RESUMO

OBJECTIVE: To describe the clinical and feeding findings of premature infants with gastroschisis (GTQ) in a neonatal intensive care unit and compare them to preterm infants (NBs) without congenital anomalies. METHODS: A retrospective case-control study was conducted with 50 premature NBs (25 with GTQ and 25 without comorbidities - control group). The NBs were compared regarding demographic and clinical data: risk of mortality and speech-language assessment (nonnutritive and nutritive sucking). Subsequently, a multiple logistic regression model was applied to determine the variables associated with the negative speech therapy outcome (speech therapy discharge after more than 7 days considering the first speech therapy evaluation). RESULTS: The results of the first analysis indicated that there was a difference between the GTQ and the CG for the following variables: total time in days of hospitalization; use of mechanical ventilation (invasive x noninvasive); days of life on the date of the first speech-language assessment; use of alternative feeding route; and the GTQ group had worse results. The results of the multiple logistic regression indicated that the diagnosis of GTQ, the use of invasive mechanical ventilation, and the absence of adequate intraoral pressure during the first speech-language evaluation were risk factors for a negative speech-language outcome. CONCLUSION: The feeding skills of preterm infants with QTG are related to the severity of the condition (gastrointestinal tract complications), requiring longer hospitalization, use of invasive mechanical ventilation, prolonged use of alternative feeding route and requiring more speech therapy to start oral feeding.

Assuntos

RESUMO

ABSTRACT Objective To describe the clinical and feeding findings of premature infants with gastroschisis (GTQ) in a neonatal intensive care unit and compare them to preterm infants (NBs) without congenital anomalies. Methods A retrospective case-control study was conducted with 50 premature NBs (25 with GTQ and 25 without comorbidities - control group). The NBs were compared regarding demographic and clinical data: risk of mortality and speech-language assessment (nonnutritive and nutritive sucking). Subsequently, a multiple logistic regression model was applied to determine the variables associated with the negative speech therapy outcome (speech therapy discharge after more than 7 days considering the first speech therapy evaluation). Results The results of the first analysis indicated that there was a difference between the GTQ and the CG for the following variables: total time in days of hospitalization; use of mechanical ventilation (invasive x noninvasive); days of life on the date of the first speech-language assessment; use of alternative feeding route; and the GTQ group had worse results. The results of the multiple logistic regression indicated that the diagnosis of GTQ, the use of invasive mechanical ventilation, and the absence of adequate intraoral pressure during the first speech-language evaluation were risk factors for a negative speech-language outcome. Conclusion The feeding skills of preterm infants with QTG are related to the severity of the condition (gastrointestinal tract complications), requiring longer hospitalization, use of invasive mechanical ventilation, prolonged use of alternative feeding route and requiring more speech therapy to start oral feeding.

RESUMO Objetivo Descrever os achados clínicos e de alimentação de prematuros com gastrosquise (GTQ) em uma unidade de terapia intensiva neonatal comparando-os a recém-nascidos (RNs) prematuros sem anomalias congênitas. Método Foi realizado estudo caso controle de caráter retrospectivo com 50 RNs prematuros (25 com GTQ e 25 sem comorbidades - grupo controle). Os RNs foram comparados quanto aos dados demográficos clínicos: risco de mortalidade e de avaliação fonoaudiológica (sucção não nutritiva e nutritiva). Posteriormente foi aplicado o modelo de regressão logística múltipla a fim de determinar as variáveis associadas ao desfecho fonoaudiológico negativo (alta fonoaudiológica após mais de 7 dias considerando a primeira avaliação fonoaudiológica). Resultados Os resultados da primeira análise indicaram que houve diferença entre o GTQ e o GC para as seguintes variáveis: tempo total em dias de internação; uso de ventilação mecânica (invasiva x não invasiva); dias de vida na data da primeira avaliação fonoaudiológica; uso de via alternativa de alimentação, sendo que o grupo GTQ apresentou piores resultados. Os resultados da regressão logística múltipla indicaram que o diagnóstico de GTQ, uso de ventilação mecânica invasiva e ausência de pressão intraoral adequada durante a primeira avaliação fonoaudiológica foram fatores de risco para o desfecho fonoaudiológico negativo. Conclusão As habilidades de alimentação dos prematuros com GTQ está relacionada à gravidade do quadro (complicações do trato gastro digestivo), exigindo maior tempo de internação, uso de ventilação mecânica invasiva, uso prolongado de via alternativa de alimentação e necessidade de mais atendimento fonoaudiológico para iniciar a alimentação por via oral.

RESUMO

Abstract Objective: To investigate the clinical and swallowing indicators related to a successful decannulation process during the hospital stay. Methods: A retrospective cohort clinical study. The study sample comprised a heterogeneous patient population who had submitted to a tracheostomy procedure in a tertiary hospital. Patients were divided into two groups (dec-annulated vs. non-decannulated) and compared not only in terms of demographic and clinical data but also the results of a swallowing assessment and intervention outcome. Results: Sixty-four patients were included in the present study: 25 (39%) who had been successfully decannulated, and 39 (61%) who could not be decannulated. Between-group comparisons indicated that both groups presented similar clinical and demographic characteristics. The groups also presented similar swallowing assessment results prior to intervention. However, significant differences were observed regarding the time to begin swallowing rehabilitation. The decannulated group was assessed nine days earlier than the non-decannulated group. Other significant differences included the removal of the alternate feeding method (72.0% of decannulated patients vs. 5.1% of non-decannulated patients) and the reintroduction of oral feeding (96.0% of decannulated patients vs. 41.0% of non-decannulated patients) and functional swallowing level at patient disclosure. The non-decannulated patient group presented higher death rates at disclosure. Conclusion: The results of the present study indicated that the following parameters were associated with a successful decannulation process: early swallowing assessment, swallowing rehabilitation, and improvement in the swallowing functional level during the hospital stay. The maintenance of low swallowing functional levels was found to be negatively associated with successful decannulation. HIGHLIGHTS Deccanulation indicators were investigated in patients who were submitted to a tracheostomy procedure. Early swallowing evaluation and rehabilitation were associated with a successful decannulation process. Low swallowing functional levels were negatively associated with the success of decannulation.

