assigning points to variables. Of the enrolled patients, 105 (60%) had dysphagia at hospital discharge. Factors prognostic of dysphagia at hospital discharge included being underweight (body mass index < 18.5 kg/m2), non-participation in a dysphagia therapy program, mechanical ventilation ≥ 15 days, age ≥ 74 years, and chronic neurologic diseases. Underweight and non-participation in a dysphagia therapy program were assigned +2 points and the other factors were assigned +1 point. Dysphagia scores showed acceptable discrimination (area under the receiver operating characteristic curve for dysphagia 0.819, 95% confidence interval: 0.754−0.873, p < 0.001) and calibration (Hosmer−Lemeshow chi-square = 9.585, with df 7 and p = 0.213). The developed dysphagia score was predictive of deglutition disorder at hospital discharge in tracheostomized patients with severe pneumonia.
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Kregel HR, Attia M, Pedroza C, Meyer DE, Wandling MW, Dodwad SJM, Wade CE, Harvin JA, Kao LS, Puzio TJ. Dysphagia is associated with worse clinical outcomes in geriatric trauma patients. Trauma Surg Acute Care Open 2022; 7:e001043. [PMID: 36483590 PMCID: PMC9723949 DOI: 10.1136/tsaco-2022-001043] [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: 10/14/2022] [Accepted: 11/18/2022] [Indexed: 12/09/2022] Open
Abstract
Introduction Dysphagia is associated with increased morbidity, mortality, and resource utilization in hospitalized patients, but studies on outcomes in geriatric trauma patients with dysphagia are limited. We hypothesized that geriatric trauma patients with dysphagia would have worse clinical outcomes compared with those without dysphagia. Methods Patients with and without dysphagia were compared in a single-center retrospective cohort study of trauma patients aged ≥65 years admitted in 2019. The primary outcome was mortality. Secondary outcomes included intensive care unit (ICU) length of stay (LOS), hospital LOS, discharge destination, and unplanned ICU admission. Multivariable regression analyses and Bayesian analyses adjusted for age, Injury Severity Score, mechanism of injury, and gender were performed to determine the association between dysphagia and clinical outcomes. Results Of 1706 geriatric patients, 69 patients (4%) were diagnosed with dysphagia. Patients with dysphagia were older with a higher Injury Severity Score. Increased odds of mortality did not reach statistical significance (OR 1.6, 95% CI 0.6 to 3.4, p=0.30). Dysphagia was associated with increased odds of unplanned ICU admission (OR 4.6, 95% CI 2.0 to 9.6, p≤0.001) and non-home discharge (OR 5.2, 95% CI 2.4 to 13.9, p≤0.001), as well as increased ICU LOS (OR 4.9, 95% CI 3.1 to 8.1, p≤0.001), and hospital LOS (OR 2.1, 95% CI 1.7 to 2.6, p≤0.001). On Bayesian analysis, dysphagia was associated with an increased probability of longer hospital and ICU LOS, unplanned ICU admission, and non-home discharge. Conclusions Clinically apparent dysphagia is associated with poor outcomes, but it remains unclear if dysphagia represents a modifiable risk factor or a marker of underlying frailty, leading to poor outcomes. This study highlights the importance of screening protocols for dysphagia in geriatric trauma patients to possibly mitigate adverse outcomes. Level of evidence Level III.
