Swallowing rehabilitation of dysphagic tracheostomized patients under mechanical ventilation in intensive care units: a feasibility study

Rodrigues, Katia Alonso; Machado, Flávia Ribeiro; Chiari, Brasília Maria; Rosseti, Heloísa Baccaro; Lorenzon, Paula; Gonçalves, Maria Inês Rebelo

doi:10.5935/0103-507x.20150011

Cited by 13 publications

(13 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“… 60 A prospective study of 14 patients evaluated a swallowing rehabilitation programme administered by speech-language pathologists and an otorhinolaryngologist. 65 Ten of the 14 patients (71%) were able to receive oral intake, with 6 (42%) having complete resolution of dysphagia, and 2 (14%) experiencing partial improvement.…”

Section: Resultsmentioning

confidence: 98%

Management of tracheostomies in the intensive care unit: a scoping review

2020

View full text Add to dashboard Cite

ObjectivesWhile there is an extensive body of literature surrounding the decision to insert, and methods for inserting, a tracheostomy, the optimal management of tracheostomies within the intensive care unit (ICU) from after insertion until ICU discharge is not well understood. The objective was to identify and map the key concepts relating to, and identify research priorities for, postinsertion management of adult patients with tracheostomies in the ICU.DesignScoping review of the literature.Data sourcesPubMed, Embase and Cumulative Index to Nursing and Allied Health Literature were searched from inception to 3 October 2019. Additional sources were searched for published and unpublished literature.Eligibility criteriaWe included studies of any methodology that addressed the a priori key questions relating to tracheostomy management in the ICU. No restrictions were placed on language or year of publication.Data extraction and synthesisTitles and abstracts were screened by two reviewers. Studies that met inclusion criteria were reviewed in full by two reviewers, with discrepancies resolved by a third. Data were extracted for included studies, and results mapped along the prespecified research questions.Results6132 articles were screened, and 102 articles were included for detailed analysis. Protocolised weaning was found to be successful in liberating patients from the ventilator in several cohort studies. Observational studies showed that strategies that use T-pieces and high-flow oxygen delivery improve weaning success. Several lines of evidence, including one clinical trial, support early cuff deflation as a safe and effective strategy as it results in a reduced time to wean, shorter ICU stays and fewer complications. Early tracheostomy downsizing and/or switching to cuffless tubes was found to be of benefit in one study. A substantial body of evidence supports the use of speaking valves to facilitate communication. While this does not influence time to wean or incidence of complications, it is associated with a major benefit in patient satisfaction and experience. Use of care bundles and multidisciplinary team approaches have been associated with reduced complications and improved outcomes in several observational studies.ConclusionsThe limited body of evidence supports use of weaning protocols, early cuff deflation, use of speaking valves and multidisciplinary approaches. Clinical trials examining post-tracheostomy management strategies in ICUs are a priority.

show abstract

Section: Resultsmentioning

confidence: 98%

Management of tracheostomies in the intensive care unit: a scoping review

2020

View full text Add to dashboard Cite

show abstract

“…Regarding the request for a speech therapist when the patient is already using an AFR, this professional's intervention is important to assess the swallowing biomechanics aiming at the progress of the diet and the safe extubation, returning to oral feeding. This is particularly the case with tracheotomized patients in mechanical ventilation in an intensive care unit 15,16 .…”

Section: Discussionmentioning

confidence: 99%

Medical criteria to indicate and remove alternative feeding routes in hospitalized older adults

et al. 2020

View full text Add to dashboard Cite

Purpose: to describe the medical criteria and the role of the speech therapist’s procedure in indicating and removing alternative feeding routes in older adults. Methods: a cross-sectional study conducted with the medical team of a public hospital. A questionnaire was administered with items on the medical criteria to indicate and remove alternative feeding routes and on the speech therapist’s work. Descriptive statistics were used for categorical variables in relative and absolute frequencies. Results: the data obtained from the participation of the 59 physicians enabled the main criteria for the indication of an alternative feeding route to be defined as follows: consciousness level, clinical condition, nutritional status, respiratory condition, and dysphagia assessment by a speech therapist. The main criteria for the removal of the alternative feeding route were the stable clinical and respiratory conditions, adequate nutritional support, and recommendation by a speech therapist. Conclusion: the clinical and respiratory conditions, nutritional status, and the speech therapist’s procedure were the main criteria considered by the medical team in the decisions to indicate and remove the alternative feeding route. The work of the speech therapist was relevant in both medical decisions, regarding the alternative feeding route in older patients.

show abstract

“…[127][128][129][130][131][132][133][134][135][136] Tracheostomy Both direct and indirect swallowing rehabilitation can begin in the ICU and while a patient with a TT is ventilator dependent. 137 In addition to instruction and practice in compensatory strategies and exercises for specific swallowing impairments that have been identified by the instrumental evaluation, addressing the physiologic effects of the TT is necessary. For these patients, therapy may initially focus on detection and management of oral secretions after cuff deflation.…”

Section: Types Of Interventionmentioning

confidence: 99%

Clinical Decision Making in the ICU: Dysphagia Screening, Assessment, and Treatment

2019

View full text Add to dashboard Cite

Clinicians often perceive the intensive care unit as among the most intimidating environments in patient care. With the proper training, acquisition of skill, and approach to clinical care, feelings of intimidation may be overcome with the great rewards this level of care has to offer. This review—spanning the ages of birth to senescence and covering oral/nasal endotracheal intubation and tracheostomy—presents a clinically relevant, directly applicable review of screening, assessment, and treatment of dysphagia in the patients who are critically ill for clinical speech–language pathologists and identifies gaps in the clinical peer-reviewed literature for researchers.

show abstract

Swallowing rehabilitation of dysphagic tracheostomized patients under mechanical ventilation in intensive care units: a feasibility study

Cited by 13 publications

References 33 publications

Management of tracheostomies in the intensive care unit: a scoping review

Management of tracheostomies in the intensive care unit: a scoping review

Medical criteria to indicate and remove alternative feeding routes in hospitalized older adults

Clinical Decision Making in the ICU: Dysphagia Screening, Assessment, and Treatment

Contact Info

Product

Resources

About