RESUMO

PURPOSE: to describe de functional development of swallowing in Intensive Care Unit (ICU) patients with COVID-19, who were submitted to a swallowing intervention. METHODS: participants of the study were 77 patients (both gender, mean age 53.4±15.9; score on the Glasgow Coma Scale ≥14 and stable respiratory condition). The functional scale of swallowing used for assessment was the American Speech-Language-Hearing Association National Outcome Measurement System (ASHA NOMS). RESULTS: the results indicate that there was a significant recovery of the functional swallowing patterns when comparing the measurements pre and post swallowing intervention. CONCLUSION: 83% of the patients needed up to 3 swallowing interventions to recover a safe swallowing pattern.

OBJETIVO: descrever a evolução funcional da deglutição em pacientes com COVID-19 submetidos à intervenção fonoaudiológica na Unidade de Tratamento Intensivo (UTI). MÉTODO: participaram do estudo 77 pacientes (ambos os gêneros; idade média 53.4±15.9; escore na Escala de Coma de Glasgow ≥14; e condição respiratória estável). A escala funcional utilizada para a avaliação da deglutição foi a American Speech-Language-Hearing Association National Outcome Measurement System (ASHA NOMS). RESULTADOS: os resultados indicam que houve recuperação significativa nos padrões funcionais da deglutição na comparação pré e pós-intervenção fonoaudiológica. CONCLUSÃO: 83% dos pacientes necessitam de até 3 intervenções para a recuperação dos padrões seguros de deglutição.

Assuntos

RESUMO

PURPOSE: The purpose of the present study was to assess the validity of a simple instrument for screening dysphagia used in a large public hospital in Brazil with heterogeneous adult population. METHOD: The Dysphagia Risk Evaluation Protocol (DREP) - screening version contains four items (altered cervical auscultation, altered vocal quality, coughing and choking before / during / after swallowing) that were previously indicated as independent risk factors associated to the presence of dysphagia in the swallowing test with water. Trained speech therapists administered and scored DREP - screening version to consecutive patients referred by hospital's medical team to perform Video Fluoroscopic for Swallowing Study (VFSS). RESULTS: 211 patients received the swallowing screen (DREP): 99 failed and 112 passed. One in every five patients was randomized to receive a VFSS. The DREP screening version demonstrated excellent validity with sensitivity at 92.9%, specificity at 75.0%, negative predictive values at 95.5% and an accuracy of 80.9%. CONCLUSION: The DREP - screening version is a simple and accurate tool to identify the risk for penetration and / or aspiration in patients who are not tube-fed, who have a good level of alertness, have no history of recurrent pneumonia, are not on pneumonia, and that do not use a tracheostomy cannula.

OBJETIVO: O objetivo do presente estudo foi realizar a validação de um instrumento simples de triagem da disfagia utilizado em um hospital público de grande porte no Brasil em população adulta heterogênea. MÉTODO: O Protocolo de Avaliação de Risco para Disfagia versão de triagem (PARDt) contém quatro itens (ausculta cervical alterada, alteração da qualidade vocal, tosse e engasgo antes/durante/após a deglutição) que foram previamente indicados como fatores de risco independentes associados à presença de disfagia no teste de deglutição com água. Fonoaudiólogos treinados administraram e classificaram o PARDt para pacientes consecutivos encaminhados pela equipe médica do hospital para realizar a videofluoroscopia da deglutição (VDF). RESULTADOS: 211 pacientes foram submetidos ao PARDt: 99 falharam e 112 passaram. Um em cada cinco pacientes foram randomicamente selecionados para VDF. O PARDt apresentou excelente validade: sensibilidade de 92,9%; especificidade de 75,0%; valores preditivos negativos de 95,5%; acurácia de 80,9%. CONCLUSÃO: O PARDt é uma ferramenta simples e precisa para identificar o risco de penetração e/ou aspiração em pacientes que não são alimentados por sonda, que apresentam bom nível de alerta, sem histórico de pneumonias de repetição, que não estejam em vigência de pneumonia e que não façam uso de cânula de traqueostomia.

Assuntos

Assuntos

RESUMO

PURPOSE: To perform a literature review on the existing international criteria and protocols for tracheostomy decannulation. RESEARCH: strategies: Literature review using the PubMed database with the English keywords "Tracheostomy", "Weaning", "Decannulation", "Removal Tube", "Speech, Language and Hearing Sciences", "Intensive Care Units", "Dysphagia", "Swallowing", "Deglutition" and "Deglutition Disorders ". SELECTION CRITERIA: Studies published in the last five years (2012 to 2017); studies with human adult population (i.e. ages above 18 years); articles published in English; unrestricted full access articles; and research related to the objectives of the study. DATA ANALYSIS: we analyzed sample characterization; professionals involved in the decannulation process; steps of the decannulation process; total time in days of tracheostomy use; total time in days to complete decannulation process; and failure factors to complete the decannulation process. RESULTS: Most of the studies investigated tracheostomy decannulation in a sample of males with neurological impairments. The professionals involved in the decannulation process were doctors, speech therapists, physiotherapists and nurses. The most cited decannulation steps were: swallowing assessment; occlusion training; evaluation of air permeability; ability to manipulate secretion and exchange of cannula; cuff deflation and cough training; use of speech valve. CONCLUSION: Speech therapists are of great help during the decannulation process, since the assessment of swallowing was one of the decisive steps of the investigated studies. The processes of decannulation includes a multidisciplinary approach and should be performed by the cooperation between physicians, physiotherapists and speech therapists.