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Affiliation(s)
- Heather R Kregel
- Department of Surgery, McGovern Medical School at the University of Texas Health Science Center, Houston, Texas, USA
| | - Mina Attia
- Department of Surgery, McGovern Medical School at the University of Texas Health Science Center, Houston, Texas, USA
| | - Claudia Pedroza
- Center for Clinical Research and Evidence-Based Medicine, McGovern Medical School at the University of Texas Health Science Center, Houston, Texas, USA
| | - David E Meyer
- Department of Surgery, McGovern Medical School at the University of Texas Health Science Center, Houston, Texas, USA
| | - Michael W Wandling
- Department of Surgery, McGovern Medical School at the University of Texas Health Science Center, Houston, Texas, USA
| | - Shah-Jahan M Dodwad
- Department of Surgery, McGovern Medical School at the University of Texas Health Science Center, Houston, Texas, USA
| | - Charles E Wade
- Center for Translational Injury Research, McGovern Medical School at The University of Texas at Houston, Houston, TX, USA
| | - John A Harvin
- Department of Surgery, McGovern Medical School at the University of Texas Health Science Center, Houston, Texas, USA
| | - Lillian S Kao
- Department of Surgery, McGovern Medical School at the University of Texas Health Science Center, Houston, Texas, USA
| | - Thaddeus J Puzio
- Department of Surgery, McGovern Medical School at the University of Texas Health Science Center, Houston, Texas, USA
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McIntyre ML, Chimunda T, Murray J, Lewis TW, Doeltgen SH. The prevalence of post-extubation dysphagia in critically ill adults: an Australian data linkage study. CRIT CARE RESUSC 2022; 24:352-359. [PMID: 38047004 PMCID: PMC10692610 DOI: 10.51893/2022.4.oa5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Objective: To define the prevalence of dysphagia after endotracheal intubation in critically ill adult patients. Design: A retrospective observational data linkage cohort study using the Australian and New Zealand Intensive Care Society Adult Patient Database and a mandatory government statewide health care administration database. Setting: Private and public intensive care units (ICUs) within Victoria, Australia. Participants: Adult patients who required endotracheal intubation for the purpose of mechanical ventilation within a Victorian ICU between July 2013 and June 2018. Main outcome measures: Presence of dysphagia, aspiration pneumonia, ICU length of stay, hospital length of stay, and cost per episode of care. Results: Endotracheal intubation in the ICU was required for 71 124 patient episodes across the study period. Dysphagia was coded in 7.3% (n = 5203) of those episodes. Patients with dysphagia required longer ICU (median, 154 [interquartile range (IQR), 78-259] v 53 [IQR, 27-107] hours; P < 0.001) and hospital admissions (median, 20 [IQR, 13-30] v 8 [IQR, 5-15] days; P < 0.001), were more likely to develop aspiration pneumonia (17.2% v 5.6%; odds ratio, 3.0; 95% CI, 2.8-3.2; P < 0.001), and the median health care expenditure increased by 93% per episode of care ($73 586 v $38 108; P < 0.001) compared with patients without dysphagia. Conclusions: Post-extubation dysphagia is associated with adverse patient and health care outcomes. Consideration should be given to strategies that support early identification of patients with dysphagia in the ICU to determine if these adverse outcomes can be reduced.
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Affiliation(s)
- Melanie L. McIntyre
- Swallowing Neurorehabilitation Research Lab, Speech Pathology, Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
- Department of Speech Pathology, Bendigo Health, Bendigo, VIC, Australia
| | - Timothy Chimunda
- Department of Critical Care, Northern Health, Epping, VIC, Australia
- University of Queensland, Brisbane, QLD, Australia
- University of Melbourne, Melbourne, VIC, Australia
| | - Joanne Murray
- Swallowing Neurorehabilitation Research Lab, Speech Pathology, Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Trent W. Lewis
- Medical Devices Research Institute, Flinders University, Adelaide, SA, Australia
- College of Science Engineering, Flinders University, Adelaide, SA, Australia
| | - Sebastian H. Doeltgen
