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Screening Tools Designed to Assess and Evaluate Oropharyngeal Dysphagia in Adult Patients: A Scoping Review. NURSING REPORTS 2022; 12:245-258. [PMID: 35466245 PMCID: PMC9036293 DOI: 10.3390/nursrep12020025] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/10/2022] [Accepted: 03/23/2022] [Indexed: 11/17/2022] Open
Abstract
Oropharyngeal Dysphagia (OD) significantly decreases a patient’s quality of life and poses a high economic burden to institutions. In this sense, evaluation and assessment are important interventions for health professionals, although current tools and instruments are multiple and are dispersed in the literature. The aim of this review was to map existing screening tools to assess and evaluate OD in adult patients, identify their relevant clinical parameters and respective contexts of use and provide a systematic approach and summary to better inform practice. A scoping review was developed guided by the JBI methodology and using PRISMA-ScR to report results published between 2014 and 2021, in English, Spanish and Portuguese. Databases included Medline, Academic Search Complete, CINAHL Complete, Scielo, Google Scholar, ScienceDirect, OpenGrey and B-On. Mendeley was used to store and screen data. A total of 33 studies were included in the study, of which 19 tools were identified, some being intervention-based tools and others an algorithm for decision. The most common context used was in the general population and older adults. Regarding clinical parameters, the most common were food consistency, presence of the cough reflex, swallowing effort, voice changes and weight. As oropharyngeal dysphagia concerns important risks for the patient, a rigorous assessment must be performed. In this sense, the review identified specific disease-related tools and more general instruments, and it is an important contribution to more efficient dysphagia screening and prevention.
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2
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Dysphagia management during COVID-19 pandemic: A review of the literature and international guidelines. Turk J Phys Med Rehabil 2021; 67:267-274. [PMID: 34870112 DOI: 10.5606/tftrd.2021.8427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 03/20/2021] [Indexed: 02/07/2023] Open
Abstract
In this review, we present the safest and most effective diagnosis and treatment approaches to dysphagia during the novel coronavirus-2019 (COVID-19) pandemic in the light of available data, relevant literature, and personal experiences. Evaluations for dysphagia patients should be based on clinical assessment during the COVID-19 pandemic and instrumental assessment should be planned for very few number of patients. The main approach to rehabilitation must depend on compensatory methods, texture-modified foods, and postural strategies. Direct treatment methods should be avoided and home-based exercise programs should be encouraged. It is also obvious that there is a need for the development of new strategies for telemedicine/telerehabilitation practices in the new world order.
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3
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Diaz JG, Lombardi I. Prevalence of swallowing difficulties in older people without neurological disorders: Swallowing profile of older people in the city of Santos, Brazil. J Oral Rehabil 2021; 48:614-620. [PMID: 33586260 DOI: 10.1111/joor.13157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/22/2021] [Accepted: 01/27/2021] [Indexed: 11/27/2022]
Abstract
Several studies report that 40% to 60% of older people have some difficulty chewing and/or swallowing, which can lead to malnutrition, dehydration, weight loss, a lack of eating desire, etc. Identify older adults with swallowing difficulties in the city of Santos, Brazil, among users of the public healthcare system. A cross-sectional study was conducted with 100 individuals aged 60 to 90 years with no neurological disorders. Patient histories were taken, and stomatognathic evaluations were performed. The Mini Mental Health Examination (MMHE) and swallowing-related quality-of-life questionnaire (SWAL-QOL) were administered. The clinical swallowing assessment was performed with liquid, pasty and solid foods using two assessment protocols (Dysphagia Risk Evaluation Protocol and the Protocol for the Introduction and Transition of Foods)'. We found complaints of poorly adapted dentures among 49.3% of denture wearers and a high prevalence of hypofunction of oro-facial muscles. Sixty-five per cent of the respondents had facial muscle hypofunction, 51% exhibited lip hypofunction, and 49% exhibited tongue hypofunction. Moreover, 54% reported difficulty swallowing. On the SWAL-QOL questionnaire, 37% reported choking when eating food, 44% reported choking when drinking liquids, 29% reported coughing during meals, and 77% reported difficulty chewing. The present study revealed an important prevalence of complaints related to swallowing difficulties among older people in the city of Santos with structural and physiological changes characteristic of presbyphagia. The most prevalent conditions were poorly adapted dentures and hypofunction of oro-facial muscles, underscoring the importance of stomatognathic interventions in primary care.