OBJETIVO: Realizar um levantamento bibliográfico a respeito da decanulação da traqueostomia para verificar os fatores e protocolos utilizados em estudos internacionais. ESTRATÉGIA DE PESQUISA: Estudo de revisão de literatura utilizando a base de dados PubMed com os descritores em língua inglesa "Tracheostomy", "Weaning", "Decannulation", "Removal tube", "Speech, Language and Hearing Sciences", "Intensive Care Units", "Dysphagia", "Swallowing", "Deglutition" e "Deglutition Disorders". CRITÉRIOS DE SELEÇÃO: Estudos publicados nos últimos cinco anos (2012 a 2017), com população acima de 18 anos de idade; pesquisas realizadas somente com seres humanos; artigos publicados em língua inglesa; artigos com acesso completo irrestrito; pesquisas relacionadas aos objetivos do estudo. ANÁLISE DOS DADOS: foram analisados quanto aos seguintes itens: caracterização da amostra; profissionais envolvidos no processo da decanulação; etapas do processo de decanulação; tempo total em dias de uso da traqueostomia; tempo total em dias para concluir processo de decanulação; fatores de insucesso para conclusão do processo de decanulação. RESULTADOS: A maior parte da população estudada foi do gênero masculino e com alterações neurológicas. Dos profissionais envolvidos no processo de decanulação, participaram em ordem decrescente médicos, fonoaudiólogos, fisioterapeutas e enfermeiros. As etapas da decanulação mais citadas foram: avaliação da deglutição; treino de oclusão; avaliação da permeabilidade de passagem do ar; habilidade de manipulação de secreção e troca de cânula; desinsuflação do cuff e treino de tosse; uso de válvula de fala. Além disso, obtiveram-se dados a respeito do tempo total de traqueostomia e de decanulação. CONCLUSÃO: A presença do fonoaudiólogo é extremamente importante no processo de decanulação, visto que a avaliação da deglutição foi a etapa mais citada nos estudos, sendo esse trabalho realizado em conjunto com médicos e fisioterapeutas.

Assuntos

RESUMO

OBJECTIVE: A swallowing disorder is present in more than 50% of patients with acute stroke. To identify clinical prognostic indicators of the swallowing function in a population with acute ischemic stroke and to determine prioritization indicators for swallowing rehabilitation. METHODS: Participants were adults admitted to the emergency room who were diagnosed with acute ischemic stroke. Data gathering involved a swallowing assessment to determine the functional level of swallowing (American Speech-Language-Hearing Association National Outcome Measurement System - ASHA NOMS) and the verification of demographic and clinical variables. RESULTS: The study sample included 295 patients. For analysis purposes, patients were grouped as follows: ASHA NOMS levels 1 and 2 - ASHA1 (n = 51); levels 3, 4 and 5 - ASHA2 (n = 96); levels 6 and 7 - ASHA3 (n = 148). Statistical analyses indicated that patients who presented a poorer swallowing function (ASHA1) were older (age ≥ 70 years); had anterior circulation infarct; had lower scores on the Glasgow Coma Scale (GCS ≤ 14 points); took longer to initiate swallowing rehabilitation; had longer hospital stays; made more use of alternative feeding methods; needed more sessions of swallowing rehabilitation to remove alternate feeding methods; took longer to return to oral feeding and had poorer outcomes (fewer individuals discharged from swallowing rehabilitation sessions and increased mortality). CONCLUSION: Patients with acute ischemic stroke, admitted to the emergency room, aged ≥ 70 years, score on the GCS ≤ 14, anterior circulation infarct and dementia should be prioritized for swallowing assessment and rehabilitation.

Assuntos

RESUMO

ABSTRACT A swallowing disorder is present in more than 50% of patients with acute stroke. Objective To identify clinical prognostic indicators of the swallowing function in a population with acute ischemic stroke and to determine prioritization indicators for swallowing rehabilitation. Methods Participants were adults admitted to the emergency room who were diagnosed with acute ischemic stroke. Data gathering involved a swallowing assessment to determine the functional level of swallowing (American Speech-Language-Hearing Association National Outcome Measurement System - ASHA NOMS) and the verification of demographic and clinical variables. Results The study sample included 295 patients. For analysis purposes, patients were grouped as follows: ASHA NOMS levels 1 and 2 - ASHA1 (n = 51); levels 3, 4 and 5 - ASHA2 (n = 96); levels 6 and 7 - ASHA3 (n = 148). Statistical analyses indicated that patients who presented a poorer swallowing function (ASHA1) were older (age ≥ 70 years); had anterior circulation infarct; had lower scores on the Glasgow Coma Scale (GCS ≤ 14 points); took longer to initiate swallowing rehabilitation; had longer hospital stays; made more use of alternative feeding methods; needed more sessions of swallowing rehabilitation to remove alternate feeding methods; took longer to return to oral feeding and had poorer outcomes (fewer individuals discharged from swallowing rehabilitation sessions and increased mortality). Conclusion Patients with acute ischemic stroke, admitted to the emergency room, aged ≥ 70 years, score on the GCS ≤ 14, anterior circulation infarct and dementia should be prioritized for swallowing assessment and rehabilitation.