- Swallowing Neurorehabilitation Research Lab, Speech Pathology, Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
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Ramos A, Joaquin C, Ros M, Martin M, Cachero M, Sospedra M, Martínez E, Sánchez Migallón JM, Sendrós MJ, Soldevila B, Puig-Domingo M. Impact of COVID-19 on nutritional status during the first wave of the pandemic. Clin Nutr 2022; 41:3032-3037. [PMID: 34049748 PMCID: PMC8106234 DOI: 10.1016/j.clnu.2021.05.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 04/18/2021] [Accepted: 05/04/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND & AIMS Patients affected by COVID-19 may develop disease related malnutrition (DRM) due to the catabolic situation, symptoms that interfere with intake and prolonged hospital stay. This study aims to know the percentage of patients admitted for COVID-19 who required artificial nutrition (AN), their clinical characteristics, as well as the prevalence of DRM and the risk of sarcopenia at hospital discharge and after 6 months. MATERIAL AND METHODS Observational, prospective study, with successive inclusion of adult patients admitted for COVID-19 in whom institutional nutritional support (NS) care protocol was applied. Those who received AN underwent a nutritional screening by Short Nutritional Assessment Questionnaire (SNAQ) and an assessment by Subjective Global Assessment (SGA) at hospital discharge, as well as a screening for sarcopenia (SARC-F test) and SNAQ re-test 15 days and 6 months after by a phone call. Symptoms related to food intake, anthropometric and analytical data were also collected. RESULTS We evaluated 936 patients with a mean age of 63.7 ± 15.3 years; predominantly male (59.7%), overweight 41%, obesity 40.4%; hypertension 52.9%; diabetes mellitus 26.6% and cancer 10.4%. The stay hospital length was 17.3 ± 13.8 days and 13.6% patients died during hospitalization. The modality of nutritional support was: 86.1% dietary adaptation + oral nutritional supplements (ONS); 12.4% enteral nutrition (EN) by nasogastric (NG) tube; 0.9% parenteral nutrition (PN) and 0.6% EN plus PN. Focusing on patients who received AN, follow-up post discharge was possible in 62 out of 87 who survived. Of these, at the time of hospital discharge, 96.7% presented nutritional risk by SNAQ and 100% malnutrition by SGA (20% B; 80% C). During admission, 82.3% presented intense anorexia and the mean weight loss was 10.9 ± 6 Kg (p < 0.001). Fifteen days after being discharged, 12.9% still had anorexia, while hyperphagia appeared in 85.5% of the patients and risk of sarcopenia by SARC-F was present in 87.1% of them. Six months after discharge, 6.8% still had anorexia and 3.4% hyperphagia, with a global weight gain of 4.03 ± 6.2 Kg (p=<0.0001). Risk of malnutrition was present in only 1.7% of the patients, although risk of sarcopenia persisted in 49.2%. CONCLUSION All patients admitted by COVID-19 for whom EN or PN were indicated following an institutional protocol still presented malnutrition at hospital discharge, and almost all showed risk of sarcopenia, that persisted in almost half of them at 6 months. These findings suggest that nutritional and functional problems persist in these patients after discharge, indicating that they require prolonged nutritional support and monitoring.
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Affiliation(s)
- Analía Ramos
- Endocrinology and Nutrition Service, Hospital Universitari Germans Trias i Pujol, Badalona, Spain,Autonomous University of Barcelona, Barcelona, Spain
| | - Clara Joaquin
- Endocrinology and Nutrition Service, Hospital Universitari Germans Trias i Pujol, Badalona, Spain,Autonomous University of Barcelona, Barcelona, Spain
| | - Mireia Ros
- Endocrinology and Nutrition Service, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Mariona Martin
- Endocrinology and Nutrition Service, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Montserrat Cachero
- Endocrinology and Nutrition Service, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - María Sospedra
- Endocrinology and Nutrition Service, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Eva Martínez
- Endocrinology and Nutrition Service, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | - María-José Sendrós
- Endocrinology and Nutrition Service, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Berta Soldevila
