Pneumonia and in-hospital mortality in the context of neurogenic oropharyngeal dysphagia (NOD) in stroke and a new NOD step-wise concept

Abstract

The aim of our work was to develop a step-wise concept for investigating neurogenic oropharyngeal dysphagia (NOD) that could be used by both trained nursing staff as well as swallowing therapists and physicians to identify patients with NOD at an early stage and so enable an appropriate therapy to be started. To achieve this objective, we assessed uniform terminology and standard operating procedures (SOP) in a new NOD step-wise concept. In-house stroke mortality rates and rates of pneumonia were measured over time (2003–2009) in order to show improvements in quality of care. In addition, outcome measures in a stroke-unit monitoring system were studied after neurorehabilitation (day 90) assessing quality of life (QL) and patient feedback. An investigation that was carried out in the context of internal and external quality assurance stroke projects revealed a significant correlation between the NOD step-wise concept and low rates of pneumonia and in-house mortality. The quality of life measures show a delta value that can contribute to “post-stroke” depression. The NOD step-wise concept (NSC) should, on the one hand, be capable of being routinely used in clinical care and, on the other, being able to fulfil the requirements of being scientifically based for investigating different stages of swallowing disorders. The value of our NSC relates to the effective management of clinical resources and the provision of adequate diagnostic and therapeutic options for different grades of dysphagia. We anticipate that our concept will provide substantial support to physicians, as well as swallowing therapists, in clinical settings and rehabilitation facilities, thereby promoting better guidance and understanding of neurogenic dysphagia as a concept in acute and rehabilitation care, especially stroke-unit settings.

Evolução da deglutição no pós-AVC agudo: estudo descritivo

“…does not classify dysphagia as a change in oral and/ or pharyngeal phase, unlike other tools concerned with data on the speech organs and swallowing biomechanics 9,[11][12][13][14][15][16] . This is because the dysphagia study in post-stroke patients in the acute phase should mainly focus the evaluation of the risk of bronchial aspiration and subsequent definition of a safer and more effective oral feeding 1,[3][4][5]9,27 . In this study, the GUSS scale allowed not only the identification of dysphagia, but also the classification of its severity and clinical changes of the acute phase of stroke.…”

“…Dysphagia is clinically diagnosed in 40 to 70% of patients in the first three days after stroke, and the incidence of aspiration of saliva, food and/or liquid ranges from 20 to 45% in the first five days [1][2][3] . Dysphagia is associated with impaired food intake, which can lead to malnutrition during hospital stay and to pulmonary complications, especially pneumonia by aspiration [3][4][5][6][7] .…”

“…Dysphagia is associated with impaired food intake, which can lead to malnutrition during hospital stay and to pulmonary complications, especially pneumonia by aspiration [3][4][5][6][7] . In addition, it also has potential impact on emotional aspects of food, as it can lead to withdrawal and isolation of the patients, compromising their quality of life 6 .…”

¿Y después del ictus, qué hacemos para nutrirle?

“…La valoración modificada de la deglución (MSA) ayuda al personal que la realiza a identificar a los pacientes con disfagia y a derivarlos a los correspondientes especialistas en disfagia para su posterior valoración (18). Se pueden identificar limitaciones deglutorias graves en las dos primeras partes de la valoración.…”

Survey on the Issues and the Changes of Oral Health Condition of Inpatients in the Intensive Care Unit

“…On the other hand, it is reported that oral cleaning and functional support from the early phase in the acute stages is effective in avoiding secondary infectious diseases. 10,11) Based on these fi ndings, studies have examined the activities and efforts by dentists and dental hygienists in the arena of professional oral health care in the acute or emergency stage. 12 14) On the other hand, these reports indicated that how the oral health status of patients was an indicator of the diffi culties faced when aiming to improve the oral health with regard to general health issues and exacerbation of diseases.…”