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Affiliation(s)
- Juliana Gonzalez Diaz
- Intedisciplinary postgraduate program at the Federal University of São Paulo, Federal University of São Paulo, Santos, SP, Brazil
| | - Império Lombardi
- Human Movement Sciences, Department of Federal University of São Paul, Santos, SP, Brazil
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4
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Sarmet M, Mangilli LD, Costa GP, Paes JPRS, Codeço VM, Million JL, Maldaner V. The relationship between pulmonary and swallowing functions in patients with neuromuscular diseases followed up by a tertiary referral center: a cross-sectional study. LOGOP PHONIATR VOCO 2021; 47:117-124. [PMID: 33586591 DOI: 10.1080/14015439.2021.1879254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Respiratory muscle weakness is common in patients with neuromuscular diseases (NMD). This puts them at risk for dysphagia and other pulmonary complications. OBJECTIVES To investigate the relationship between pulmonary function and swallowing in NMD. MATERIALS AND METHODS In this cross-sectional study, medical records of patients undergoing treatment at the Tertiary Referral Center for Neuromuscular Diseases of Hospital de Apoio de Brasília, Brazil, were reviewed. Respiratory function was assessed through spirometry (FVC and FEV1 measured) and swallowing assessed by the Dysphagia Risk Evaluation Protocol and the Functional Oral Intake Scale. RESULTS Two hundred and twenty-two patients were included. Dysphagia was present in 46.8% of patients and impairment of pulmonary function in 64.0%. The mean FVC observed was 66.9% and FEV1 was 66.0%, indicating restrictive lung disease. A correlation between the decline of pulmonary and swallowing functions was observed in patients with NMDs (FVC vs. DREP, R = 0.46; FVC vs. FOIS, R = 0.42; FEV1 vs. DREP, R = 0.42; FEV1 vs. FOIS, R = 0.40, p<.01). FVC and FEV1 values tend to be lower in patients with dysphagia in the context of NMD. CONCLUSIONS A positive correlation between pulmonary function and swallowing outcomes was observed in patients with NMD. Despite respiratory and swallowing impairment being widely present in the population with NMD, they require different treatments according to the disease's pathophysiology. Future studies should be conducted to explore the disease-specific relationship between pulmonary function and swallowing in patients with NMD.
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Affiliation(s)
- Max Sarmet
- Departments of Speech Therapy and Physical Therapy, Hospital de Apoio de Brasília, Tertiary Referral Center of Neuromuscular Diseases, Brasília, Brazil.,Graduate Department of Health Sciences and Technologies, University of Brasília (UnB), Brasília, Brazil
| | | | - Geovanna Pereira Costa
- Undergraduate Program, College of Medicine, Escola Superior de Ciências da Saúde, Brasília, Brazil
| | | | - Vitor Martins Codeço
- Department of Thoracic Diseases, Hospital Regional da Asa Norte, Brasília, Brazil
| | - Janae Lyon Million
- Department of Human Biology, University of California, Santa Cruz, CA, USA
| | - Vinicius Maldaner
- Departments of Speech Therapy and Physical Therapy, Hospital de Apoio de Brasília, Tertiary Referral Center of Neuromuscular Diseases, Brasília, Brazil.,Undergraduate Program, College of Medicine, Escola Superior de Ciências da Saúde, Brasília, Brazil
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5
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Dobak S, Kelly D. Tough Pill to Swallow: Postextubation Dysphagia and Nutrition Impact in the Intensive Care Unit. Nutr Clin Pract 2020; 36:80-87. [PMID: 33242222 DOI: 10.1002/ncp.10602] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 10/16/2020] [Indexed: 12/31/2022] Open
Abstract
More than 5 million patients are admitted to US intensive care units (ICUs) each year. Many of these patients have risk factors for dysphagia. Dysphagia must be promptly addressed and appropriately treated to avoid the deleterious impacts of aspiration and malnutrition. Therefore, clinicians must be aware of ways to identify and treat dysphagia. This review will highlight the risk factors, mechanisms, and impact of dysphagia in the ICU as well as provide screening, diagnostic, and management options.