- Endocrinology and Nutrition Service, Hospital Universitari Germans Trias i Pujol, Badalona, Spain,Autonomous University of Barcelona, Barcelona, Spain
| | - Manel Puig-Domingo
- Endocrinology and Nutrition Service, Hospital Universitari Germans Trias i Pujol, Badalona, Spain,Autonomous University of Barcelona, Barcelona, Spain,Corresponding author. Endocrinology and Nutrition Service, Hospital Universitari Germans Trias i Pujol, Ctra. Canyet s / n, 08916, Badalona, Barcelona, Spain
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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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Miles A, McRae J, Clunie G, Gillivan-Murphy P, Inamoto Y, Kalf H, Pillay M, Pownall S, Ratcliffe P, Richard T, Robinson U, Wallace S, Brodsky MB. An International Commentary on Dysphagia and Dysphonia During the COVID-19 Pandemic. Dysphagia 2022; 37:1349-1374. [PMID: 34981255 PMCID: PMC8723823 DOI: 10.1007/s00455-021-10396-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 12/01/2021] [Indexed: 12/16/2022]
Abstract
COVID-19 has had an impact globally with millions infected, high mortality, significant economic ramifications, travel restrictions, national lockdowns, overloaded healthcare systems, effects on healthcare workers' health and well-being, and large amounts of funding diverted into rapid vaccine development and implementation. Patients with COVID-19, especially those who become severely ill, have frequently developed dysphagia and dysphonia. Health professionals working in the field have needed to learn about this new disease while managing these patients with enhanced personal protective equipment. Emerging research suggests differences in the clinical symptoms and journey to recovery for patients with COVID-19 in comparison to other intensive care populations. New insights from outpatient clinics also suggest distinct presentations of dysphagia and dysphonia in people after COVID-19 who were not hospitalized or severely ill. This international expert panel provides commentary on the impact of the pandemic on speech pathologists and our current understanding of dysphagia and dysphonia in patients with COVID-19, from acute illness to long-term recovery. This narrative review provides a unique, comprehensive critical appraisal of published peer-reviewed primary data as well as emerging previously unpublished, original primary data from across the globe, including clinical symptoms, trajectory, and prognosis. We conclude with our international expert opinion on what we have learnt and where we need to go next as this pandemic continues across the globe.
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Affiliation(s)
- Anna Miles
- Speech Science, School of Psychology, The University of Auckland, Grafton Campus, Private Bag 92019, Auckland, New Zealand.
| | - Jackie McRae
- Centre for Allied Health, St George's, University of London/University College London Hospitals NHS Foundation Trust, London, UK
| | - Gemma Clunie
- Imperial College London & Clinical Specialist SLT (Airways/ENT), Imperial College Healthcare NHS Trust, London, UK
| | - Patricia Gillivan-Murphy
- Clinical Specialist SLT, Voice & Swallowing Clinic, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Yoko Inamoto
- SLHT, Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Japan
| | - Hanneke Kalf
- Division of Speech Pathology, Department of Rehabilitation, Radboud University Medical Centre / Donders Centre for Neuroscience, Nijmegen, The Netherlands
| | - Mershen Pillay
- Speech-Language Therapy, University of KwaZulu-Natal, Durban, South Africa
| | - Susan Pownall
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Philippa Ratcliffe
- Consultant SLT Royal National ENT and EDH University College London Hospitals NHS Foundation Trust, London, UK
| | - Theresa Richard
- Mobile Dysphagia Diagnostics, Medical SLP Collective, Buffalo, USA
| | - Ursula Robinson
- SLT, Belfast City Hospital, Belfast Health & Social Care Trust, Belfast, UK
| | - Sarah Wallace
- Consultant SLT, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Martin B Brodsky
- Division of Pulmonary and Critical Care Medicine, Department of Physical Medicine and Rehabilitation, Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, MD, USA