RESUMO Alterações da deglutição são observadas em mais de 50% dos pacientes com acidente vascular cerebral isquêmico (AVCI) agudo. Objetivo Identificar os indicadores de prognóstico clínico da funcionalidade da deglutição na população com AVCI em fase aguda, visando o estabelecimento de indicadores de priorização de atendimento fonoaudiológico. Métodos Participaram do estudo adultos admitidos em Pronto Socorro (PS) com AVCI. As etapas de coleta de dados envolveram avaliação fonoaudiológica para determinação do nível funcional da deglutição (American Speech-Language-Hearing Association National Outcome Measurement System - ASHA NOMS) e a coleta de variáveis demográficas e clínicas. Resultados A amostra do estudo incluiu 295 pacientes agrupados de acordo com os níveis ASHA NOMS: níveis 1 e 2 - ASHA1 (n = 51); níveis 3, 4 e 5 - ASHA2 (n = 96); níveis 6 e 7 - ASHA3 (n = 148). As análises indicaram os seguintes resultados significantes: pacientes com pior funcionalidade da deglutição (ASHA1) apresentaram média de idade superior a 70 anos, maior comprometimento da circulação cerebral anterior pós-AVCI, pior pontuação na Escala de Coma de Glasgow (ECG ≤ 14 pontos), demoraram mais tempo para iniciar o atendimento fonoaudiológico, permaneceram mais tempo internados no hospital, fizeram mais uso de via alternativa de alimentação, necessitaram de mais sessões fonoaudiológicas para retirada da via alternativa de alimentação, demoraram mais tempo para retornar para alimentação por via oral e apresentaram pior desfecho (um número menor de indivíduos recebeu alta fonoaudiológica e apresentaram mortalidade aumentada). Conclusão Pacientes com AVCI agudo, admitidos em PS, que apresentem idade ≥ 70 anos, pontuação na ECG ≤ 14, com comprometimento do sistema circulatório cerebral anterior e demência, devem ser priorizados no atendimento fonoaudiológico.

Assuntos

RESUMO

PURPOSE: To characterize and compare the functional aspects of swallowing and clinical markers in intensive care patients with traumatic brain injury (TBI) in Intensive Care Unit (ICU). METHODS: Participants of this study were 113 adults diagnosed with TBI. Data collection stage involved: clinical assessment of the risk for bronchoaspiration performed by a speech-language therapist; assessment of the functional level of swallowing (American Speech-Language-Hearing Association National Outcome Measurement System - ASHA NOMS ); assessment of the patient' health status (Sequential Organ Failure Assessment - SOFA). RESULTS: After the inclusion criteria were applied, patients were grouped according to their swallowing functional level: levels 1 and 2 - ASHA1 (n=25); levels 3, 4 and 5 - ASHA2 (n=37); levels 6 and 7 - ASHA3 (n=51). The statistical analyses indicated the following significant results: the ASHA3 group presented lower severity levels of TBI at the clinical assessment of bronchoaspiration, remained less time intubated (approximately um third less than the more severe group), remained fewer days in hospital and needed less therapy sessions to return to safe oral feeding. The clinical predictor signs for bronchoaspiration that best characterized the groups were the presence of altered auscultation and the presence of coughing after swallowing. Patients in the ASHA3 group presented these signs less frequently. CONCLUSION: The score obtained on the SOFA and the time of orotracheal intubation were identified as the prognostic indicators of functional swallowing. The presence of altered cervical auscultation and coughing were clinical predictors of dysphagia.

OBJETIVO: caracterizar e comparar os aspectos funcionais da deglutição e indicadores clínicos na população com traumatismo cranioencefálico (TCE) em unidade de terapia intensiva. MÉTODO: Participaram do estudo 113 adultos com diagnóstico de TCE. As etapas de coleta de dados envolveram: a avaliação fonoaudiológica clínica do risco de broncoaspiração, determinação do nível funcional da deglutição (American Speech-Language-Hearing Association National Outcome Measurement System ­ ASHA NOMS), determinação da gravidade clínica do indivíduo de acordo com a Sequential Organ Failure Assessment (SOFA). RESULTADOS: Após a aplicação dos critérios de inclusão, os pacientes selecionados foram agrupados de acordo com os níveis funcionais de deglutição: níveis 1 e 2 ­ ASHA1 (n=25); níveis 3, 4 e 5 ­ ASHA2 (n=37); níveis 6 e 7 ­ ASHA3 (n=51). As análises estatísticas indicaram os seguintes resultados significantes: o grupo ASHA3 apresentou menor gravidade do TCE no momento da avaliação fonoaudiológica, menor tempo de intubação orotraqueal (um terço a menos que o grupo mais grave), ficou menos tempo hospitalizado e necessitou de menos sessões de atendimento fonoaudiológico para o retorno seguro para via oral de alimentação. Os sinais clínicos preditores de broncoaspiração que mais diferenciaram os grupos foi a presença de ausculta cervical alterada e presença de tosse após a deglutição, sendo que o grupo ASHA3 apresentou esses sinais com menor frequência. CONCLUSÃO: O escore SOFA e o tempo de intubação orotraqueal foram indicadores do prognóstico da funcionalidade da deglutição. A presença ausculta cervical alterada e tosse foram preditores clínicos de disfagia.

Assuntos

RESUMO

RESUMO Objetivo apresentar o Protocolo de Prevenção de Broncoaspiração (PPB), visando estabelecer um fluxo padronizado para o manejo do paciente com risco de broncoaspiração. Esse protocolo, de aplicabilidade multiprofissional, estabelece um padrão assistencial de práticas clínicas para garantir a segurança do paciente em unidades de terapia intensiva (UTI), unidades de internação (UI) e pronto-socorro (PS). Métodos na admissão do paciente, ou durante sua permanência hospitalar, a equipe multiprofissional deverá observar se o paciente se encaixa em, pelo menos, UM dos critérios de inclusão do PPB. Caso o paciente seja identificado como em risco de broncoaspiração, a equipe de enfermagem deverá sinalizá-lo com a Pulseira do Risco de Broncoaspiração (cor cinza/prata). Resultados o PPB já foi aprovado pela Comissão de UTI Cirúrgica e pelo Serviço de Controle de Infecção Hospitalar (SCCIH) do Instituto Central do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (ICHCFMUSP). Com isso, o PPB mostrou-se factível, de baixo custo e efetivo em sua proposta. Conclusão a aplicabilidade do PPB nas Unidades de Terapia Intensiva, Unidades de Internação e Pronto-Socorro do ICHCFMUSP é uma iniciativa pioneira. O uso do protocolo e da pulseira é uma conquista para a Fonoaudiologia e a consolidação da sua existência nas unidades de internação hospitalar.