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Affiliation(s)
- Stephanie Dobak
- Department of Neurology, Jefferson Weinberg ALS Center, Philadelphia, Pennsylvania, USA
| | - Daniel Kelly
- Department of Rehabilitation, Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
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6
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Beduneau G, Souday V, Richard JC, Hamel JF, Carpentier D, Chretien JM, Bouchetemble P, Laccoureye L, Astier A, Tanguy V, Mercat A, Beloncle F, Tamion F. Persistent swallowing disorders after extubation in mechanically ventilated patients in ICU: a two-center prospective study. Ann Intensive Care 2020; 10:138. [PMID: 33052476 PMCID: PMC7560673 DOI: 10.1186/s13613-020-00752-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 10/03/2020] [Indexed: 11/10/2022] Open
Abstract
Background Persistent swallowing disorders (SD) are non-pulmonary complications of mechanical ventilation (MV). However, there are few clinical studies on persistent SD in critically ill patients undergoing tracheal intubation for MV. The aim of the present study was to assess the incidence and characteristics of clinical manifestations associated with persistent SD. Methods We prospectively evaluated in patients requiring more than 7 days of invasive MV the incidence and characteristics of clinical manifestations related to persistent SD. For this purpose, quality of swallowing was assessed within 24 h after extubation by an experienced physical therapist not directly involved in patient management. Swallowing assessment consisted in a specific standardized test combining a swallowing test and a full clinical evaluation of the cranial nerves involved in swallowing. In patients with SD on the first test, a second test was done within 48 h in order to discriminate between transient and persistent SD. Results Among the 482 patients mechanically ventilated more than 7 days, 138 were enrolled in this study. The first test performed 24 h after extubation revealed SD in 35 patients (25%). According to the second test performed 48 h later, SD were considered transient in 21 (15%) and persistent in 14 (10%) cases. Patients with persistent SD were older (66 ± 16 vs 58 ± 15 years), had lower bodyweight at admission (76 ± 15 vs 87 ± 23 kg) and received less often neuromuscular blocking agents (36% vs 66%) compared to patients without or with only transient SD. Patients with persistent SD had longer duration of Intensive Care Unit (ICU) stay after first extubation and longer delay to oral feeding than patients without or with only transient SD, respectively, 11 ± 9 vs 7 ± 6 days and 23 ± 33 vs 5 ± 7 days. Conclusions Based on a specific standardized clinical test, 25% of patients mechanically ventilated more than 7 days exhibited clinical manifestations of SD. However, SD were considered as persistent after extubation in only 10% of them. Persistent SD were associated with longer duration of ICU stay after extubation and longer time of enteral feeding. Trial registration: The study is registered with Clinical Trials (NCT01360580).
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Affiliation(s)
- G Beduneau
- Medical Intensive Care Unit, Normandie Univ, UNIROUEN, EA 3830, Rouen University Hospital, 76000, Rouen, France.