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Dysphagia and mechanical ventilation in SARS-COV-2 pneumonia: It's real. Clin Nutr 2022; 41:2927-2933. [PMID: 34879968 PMCID: PMC8608682 DOI: 10.1016/j.clnu.2021.11.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 10/27/2021] [Accepted: 11/19/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND & AIMS Dysphagia can be a consequence of prolonged hospitalization in intensive care units (ICUs) due to severe SARS-CoV-2 pneumonia. This study aims at Identifying the risk factors for dysphagia in ICU patients with COVID-19 pneumonia requiring invasive mechanical ventilation, and at determining the frequency of postextubation dysphagia in this population. METHODS Observational, descriptive, retrospective, cohort study of SARS-CoV-2 pneumonia patients admitted into the ICUs from March to May 2020. The Modified Viscosity Volume Swallowing Test (mV-VST) was used to screening for dysphagia during the first 48 h of extubation in patients requiring mechanical ventilation. Descriptive statistics, univariate and multivariate analyses were conducted. A logistic regression was applied to construct a predictive model of dysphagia. RESULTS A total of 232 patients were admitted into the ICUs (age [median 60.5 years (95% CI: 58.5 to 61.9)]; male [74.1% (95% CI: 68.1 to 79.4)]; APACHE II score [median 17.7 (95% CI: 13.3 to 23.2)]; length of mechanical ventilation [median 14 days (95% CI: 11 to 16)]; prone position [79% (95% CI: 72.1 to 84.6)]; respiratory infection [34.5% (95% CI: 28.6 to 40.9)], renal failure [38.5% (95% CI: 30 to 50)])). 72% (167) of patients required intubation; 65.9% (110) survived; and in 84.5% (93) the mV-VST was performed. Postextubation dysphagia was diagnosed in 26.9% (25) of patients. APACHE II, prone position, length of ICU and hospital stay, length of mechanical ventilation, tracheostomy, respiratory infection and kidney failure developed during admission were significantly associated (p < 0.05) with dysphagia. Dysphagia was independently explained by the APACHE II score (OR: 1.1; 95% CI: 1.01 to 1.3; p = 0.04) and tracheostomy (OR: 10.2; 95% CI: 3.2 to 32.1) p < 0.001). The predictive model forecasted dysphagia with a good ROC curve (AUC: 0.8; 95% CI: 0.7 to 0.9). CONCLUSIONS Dysphagia affects almost one-third of patients with SARS-COV-2 pneumonia requiring intubation in the ICU. The risk of developing dysphagia increases with prolonged mechanical ventilation, tracheostomy, and poorer prognosis on admission (worst APACHE II score).
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Flim M, Rustøen T, Blackwood B, Spronk P. Thirst in adult patients in the intensive care unit: protocol for a scoping review. BMJ Open 2022; 12:e063006. [PMID: 36446463 PMCID: PMC9710361 DOI: 10.1136/bmjopen-2022-063006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Thirst is one of the most bothersome symptoms experienced by intensive care unit (ICU) patients. Effective diagnosis and management of thirst in the ICU is essential, particularly as patients are less sedated than previously and more aware of this problem. Currently, no overview of publications on thirst identification and management in ICU patients exists. The scoping review will address the broad question 'What is known about thirst as a symptom in adult critically ill patients?' It aims to provide an overview of the causes and risk factors, diagnosis and measurement, the symptom dimensions and its interaction with other symptoms, and thirst management. METHODS AND ANALYSIS The review will follow the Joanna Briggs Institute methodology framework to guide the process and will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Methods include: defining the review questions, eligibility criteria, concepts of interest and context; and outlining the search strategy, study selection process, data extraction and analysis. PubMed, MEDLINE, EMBASE and CINAHL will be searched from inception to April 2022. ETHICS AND DISSEMINATION Ethical approval is not required, as the scoping review will synthesise information from available publications. The scoping review will be submitted for publication to a scientific journal, presented at relevant conferences and disseminated as part of future workshops with ICU support groups and the critical care professional community.