ABSTRACT Purpose To present the Bronchoaspiration Prevention Protocol (PPB) for the management of patients at risk of brochoaspiration. This protocol has a multidisciplinary approach and aims to standardize clinical practice in order to ensure patients' safety in Inpatient, Emergency and Intensive Care Units (ICUs). Methods Upon admission or during patients' hospital stay, the multidisciplinary team must observe if the patient presents at least one of the inclusion criteria for the PPB. In case the patient is classifies as at risk of bronchoaspiration, the nursing team will identify the patient with the silicone Bracelet for Risk of Bronchoaspiration (grey/silver color). Results The PPB has already been approved by the Instituto Central do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (ICHC FMUSP) ICU Commission and Hospital Infection Control Service (HICS). The PPB proved to fulfil its purpose in a viable, low-cost and effective manner. Conclusion Applicability of the PPB in Inpatient, Emergency and Intensive Care Units (ICUs) is a pioneer initiative. The use of the protocol and bracelet is an achievement for the Speech-Language and Hearing Sciences and consolidates our existence in the inpatient hospital setting.

Assuntos

RESUMO

OBJECTIVE: to identify factors associated with dysphagia in patients undergoing prolonged orotracheal intubation (pOTI) and the post-extubation consequences. METHODS: 150 patients undergoing pOTI participated in the study, evaluated according to the deglutition functional level (American Speech Language - Hearing Association National Outcome Measurement System - ASHA NOMS), severity determination (The Simplified Acute Physiology Score - SOFA) and submitted to collection of variables age, mortality, days of orotracheal intubation, number of sessions to introduce oral diet, and days to hospital discharge. We grouped patients according to ASHA classification: 1 (levels 1 and 2), 2 (levels 3, 4 and 5) and 3 (levels 6 and 7). RESULTS: the variables associated with impaired deglutition functionality were age (p<0.001), mortality (p<0.003), OTI days (p=0.001), number of sessions to introduce oral diet (p<0.001) and days to hospital discharge (p=0.018). Multiple comparisons indicated significant difference between ASHA1 and ASHA2 groups in relation to ASHA3 group. ASHA1 and ASHA2 groups had a lower SOFA score when compared with the ASHA3 group (p=0.004). Only 20% of ASHA1 patients and 32% of ASHA2 patients presented safe deglutition levels before discharge. CONCLUSION: factors associated with dysphagia in patients submitted to pOTI were age over 55 years and orotracheal intubation time (greater in the cases with worse deglutition functionality). The post-extubation consequences were increased mortality and length of hospital stay in the presence of dysphagia.

OBJETIVO: identificar os fatores associados à disfagia em pacientes submetidos à intubação orotraqueal prolongada (IOTp) e as consequências pós-extubação. MÉTODOS: participaram do estudo 150 pacientes submetidos à IOTp, avaliados segundo o nível funcional da deglutição (American Speech Language - Hearing Association National Outcome Measurement System - ASHA NOMS), a determinação da gravidade (The Simplified Acute Physiology Score - SOFA) e a coleta das seguintes variáveis: idade, mortalidade, dias de intubação orotraqueal, número de atendimentos para introdução da alimentação oral e dias para alta hospitalar. Os pacientes foram agrupados de acordo com a classificação do ASHA: 1 (níveis 1 e 2), 2 (níveis 3, 4 e 5) e 3 (níveis 6 e 7). RESULTADOS: as análises indicaram as seguintes variáveis associadas a pior funcionalidade da deglutição: idade (p<0,001), mortalidade (p<0,003); dias de IOT (p=0,001), número de atendimentos para introdução de dieta oral (p<0,001) e dias para alta hospitalar (p=0,018). As comparações múltiplas indicaram diferença significante na comparação dos grupos ASHA1 e ASHA2 em relação ao grupo ASHA3. Os grupos ASHA1 e ASHA2 apresentaram menor score na SOFA quando comparados ao grupo ASHA3 (p=0,004). Somente 20% dos pacientes do grupo ASHA1 e 32% dos pacientes do ASHA2 apresentaram níveis seguros de deglutição antes da alta hospitalar. CONCLUSÃO: os fatores associados à disfagia em pacientes submetidos à IOTp foram: idade acima de 55 anos e tempo de intubação orotraqueal (maior nos casos com pior funcionalidade da deglutição). As consequências pós-extubação foram: aumento da mortalidade e do tempo de internação hospitalar na presença da disfagia.