| | - V Souday
- Medical Intensive Care Unit, University Hospital of Angers, UNIV Angers, Angers, France
| | - J C Richard
- Medical Intensive Care Unit, University Hospital of Angers, UNIV Angers, Angers, France.,INSERM UMR 955 Eq13, Créteil, France
| | - J F Hamel
- Department of Biostatistics and Methodology, University Hospital of Angers, UNIV ANGERS, 49000, Angers, France
| | - D Carpentier
- Medical Intensive Care Unit, Rouen University Hospital, 76000, Rouen, France
| | - J M Chretien
- Clinical Research Department, University Hospital of Angers, 49000, Angers, France
| | - P Bouchetemble
- Otolaryngology-Head and Neck Surgery Department, Rouen University Hospital, 76000, Rouen, France
| | - L Laccoureye
- Otolaryngology-Head and Neck Surgery Department, University Hospital of Angers, UNIV Angers, Angers, France
| | - A Astier
- Medical Intensive Care Unit, Rouen University Hospital, 76000, Rouen, France
| | - V Tanguy
- Medical Intensive Care Unit, University Hospital of Angers, UNIV Angers, Angers, France
| | - A Mercat
- Medical Intensive Care Unit, University Hospital of Angers, UNIV Angers, Angers, France
| | - F Beloncle
- Medical Intensive Care Unit, University Hospital of Angers, UNIV Angers, Angers, France
| | - F Tamion
- Medical Intensive Care Unit, Normandie Univ, UNIROUEN, Inserm U1096, Rouen University Hospital, 76000, Rouen, France
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Birchall O, Bennett M, Lawson N, Cotton SM, Vogel AP. Instrumental Swallowing Assessment in Adults in Residential Aged Care Homes: A Scoping Review. J Am Med Dir Assoc 2020; 22:372-379.e6. [PMID: 33069625 DOI: 10.1016/j.jamda.2020.08.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 08/20/2020] [Accepted: 08/21/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To systematically describe evidence on the use of instrumental swallowing assessment for residents of aged care homes. DESIGN Scoping review using the Joanna Briggs Institute methodology for scoping reviews. SETTING AND PARTICIPANTS Published peer-reviewed and gray literature written in English between 2000 and 2020 about instrumental swallowing assessment (ISA) in adults in residential aged care homes (RACHs). MEASURES A systematic, 3-tiered search of databases including Medline, CINAHL, Embase, Scopus, and Cochrane Database of Systematic Reviews, and gray literature databases was conducted. Content analysis identified common themes. RESULTS Forty-two sources, 30 from peer-reviewed journals, 12 gray literature publications, and 66 websites of mobile ISA providers that discussed videofluoroscopic swallowing studies (VFSS) and/or fiberoptic endoscopic evaluation of swallowing (FEES) use in RACHs were included. Most peer-reviewed sources were referenced narratives or surveys of speech pathology practice patterns (53.3%). Researchers in 3 studies used onsite mobile FEES and in 2 studies off-site VFSS, with adults living in RACHs, as part of their research design (16.7%). There were 66 mobile instrumental swallowing assessment provider websites, based within the United States. Three countries (Australia, United States, United Kingdom) had professional guidelines that stipulated minimal requirements for the safe and appropriate provision of ISA services across settings. Themes identified across sources included (1) the approach to swallowing management and clinical indicators for ISA, (2) the role of ISA, (3) service and consumer influences on ISA, and (4) mobile FEES. CONCLUSIONS AND IMPLICATIONS There is a paucity of quality research on instrumental swallowing assessment in adults living in RACHs. There are broad regional and international variances in the way that videofluoroscopy and FEES are accessed and used. A more robust evidence base is required to guide health professionals to design tailored ISA care pathways for residents of RACHs, to achieve high-quality health, social, and economic outcomes.
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Affiliation(s)
- Olga Birchall
- Centre for Neuroscience of Speech, The University of Melbourne, Melbourne, Australia; Department of Audiology and Speech Pathology, The University of Melbourne, Melbourne, Australia.
| | - Michelle Bennett
- School of Allied Health, Australian Catholic University, North Sydney, Australia
| | - Nadine Lawson
- Speech Pathology Department, Cabrini Hospital, Malvern, Australia
| | - Susan M Cotton
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Adam P Vogel
- Centre for Neuroscience of Speech, The University of Melbourne, Melbourne, Australia; Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany; Redenlab, Melbourne, Australia
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Real CS, Balbinot J, Signorini AV, Hübner LS, Machado GDC, Dornelles S. Characterization of posterior leakage in swallowing. Codas 2020; 32:e20190072. [PMID: 32049105 DOI: 10.1590/2317-1782/20202019072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 08/27/2019] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To describe and characterize a finding, i.e., delayed posterior leakage of food residue during swallowing, according to age, gender and food consistency, which occurred in the event. METHODS Data were collected through the analysis of each functional videonasoendoscopy test of swallowing previously recorded in a specialist outpatient clinic. The study population included 200 patients, both males and females, aged between 46 and 87 years, with and without an underlying pathology for dysphagia. The images were studied individually by the researcher and analyzed by judges in order to identify and select images that would confirm the presence or absence of the study event. RESULTS Delayed escape was found in 45 out of the 200 analyzed tests. The tests selected for the study showed delayed posterior bolus leakage in at least one consistency. The highest frequency of delayed posterior leakage occurred with fluids. The analysis showed the significance of the study event with the population related to older ages in the sample analyzed. CONCLUSION Delayed posterior leakage occurs predominantly in the liquid consistency in older populations with no gender predominance.