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Affiliation(s)
- Marleen Flim
- Intensive Care, Gelre Ziekenhuizen, Apeldoorn, The Netherlands
- Expertise centre for Intensive Care Rehabilitation Apeldoorn (ExpIRA), Apeldoorn, The Netherlands
| | - Tone Rustøen
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Norway, Oslo, Norway
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo universitetssykehus Ulleval, Oslo, Norway
| | - Bronagh Blackwood
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - Peter Spronk
- Intensive Care, Gelre Ziekenhuizen, Apeldoorn, The Netherlands
- Expertise centre for Intensive Care Rehabilitation Apeldoorn (ExpIRA), Apeldoorn, The Netherlands
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Lapa S, Neuhaus E, Harborth E, Neef V, Steinmetz H, Foerch C, Reitz SC. Dysphagia assessment in ischemic stroke after mechanical thrombectomy: When and how? Front Neurol 2022; 13:1024531. [PMID: 36504648 PMCID: PMC9726734 DOI: 10.3389/fneur.2022.1024531] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 11/08/2022] [Indexed: 11/24/2022] Open
Abstract
Background Dysphagia is a frequent symptom in acute ischemic stroke (AIS). Endovascular treatment (EVT) has become the standard of care for acute stroke secondary to large vessel occlusion. Although standardized guidelines for poststroke dysphagia (PSD) management exist, they do not account for this setting in which patients receive EVT under general anesthesia. Therefore, the aim of this study was to evaluate PSD prevalence and severity, as well as an appropriate time point for the PSD evaluation, in patients undergoing EVT under general anesthesia (GA). Methods We prospectively included 54 AIS patients undergoing EVT under GA. Fiberoptic Endoscopic Evaluation of Swallowing (FEES) was performed within 24 h post-extubation in all patients. Patients presenting significant PSD received a second FEES-assessment to determine the course of dysphagia deficits over time. Dysphagia severity was rated according the Fiberoptic Dysphagia Severity Scale (FEDSS). Results At first FEES (FEES 1) assessment, performed in the median 13 h (IQR 5-17) post-extubation, 49/54 patients (90.7%) with dysphagia were observed with a median FEDSS of 4 (IQR 3-6). Severe dysphagia requiring tube feeding was identified in 28/54 (51.9%) subjects, whereas in 21 (38.9%) patients early oral diet with certain food restrictions could be initiated. In the follow up FEES examination conducted in the median 72 h (IQR 70-97 h) after initial FEES 34/49 (69.4%) patients still presented PSD. Age (p = 0.030) and ventilation time (p = 0.035) were significantly associated with the presence of PSD at the second FEES evaluation. Significant improvement of dysphagia frequency (p = 0.006) and dysphagia severity (p = 0.001) could be detected between the first and second dysphagia assessment. Conclusions PSD is a frequent finding both immediately within 24 h after extubation, as well as in the short-term course. In contrast to common clinical practice, to delay evaluation of swallowing for at least 24 h post-extubation, we recommend a timely assessment of swallowing function after extubation, as 50% of patients were safe to begin oral intake. Given the high amount of severe dysphagic symptoms, we strongly recommend application of instrumental swallowing diagnostics due to its higher sensitivity, when compared to clinical swallowing examination. Furthermore, advanced age, as well as prolonged intubation, were identified as significant predictors for delayed recovery of swallowing function.
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Affiliation(s)
- Sriramya Lapa
- Department of Neurology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany,*Correspondence: Sriramya Lapa
| | - Elisabeth Neuhaus
- Institute of Neuroradiology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Elena Harborth
- Department of Neurology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Vanessa Neef
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Helmuth Steinmetz
- Department of Neurology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Christian Foerch
- Department of Neurology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Sarah Christina Reitz
- Department of Neurology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
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Catlow R, Cheeseman C, Newman H. COVID-19: Nutrition and functional outcomes for critical care survivors in a 400- bedded district general hospital in North London. J Intensive Care Soc 2022; 23:510-512. [PMID: 36751351 PMCID: PMC9679901 DOI: 10.1177/17511437211025420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Novel coronavirus disease (COVID-19) has resulted in huge numbers of critically ill patients. This study describes the inpatient recovery and rehabilitation needs of patients admitted with COVID-19 to the critical care unit of a 400 bedded general hospital in London, United Kingdom. The rehabilitation needs of our sample were considerable. It is recommended that the increase demand on allied health professionals capacity demonstrated is considered in future COVID-19-related workforce-planning.
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Affiliation(s)
- Rachel Catlow
- Rachel Catlow, Therapy Department, Barnet
Hospital, London NW3 2 QG, UK.