Assuntos

RESUMO

RESUMO Objetivo: identificar os fatores associados à disfagia em pacientes submetidos à intubação orotraqueal prolongada (IOTp) e as consequências pós-extubação. Métodos: participaram do estudo 150 pacientes submetidos à IOTp, avaliados segundo o nível funcional da deglutição (American Speech Language - Hearing Association National Outcome Measurement System - ASHA NOMS), a determinação da gravidade (The Simplified Acute Physiology Score - SOFA) e a coleta das seguintes variáveis: idade, mortalidade, dias de intubação orotraqueal, número de atendimentos para introdução da alimentação oral e dias para alta hospitalar. Os pacientes foram agrupados de acordo com a classificação do ASHA: 1 (níveis 1 e 2), 2 (níveis 3, 4 e 5) e 3 (níveis 6 e 7). Resultados: as análises indicaram as seguintes variáveis associadas a pior funcionalidade da deglutição: idade (p<0,001), mortalidade (p<0,003); dias de IOT (p=0,001), número de atendimentos para introdução de dieta oral (p<0,001) e dias para alta hospitalar (p=0,018). As comparações múltiplas indicaram diferença significante na comparação dos grupos ASHA1 e ASHA2 em relação ao grupo ASHA3. Os grupos ASHA1 e ASHA2 apresentaram menor score na SOFA quando comparados ao grupo ASHA3 (p=0,004). Somente 20% dos pacientes do grupo ASHA1 e 32% dos pacientes do ASHA2 apresentaram níveis seguros de deglutição antes da alta hospitalar. Conclusão: os fatores associados à disfagia em pacientes submetidos à IOTp foram: idade acima de 55 anos e tempo de intubação orotraqueal (maior nos casos com pior funcionalidade da deglutição). As consequências pós-extubação foram: aumento da mortalidade e do tempo de internação hospitalar na presença da disfagia.

ABSTRACT Objective: to identify factors associated with dysphagia in patients undergoing prolonged orotracheal intubation (pOTI) and the post-extubation consequences. Methods: 150 patients undergoing pOTI participated in the study, evaluated according to the deglutition functional level (American Speech Language - Hearing Association National Outcome Measurement System - ASHA NOMS), severity determination (The Simplified Acute Physiology Score - SOFA) and submitted to collection of variables age, mortality, days of orotracheal intubation, number of sessions to introduce oral diet, and days to hospital discharge. We grouped patients according to ASHA classification: 1 (levels 1 and 2), 2 (levels 3, 4 and 5) and 3 (levels 6 and 7). Results: the variables associated with impaired deglutition functionality were age (p<0.001), mortality (p<0.003), OTI days (p=0.001), number of sessions to introduce oral diet (p<0.001) and days to hospital discharge (p=0.018). Multiple comparisons indicated significant difference between ASHA1 and ASHA2 groups in relation to ASHA3 group. ASHA1 and ASHA2 groups had a lower SOFA score when compared with the ASHA3 group (p=0.004). Only 20% of ASHA1 patients and 32% of ASHA2 patients presented safe deglutition levels before discharge. Conclusion: factors associated with dysphagia in patients submitted to pOTI were age over 55 years and orotracheal intubation time (greater in the cases with worse deglutition functionality). The post-extubation consequences were increased mortality and length of hospital stay in the presence of dysphagia.

Assuntos

RESUMO

OBJECTIVE: To determine whether the severity of non-neurological critically ill patients correlates with clinical predictors of bronchial aspiration. METHODS: We evaluated adults undergoing prolonged orotracheal intubation (> 48 h) and bedside swallowing assessment within the first 48 h after extubation. We collected data regarding the risk of bronchial aspiration performed by a speech-language pathologist, whereas data regarding the functional level of swallowing were collected with the American Speech-Language-Hearing Association National Outcome Measurement System (ASHA NOMS) scale and those regarding health status were collected with the Sequential Organ Failure Assessment (SOFA). RESULTS: The study sample comprised 150 patients. For statistical analyses, the patients were grouped by ASHA NOMS score: ASHA1 (levels 1 and 2), ASHA2 (levels 3 to 5); and ASHA3 (levels 6 and 7). In comparison with the other patients, those in the ASHA3 group were significantly younger, remained intubated for fewer days, and less severe overall clinical health status (SOFA score). The clinical predictors of bronchial aspiration that best characterized the groups were abnormal cervical auscultation findings and cough after swallowing. None of the patients in the ASHA 3 group presented with either of those signs. CONCLUSIONS: Critically ill patients 55 years of age or older who undergo prolonged orotracheal intubation (≥ 6 days), have a SOFA score ≥ 5, have a Glasgow Coma Scale score ≤ 14, and present with abnormal cervical auscultation findings or cough after swallowing should be prioritized for a full speech pathology assessment.

Assuntos

RESUMO

Objective: To determine whether the severity of non-neurological critically ill patients correlates with clinical predictors of bronchial aspiration. Methods: We evaluated adults undergoing prolonged orotracheal intubation (> 48 h) and bedside swallowing assessment within the first 48 h after extubation. We collected data regarding the risk of bronchial aspiration performed by a speech-language pathologist, whereas data regarding the functional level of swallowing were collected with the American Speech-Language-Hearing Association National Outcome Measurement System (ASHA NOMS) scale and those regarding health status were collected with the Sequential Organ Failure Assessment (SOFA). Results: The study sample comprised 150 patients. For statistical analyses, the patients were grouped by ASHA NOMS score: ASHA1 (levels 1 and 2), ASHA2 (levels 3 to 5); and ASHA3 (levels 6 and 7). In comparison with the other patients, those in the ASHA3 group were significantly younger, remained intubated for fewer days, and less severe overall clinical health status (SOFA score). The clinical predictors of bronchial aspiration that best characterized the groups were abnormal cervical auscultation findings and cough after swallowing. None of the patients in the ASHA 3 group presented with either of those signs. Conclusions: Critically ill patients 55 years of age or older who undergo prolonged orotracheal intubation (≥ 6 days), have a SOFA score ≥ 5, have a Glasgow Coma Scale score ≤ 14, and present with abnormal cervical auscultation findings or cough after swallowing should be prioritized for a full speech pathology assessment.