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Affiliation(s)
- Caroline Santana Real
- Programa de Pós-graduação em Medicina: Ciências Cirúrgicas, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS), Brasil
| | - Jordana Balbinot
- Programa de Pós-graduação em Medicina: Ciências Cirúrgicas, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS), Brasil
| | - Alana Verza Signorini
- Serviço de Fonoaudiologia, Hospital de Clínicas de Porto Alegre - HCPA - Porto Alegre (RS), Brasil
| | - Luise Stumpf Hübner
- Programa de Pós-graduação em Medicina: Ciências Cirúrgicas, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS), Brasil
| | - Gabriela de Castro Machado
- Programa de Pós-graduação em Medicina: Ciências Cirúrgicas, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS), Brasil
| | - Sílvia Dornelles
- Serviço de Fonoaudiologia, Hospital de Clínicas de Porto Alegre - HCPA - Porto Alegre (RS), Brasil.,Departamento de Saúde de Comunicação Humana, Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS), Brasil
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9
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Leder SB, Warner HL, Suiter DM, Young NO, Bhattacharya B, Siner JM, Davis KA, Maerz LL, Rosenbaum SH, Marshall PS, Pisani MA, Siegel MD, Brennan JJ, Schuster KM. Evaluation of Swallow Function Post-Extubation: Is It Necessary to Wait 24 Hours? Ann Otol Rhinol Laryngol 2019; 128:619-624. [PMID: 30841709 DOI: 10.1177/0003489419836115] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Post-extubation dysphagia is associated with an increased incidence of nosocomial pneumonias, longer hospitalizations, and higher re-intubation rates. The purpose of this study was to determine if it is necessary to delay swallow evaluation for 24 hours post-extubation. METHODS A prospective investigation of swallowing was conducted at 1, 4, and 24 hours post-extubation to determine if it is necessary to delay swallow evaluation following intubation. Participants were 202 adults from 5 different intensive care units (ICU). RESULTS A total of 166 of 202 (82.2%) passed the Yale Swallow Protocol at 1 hour post-extubation, with an additional 11 (177/202; 87.6%) at 4 hours, and 8 more (185/202; 91.6%) at 24 hours. Only intubation duration ≥4 days was significantly associated with nonfunctional swallowing. CONCLUSIONS We found it is not necessary to delay assessment of swallowing in individuals who are post-extubation. Specifically, the majority of patients in our study (82.2%) passed a swallow screening at 1 hour post-extubation.