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Oda A, Oue K, Oda Y, Taguchi S, Takahashi T, Mukai A, Doi M, Shimizu Y, Irifune M, Yoshida M. Difficult intubation and postoperative aspiration pneumonia associated with Moebius syndrome: a case report. BMC Anesthesiol 2022; 22:316. [PMID: 36221060 PMCID: PMC9552434 DOI: 10.1186/s12871-022-01859-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 10/05/2022] [Indexed: 12/05/2022] Open
Abstract
Background Moebius syndrome is a rare congenital disorder characterized by non-progressive palsy of the abducens (VI) and facial (VII) cranial nerves. Its common features include dysfunctions associated with other cranial nerves, orofacial abnormalities, skeletal muscle hypotonia, and other systemic disorders of differing severities. There are several concerns in the perioperative management of patients with Moebius syndrome. Case presentation We present a report on the management of general anesthesia of a 14-year-old male patient with Moebius syndrome who was scheduled for mandibular cystectomy. The patient was diagnosed with Moebius syndrome at the age of 7 years based on his clinical manifestations of nerve palsy since birth and cranial nerve palsy of the trigeminal (V), facial (VII), glossopharyngeal (IX), vagus (X), and sublingual nerves (XII). The patient’s oral morphological abnormalities made intubation difficult. He also experienced dysphagia and aspiration pneumonia on a daily basis. Oral secretions were frequently suctioned postoperatively. However, after discharge, the patient developed aspiration pneumonia and was readmitted to the hospital. Conclusions The main problem arising when administering general anesthesia to patients with this syndrome is difficult airway management. The oral abnormalities in these patients, such as small jaw and extreme dental stenosis, make mask ventilation and intubation difficult. Furthermore, this syndrome often involves respiratory impairment and dysphagia due to cerebral nerve palsy, so there is a high risk of postoperative respiratory complications. Since multiple organs are affected in patients with Moebius syndrome, appropriate perioperative management strategies must be prepared for these patients.
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Affiliation(s)
- Aya Oda
- Department of Dental Anesthesiology, Division of Oral and Maxillofacial Surgery and Oral Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima, 734-8551, Japan
| | - Kana Oue
- Department of Dental Anesthesiology, Division of Oral and Maxillofacial Surgery and Oral Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima, 734-8551, Japan.
| | - Yuki Oda
- Department of Special Care Dentistry, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima, 734-8551, Japan
| | - Shima Taguchi
- Department of Anesthesiology and Critical Care, Hiroshima University, Hiroshima, Japan
| | - Tamayo Takahashi
- Department of Dental Anesthesiology, Division of Oral and Maxillofacial Surgery and Oral Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima, 734-8551, Japan
| | - Akari Mukai
- Department of Dental Anesthesiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Mitsuru Doi
- Department of Dental Anesthesiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yoshitaka Shimizu
- Department of Dental Anesthesiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Masahiro Irifune
- Department of Dental Anesthesiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Mitsuhiro Yoshida
- Department of Dental Anesthesiology, Division of Oral and Maxillofacial Surgery and Oral Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima, 734-8551, Japan
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Holdiman A, Rogus-Pulia N, Pulia MS, Stalter L, Thibeault SL. Risk Factors for Dysphagia in Patients Hospitalized with COVID-19. Dysphagia 2022; 38:933-942. [PMID: 36109398 PMCID: PMC9483550 DOI: 10.1007/s00455-022-10518-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 08/26/2022] [Indexed: 11/29/2022]
Abstract
Patients hospitalized with COVID-19 may be at risk for dysphagia and vulnerable to associated consequences. We investigated predictors for dysphagia and its severity in a cohort of patients hospitalized with COVID-19 at a single hospital center. A large level I trauma center database was queried for all patients hospitalized with COVID-19. Demographics, medical information associated with COVID-19, specific to dysphagia, and interventions were collected. 947 patients with confirmed COVID-19 met the criteria. 118 (12%) were seen for a swallow evaluation. Individuals referred for evaluation were significantly older, had a lower BMI, more severe COVID-19, and higher rates of intubation, pneumonia, mechanical ventilation, tracheostomy placements, prone positioning, and ARDS. Pneumonia (OR 3.57, p = 0.004), ARDS (OR 3.57, p = 0.029), prone positioning (OR 3.99, p = 0.036), ventilation (OR 4.01, p = 0.006), and intubation (OR 4.75, p = 0.007) were significant risk factors for dysphagia. Older patients were more likely to have more severe dysphagia such that for every 1-year increase in age, the odds of severe dysphagia were 1.04 times greater (OR 1.04, p = 0.028). Patients hospitalized with COVID-19 are at risk for dysphagia. We show predictive variables that should be considered when referring COVID-19 patients for dysphagia services to reduce time to intervention/evaluation.