Objetivo: Correlacionar a gravidade de pacientes críticos não neurológicos com preditores clínicos do risco de broncoaspiração. Métodos: Participaram do estudo adultos com histórico de intubação orotraqueal prolongada (> 48 h) e submetidos à avaliação da deglutição à beira do leito nas primeiras 48 h após a extubação. Dados relacionados a avaliação fonoaudiológica clínica do risco de aspiração broncopulmonar, nível funcional da deglutição por meio da escala American Speech-Language-Hearing Association National Outcome Measurement System (ASHA NOMS) e status de saúde pelo Sequential Organ Failure Assessment (SOFA) foram coletados. Resultados: A amostra do estudo foi composta por 150 pacientes. Para fins da análise estatística, os pacientes foram agrupados com base nos escores ASHA NOMS: ASHA1 (níveis 1-2), ASHA2 (níveis 3-5) e ASHA3 (níveis 6-7). Os indivíduos no grupo ASHA3 eram significativamente mais jovens, permaneceram intubados por menos tempo e apresentaram menor gravidade de quadro clínico geral (escore SOFA) do que os indivíduos nos demais grupos. Os preditores clínicos de broncoaspiração que melhor caracterizaram os grupos foram achados de ausculta cervical alterada e presença de tosse após a deglutição. O grupo ASHA3 não apresentou esses sinais. Conclusões: Pacientes críticos com idade ≥ 55 anos, período de intubação ≥ 6 dias, gravidade de quadro clínico geral (escore SOFA ≥ 5), escore na Escala de Coma de Glasgow ≤ 14, ausculta cervical alterada e tosse após a deglutição devem ser priorizados para a avaliação fonoaudiológica completa.

Assuntos

RESUMO

INTRODUCTION: Oral transit time is one of the parameters observed during the clinical assessment of the swallowing function. The importance of this parameter is due to its impact on the total duration of a meal, whose consequence can be an unfavorable nutritional prognostic. OBJECTIVE: To document scientific papers that measure oral transit time in healthy subjects. METHOD: The review followed the steps proposed by the Cochrane Handbook. The search was done via the PubMed database through the use of descriptors related to the oral phase of swallowing, as well as to types of food consistency. RESULTS: The articles on the theme had different definitions for oral transit time, as well as heterogeneity of tested volumes, age and gender of the participants. The times found varied from 0.35 s to 1.54 s for liquids, from 0.39 s to 1.05 s for pasty foods and from 1 s to 12.8 s for solid foods. Also, regardless of volume or consistency, oral transit time in elderly people is significantly longer than in adults. CONCLUSION: There's no consensus in the literature about oral transit time in healthy subjects. However, this parameter should be valued during the assessment of the swallowing function due to its negative impact on the dynamics of swallowing, which can cause high energy expenditure during feeding. .

Introdução: O tempo de trânsito oral é um dos parâmetros observados na avaliação clínica da deglutição. A importância se deve ao seu impacto na duração total da refeição, o que pode ter como consequência prognóstico nutricional desfavorável. Objetivo: Documentar os textos científicos internacionais que abordem o tempo de trânsito oral em sujeitos saudáveis. Método: Estudo de revisão crítica que segue os preceitos do Cochrane Handbook. Os artigos foram selecionados por meio da base de dados PubMed, com utilização de descritores relacionados à fase oral da deglutição e aos tipos de consistência alimentar. Resultado: Os trabalhos analisados divergiram quanto à definição de tempo de trânsito oral, bem como quanto aos volumes testados e às idades e gêneros dos sujeitos avaliados. Os tempos encontrados variaram de 0,35 s a 1,54 s para líquido, de 0,39 s a 1,05 s para a consistência pastosa e de 1 s a 12,8 s para a consistência sólida. Foi observado também que o tempo de trânsito oral é significativamente aumentado em idosos, em relação a adultos, independente de volume e consistência alimentar. Conclusão: Não há consenso na literatura quanto ao tempo de trânsito oral na população saudável. Ainda assim, entende-se que este parâmetro deva ser valorizado durante a avaliação da disfagia, uma vez que possui impacto negativo na dinâmica da deglutição, o que acarreta desgaste energético ocasionado pela alimentação. .

Assuntos

RESUMO

INTRODUÇÃO: A deglutição é um processo complexo que requer a coordenação precisa de mais de 25 músculos, seis pares de nervos cranianos e os lobos frontais. O comprometimento neste processo, denominado de disfagia, pode aumentar a taxa de morbidade dos pacientes e também o risco para a aspiração, retardando a administração de uma nutrição adequada por via oral. A intubação orotraqueal prolongada, definida na literatura como período superior a 48 horas de intubação, poderá causar alterações na deglutição e ocasionar a disfagia após a extubação. OBJETIVO: correlacionar a gravidade de pacientes críticos não neurológicos com preditores clínicos do risco de broncoaspiração. MÉTODOS: Participaram do estudo adultos, com histórico de intubação orotraqueal prolongada ( > 48 horas), submetidos à avaliação da deglutição em beira de leito nas primeiras 48 horas após a extubação. A coleta de dados envolveu: avaliação fonoaudiológica clínica do risco de aspiração broncopulmonar; determinação do nível funcional da deglutição (American Speech-Language-Hearing Association National Outcome Measurement System); determinação da gravidade do paciente (Sequential Organ Failure Assessment). RESULTADOS: a amostra do estudo foi composta por 150 pacientes. Para fins da análise estatística, os pacientes foram agrupados da seguinte forma: ASHA 1 (sem possibilidade de alimentação por via oral); ASHA 2 (sem possibilidade de alimentação por via oral); ASHA 3 (deglutição funcional). As análises estatísticas indicaram os seguintes resultados significantes: indivíduos no grupo ASHA 3 eram mais jovens (46,4±18,30), permaneceram entubados por menos tempo (4,9±2,7 dias) e apresentaram menor gravidade de quadro clínico geral (Sequential Organ Failure Assessment 2,00-5,00). Os sinais clínicos preditores de broncoaspiração que mais diferenciaram os grupos foi a presença de ausculta cervical alterada e presença de tosse após a deglutição, sendo que o grupo ASHA 3 não apresentou esses sinais....