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Affiliation(s)
- Steven B Leder
- 1 Department of Surgery, Section of Otolaryngology, Yale School of Medicine, New Haven, CT, USA
| | | | | | - Nwanmegha O Young
- 1 Department of Surgery, Section of Otolaryngology, Yale School of Medicine, New Haven, CT, USA
| | - Bishwajit Bhattacharya
- 4 Department of Surgery, Section of Trauma, Surgical Critical Care, and Surgical Emergencies, Yale School of Medicine, New Haven, CT, USA
| | - Jonathan M Siner
- 5 Department of Internal Medicine, Section of Pulmonary, Critical Care, & Sleep Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Kimberly A Davis
- 4 Department of Surgery, Section of Trauma, Surgical Critical Care, and Surgical Emergencies, Yale School of Medicine, New Haven, CT, USA
| | - Linda L Maerz
- 4 Department of Surgery, Section of Trauma, Surgical Critical Care, and Surgical Emergencies, Yale School of Medicine, New Haven, CT, USA
| | | | - Peter S Marshall
- 5 Department of Internal Medicine, Section of Pulmonary, Critical Care, & Sleep Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Margaret A Pisani
- 7 Department of Pulmonary Critical Care & Sleep Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Mark D Siegel
- 5 Department of Internal Medicine, Section of Pulmonary, Critical Care, & Sleep Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Joseph J Brennan
- 8 Department of Cardiology, Yale School of Medicine, New Haven, CT, USA
| | - Kevin M Schuster
- 4 Department of Surgery, Section of Trauma, Surgical Critical Care, and Surgical Emergencies, Yale School of Medicine, New Haven, CT, USA
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Borges MDSD, Mangilli LD, Ferreira MC, Celeste LC. Apresentação de um Protocolo Assistencial para Pacientes com Distúrbios da Deglutição. Codas 2017; 29:e20160222. [DOI: 10.1590/2317-1782/20172016222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 05/15/2017] [Indexed: 11/21/2022] Open
Abstract
RESUMO Objetivo Descrever o processo de implantação de Protocolo Assistencial para os Distúrbios da Deglutição em unidade hospitalar pública de alta densidade tecnológica no Distrito Federal. Método Trata-se de um estudo descritivo do tipo Relato de Experiência com descrição do processo de implantação de Protocolo Assistencial para os Distúrbios da Deglutição em unidade hospitalar pública de alta densidade tecnológica no Distrito Federal. Resultados A implantação do Protocolo consistiu em três etapas de trabalho: Etapa 1 - busca na literatura sobre os procedimentos que caracterizariam as melhores práticas propedêuticas e terapêuticas; Etapa 2 - discussão com equipe multidisciplinar para ajustes necessários à execução da proposta de implantação de um Protocolo Assistencial para os Distúrbios da Deglutição; e Etapa 3 - proposta final do Protocolo Assistencial para os Distúrbios da Deglutição considerando as particularidades do serviço. Conclusão A proposta final do Protocolo Assistencial para os Distúrbios da Deglutição (PADD) apresenta um método sistematizado pré-definido para acompanhar os pacientes com alteração da deglutição de unidades de saúde de alta densidade tecnológica. O PADD propõe-se a favorecer a detecção precoce do distúrbio, a tomada de decisões terapêuticas uniformes, a utilização de métodos propedêuticos e terapêuticos de baixo custo e a auxiliar gestores no processo de avaliar a qualidade do serviço ofertado através da mensuração de indicadores.
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Barroqueiro PC, Lopes MKD, Moraes AMS. Critérios fonoaudiológicos para indicação de via alternativa de alimentação em unidade de terapia intensiva em um hospital universitário. REVISTA CEFAC 2017. [DOI: 10.1590/1982-021620171927116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo: identificar os critérios utilizados para indicação de via alternativa de alimentação para pacientes internados em unidade de terapia intensiva em um hospital universitário. Métodos: estudo transversal, retrospectivo, quantitativo e descritivo. Foram levantados os protocolos dos pacientes que tiveram via alternativa de alimentação indicada por fonoaudiólogo no período entre janeiro e dezembro de 2014. Os dados foram tabulados utilizando-se o programa Microsoft Excel. Para a análise estatística foi utilizado o programa STATA 12.0, por meio do qual foram estimadas médias e desvios-padrão ou medianas, respectivamente. Resultados: dos 25 participantes, 76% encontravam-se com nível de consciência alterado. Apesar disto, 52% destes tiveram dieta prescrita por médico. 24% tinham alteração de linguagem, 52%, de fonoarticulação e 44%, de voz. Somente oito pacientes tiveram condições de ser avaliados com oferta dieta oral. O critério utilizado para indicação de via alternativa de alimentação com maior frequência foi a alteração do nível de consciência. Conclusão: este estudo corrobora com outros já realizados apontando alteração do nível de consciência como fator de risco para disfagia. Ressalta-se a importância do fonoaudiólogo no ambiente hospitalar de modo a detectar precocemente os pacientes que necessitam de intervenção.