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Affiliation(s)
- Anna Holdiman
- Division of Otolaryngology, Department of Surgery, UW-Madison, 5103 WIMR, 1111 Highland Ave., Madison, WI, 53705, USA
| | - Nicole Rogus-Pulia
- Division of Geriatrics and Gerontology, Department of Medicine, UW-Madison, Madison, WI, USA
| | - Michael S Pulia
- Department of Emergency Medicine, UW-Madison, Madison, WI, USA
| | - Lily Stalter
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, UW-Madison, Madison, WI, USA
| | - Susan L Thibeault
- Division of Otolaryngology, Department of Surgery, UW-Madison, 5103 WIMR, 1111 Highland Ave., Madison, WI, 53705, USA.
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Moisey LL, Merriweather JL, Drover JW. The role of nutrition rehabilitation in the recovery of survivors of critical illness: underrecognized and underappreciated. Crit Care 2022; 26:270. [PMID: 36076215 PMCID: PMC9461151 DOI: 10.1186/s13054-022-04143-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 08/25/2022] [Indexed: 11/10/2022] Open
Abstract
AbstractMany survivors of critical illness face significant physical and psychological disability following discharge from the intensive care unit (ICU). They are often malnourished, a condition associated with poor outcomes, and nutrition remains problematic particularly in the early phases of ICU recovery. Yet nutrition rehabilitation, the process of restoring or optimizing nutritional status following illness, is seldom prioritized, possibly because it is an underrecognized and underappreciated area in critical care rehabilitation and research. To date, 16 original studies have been published where one of the objectives includes measurement of indices relating to nutritional status (e.g., nutrition intake or factors impacting nutrition intake) in ICU survivors. The primary aim of this narrative review is to provide a comprehensive summary of key themes arising from these studies which form the basis of our current understanding of nutritional recovery and rehabilitation in ICU survivors. ICU survivors face a multitude of barriers in achieving optimal nutrition that are of physiological (e.g., poor appetite and early satiety), functional (e.g., dysphagia, reduced ability to feed independently), and psychological (e.g., low mood, body dysmorphia) origins. Organizational-related barriers such as inappropriate feeding times and meal interruptions frequently impact an ICU survivor’s ability to eat. Healthcare providers working on wards frequently lack knowledge of the specific needs of recovering critically ill patients which can negatively impact post-ICU nutrition care. Unsurprisingly, nutrition intake is largely inadequate following ICU discharge, with the largest deficits occurring in those who have had enteral nutrition prematurely discontinued and rely on an oral diet as their only source of nutrition. With consideration to themes arising from this review, pragmatic strategies to improve nutrition rehabilitation are explored and directions for future research in the field of post-ICU nutrition recovery and rehabilitation are discussed. Given the interplay between nutrition and physical and psychological health, it is imperative that enhancing the nutritional status of an ICU survivor is considered when developing multidisciplinary rehabilitation strategies. It must also be recognized that dietitians are experts in the field of nutrition and should be included in stakeholder meetings that aim to enhance ICU rehabilitation strategies and improve outcomes for survivors of critical illness.
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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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