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12
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Amaral ACF, Rodrigues LA, Furlan RMMM, Vicente LCC, Motta AR. Speech-Language and Nutritional Sciences in hospital environment: analysis of terminology of food consistencies classification. Codas 2015; 27:541-9. [PMID: 26691618 DOI: 10.1590/2317-1782/20152015059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 05/06/2015] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To verify if there is an agreement between speech-language pathologists and nutritionists about the classification of food textures used in hospitals and their opinions about the possible consequences of differences in this classification. METHODS This is a descriptive, cross-sectional study with 30 speech-language pathologists and 30 nutritionists who worked in 14 hospitals of public and/or private network in Belo Horizonte, Brazil. The professionals answered a questionnaire, prepared by the researchers, and classified five different foods, with and without theoretical direction. The data were analyzed using Fisher's exact and Z -tests to compare ratios with a 5% significance level. RESULTS Both speech-language therapists (100%) and nutritionists (90%) perceive divergence in the classification and, 86.2% and 100% of them, respectively, believe that this difference may affect the patients' recovery. Aspiration risk was the most mentioned problem. For the general classification of food textures, most of the professionals (88.5%) suggested four to six terms. As to the terminology used in the classification of food presented without theoretical direction, the professionals cited 49 terms and agreed only in the solid and liquid classifications. With theoretical direction, the professionals also agreed in the classification of thick and thin paste. CONCLUSION Both the professionals recognized divergences in the classification of food textures and the consequent risk of damage to patient's recovery. The use of theoretical direction increased the agreement between these professionals.
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Affiliation(s)
| | | | | | | | - Andréa Rodrigues Motta
- Departamento de Fonoaudiologia, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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13
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Scheel R, Pisegna JM, McNally E, Noordzij JP, Langmore SE. Endoscopic Assessment of Swallowing After Prolonged Intubation in the ICU Setting. Ann Otol Rhinol Laryngol 2015. [PMID: 26215724 DOI: 10.1177/0003489415596755] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The purpose of this study was to identify the frequency of swallowing dysfunction after extubation in a sample of patients with no preexisting dysphagia. METHODS Mechanically ventilated patients in the ICU with no prior history of dysphagia received a flexible endoscopic evaluation of swallowing (FEES) exam within 72 hours after extubation. The FEES was then analyzed for variables related to swallowing patterns and laryngeal pathology. Univariate analyses were performed to identify relationships between variables. RESULTS Fifty-nine patients were included in this study. After extubation, 21 (35.6%) penetrated and 13 (22.0%) aspirated. The mean days intubated was 9.4 ± 6.1. Various forms of laryngeal injury were associated with worse swallowing scores, and delayed onset of the swallow was a common finding in all patients post extubation. Of the 44 participants evaluated ≤ 24 hours post extubation, 56.8% penetrated/aspirated. Of the 15 patients evaluated >24 hours post extubation, 60.0% penetrated/aspirated. CONCLUSIONS This study found a high frequency of dysphagia after prolonged intubation in patients with no preexisting dysphagia. Important variables leading to dysphagia are often overlooked, such as swallowing delay and laryngeal pathology. The timing of swallowing assessments did not reveal any difference in dysphagia frequency, suggesting that it might not be necessary to wait to perform dysphagia screens or evaluations.
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Affiliation(s)
- Rebecca Scheel
- Boston University Medical Center, Otolaryngology, Boston, Massachusetts, USA
| | - Jessica M Pisegna
- Boston University Medical Center, Otolaryngology, Boston, Massachusetts, USA Boston University, Sargent College, College of Health and Rehabilitation Sciences, Boston, Massachusetts, USA
| | - Edel McNally
- Boston University Medical Center, Otolaryngology, Boston, Massachusetts, USA
| | | | - Susan E Langmore
- Boston University, Sargent College, College of Health and Rehabilitation Sciences, Boston, Massachusetts, USA Boston University School of Medicine, Otolaryngology, Boston, Massachusetts, USA
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Rodrigues KA, Machado FR, Chiari BM, Rosseti HB, Lorenzon P, Gonçalves MIR. Swallowing rehabilitation of dysphagic tracheostomized patients under mechanical ventilation in intensive care units: a feasibility study. Rev Bras Ter Intensiva 2015; 27:64-71. [PMID: 25909315 PMCID: PMC4396899 DOI: 10.5935/0103-507x.20150011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 02/22/2015] [Indexed: 01/15/2023] Open
Abstract
Objective The aim of the present study was to assess the feasibility of the early
implementation of a swallowing rehabilitation program in tracheostomized patients
under mechanical ventilation with dysphagia. Methods This prospective study was conducted in the intensive care units of a university
hospital. We included hemodynamically stable patients under mechanical ventilation
for at least 48 hours following 48 hours of tracheostomy and with an appropriate
level of consciousness. The exclusion criteria were previous surgery in the oral
cavity, pharynx, larynx and/or esophagus, the presence of degenerative diseases or
a past history of oropharyngeal dysphagia. All patients were submitted to a
swallowing rehabilitation program. An oropharyngeal structural score, a swallowing
functional score and an otorhinolaryngological structural and functional score
were determined before and after swallowing therapy. Results We included 14 patients. The mean duration of the rehabilitation program was 12.4
± 9.4 days, with 5.0 ± 5.2 days under mechanical ventilation. Eleven
patients could receive oral feeding while still in the intensive care unit after 4
(2 - 13) days of therapy. All scores significantly improved after therapy. Conclusion In this small group of patients, we demonstrated that the early implementation of
a swallowing rehabilitation program is feasible even in patients under mechanical
ventilation.
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Affiliation(s)
- Katia Alonso Rodrigues
- Departamento de Fonoaudiologia, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Flávia Ribeiro Machado
- Disciplina de Anestesiologia, Dor e Terapia Intensiva, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Brasília Maria Chiari
- Departamento de Fonoaudiologia, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Heloísa Baccaro Rosseti
- Disciplina de Anestesiologia, Dor e Terapia Intensiva, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Paula Lorenzon
- Departamento de Otorrinolaringologia, Universidade Federal de São Paulo, São Paulo, SP, Brasil
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15
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Drozdz D, Mancopes R, Silva AMT, Reppold C. Analysis of the level of Dysphagia, anxiety, and nutritional status before and after speech therapy in patients with stroke. Int Arch Otorhinolaryngol 2014; 18:172-7. [PMID: 25992086 PMCID: PMC4297005 DOI: 10.1055/s-0033-1364169] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 11/18/2013] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION The rehabilitation in oropharyngeal dysphagia evidence-based implies the relationship between the interventions and their results. OBJECTIVE Analyze level of dysphagia, oral ingestion, anxiety levels and nutritional status of patients with stroke diagnosis, before and after speech therapy. METHOD Clinical assessment of dysphagia partially using the Protocol of Risk Assessment for Dysphagia (PARD), applying the scale Functional Oral Intake Scale for Dysphagia in Stroke Patients (FOIS), Beck Anxiety Inventory (BAI) and the Mini Nutritional Assessment MNA(®). The sample consisted of 12 patients, mean age of 64.6 years, with a medical diagnosis of hemorrhagic and ischemic stroke and without cognitive disorders. All tests were applied before and after speech therapy (15 sessions). Statistical analysis was performed using the chi-square test or Fisher's exact test, McNemar's test, Bowker's symmetry test and Wilcoxon's test. RESULTS During the pre-speech therapy assessments, 33.3% of patients had mild to moderate dysphagia, 88.2% did not receive food orally, 47.1% of the patients showed malnutrition and 35.3% of patients had mild anxiety level. After the therapy sessions, it was found that 33.3% of patients had mild dysphagia, 16.7% were malnourished and 50% of patients had minimal level of anxiety. CONCLUSION There were statistically significant evolution of the level of dysphagia (p = 0.017) and oral intake (p = 0.003) post-speech therapy. Although not statistically significant, there was considerable progress in relation to the level of anxiety and nutritional status.
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Affiliation(s)
- Daniela Drozdz
- MSc, Human Communication Disorder, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil
| | - Renata Mancopes
- PhD, Linguistics, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
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