INTRODUCTION: Swallowing is a complex process, that require the precise timing and coordination of more than 25 muscles, six cranial nerves and frontal lobes. Compromise of this process, or dysphagia, can result in profund morbidity, increasing the changes of aspiration and delaying the admistration of proper oral nutrition. It is know that an orotracheal tube might disturb these intricately choreographed events and cause post-extubation dysphagia. Prolonged intubation, typically defined as longer than 48 hours in the literature, is thought to contribute to swallowing dysfunction. OBJECTIVES: to correlate the severity of non-neurologic critical patients with clinical predictors for the risk of bronchoaspiration. METHODS: Participants of this study were adults, submitted to prolonged orotracheal intubation ( > 48 hours) and to a swallowing bedside evaluation during the first 48 hours after extubation. Data gathering involved: clinical assessment of the risk for bronchoaspiration performed by a speech-language pathologist; assessment of the funcitional level of swallowing (American Speech-Language-Hearing Association National Outcome Measurement System); assessment of the patient's health status (Sequential Organ Failure Assessment). RESULTS: the study sampel was composed by 150 patients. For the analyses purposes, patients were grouped as follows: ASHA 1 (individual is not able to swallow safely and alternative feeding is required); ASHA 2 (alternative feeding is required, but individual may receive some nutrition and hydration by mouth); ASHA 3 (swallowing is functional). Statistical analyses indicated that: ASHA 3 patients were younger (46,4±18,30 years), remained intubated for fewer days (4,9±2,7) and presented a less severe overall health status (Sequential Organ Failure Assessment 2,00-5,00). The clinical predictor signs for bronchoaspiration that best characterized the groups were altered cervical auscultation and presence of...

Assuntos

RESUMO

OBJECTIVES: To elucidate independent risk factors for dysphagia after prolonged orotracheal intubation. METHODS: The participants were 148 consecutive patients who underwent clinical bedside swallowing assessments from September 2009 to September 2011. All patients had received prolonged orotracheal intubations and were admitted to one of several intensive care units of a large Brazilian school hospital. The correlations between the conducted water swallow test results and dysphagia risk levels were analyzed for statistical significance. RESULTS: Of the 148 patients included in the study, 91 were male and 57 were female (mean age, 53.64 years). The univariate analysis results indicated that specific variables, including extraoral loss, multiple swallows, cervical auscultation, vocal quality, cough, choking, and other signs, were possible significant high-risk indicators of dysphagia onset. The multivariate analysis results indicated that cervical auscultation and coughing were independent predictive variables for high dysphagia risk. CONCLUSIONS: Patients displaying extraoral loss, multiple swallows, cervical auscultation, vocal quality, cough, choking and other signs should benefit from early swallowing evaluations. Additionally, early post-extubation dysfunction recognition is paramount in reducing the morbidity rate in this high-risk population.

Assuntos

RESUMO

OBJECTIVES: To elucidate independent risk factors for dysphagia after prolonged orotracheal intubation. METHODS: The participants were 148 consecutive patients who underwent clinical bedside swallowing assessments from September 2009 to September 2011. All patients had received prolonged orotracheal intubations and were admitted to one of several intensive care units of a large Brazilian school hospital. The correlations between the conducted water swallow test results and dysphagia risk levels were analyzed for statistical significance. RESULTS: Of the 148 patients included in the study, 91 were male and 57 were female (mean age, 53.64 years). The univariate analysis results indicated that specific variables, including extraoral loss, multiple swallows, cervical auscultation, vocal quality, cough, choking, and other signs, were possible significant high-risk indicators of dysphagia onset. The multivariate analysis results indicated that cervical auscultation and coughing were independent predictive variables for high dysphagia risk. CONCLUSIONS: Patients displaying extraoral loss, multiple swallows, cervical auscultation, vocal quality, cough, choking and other signs should benefit from early swallowing evaluations. Additionally, early post-extubation dysfunction recognition is paramount in reducing the morbidity rate in this high-risk population. .

Assuntos

RESUMO

Objetivos: Comparar as habilidades de deglutição e alimentação entre pacientes extubados, com e sem dano cerebral. Métodos: Estudo etrospectivo, que incluiu 44 pacientes de 20 a 50 anos, submetidos à intubação orotraqueal (IOT) prolongada (> 48 horas). Foram analisados dois grupos, sendo o Grupo 1 composto por pacientes sem traumatismo crânio-encefálico (TCE) e o Grupo 2 de pacientes com TCE. Para a comparação, foram utilizadas duas escalas que caracterizaram as habilidades funcionais de deglutição e alimentação. Avaliou-se também o nível de alerta, consciência e colaboração dos pacientes. Rresultados: Os grupos apresentaram-se equiparáveis quanto à idade, número e tempo de intubação e de extubação na data da avaliação. Em relação ao diagnóstico fonoaudiológico, o Grupo 1 apresentou maior porcentagem de deglutição funcional e disfagia leve, enquanto o Grupo 2 apresentou maior concentração das disfagias de grau moderado a grave e de grau grave. A média observada na Escala Funcional de Ingestão Oral na data da avaliação foi maior no Grupo 1. Além disso, o grupo de lesados cerebrais apresentou-se mais sonolento, menos contactuante e menos colaborativo na primeira avaliação. Cconclusões: Neste estudo, os pacientes submetidos à IOT prolongada apresentaram disfagia em diferentes graus, porém os pacientes com dano cerebral tiveram maior freqüência e gravidade deste distúrbio. Desta forma, concluímos que a IOT não pode ser considerada como fator causador da disfagia isoladamente, principalmente nos pacientes neurológicos. Além disso, observou-se que alguns fatores cognitivos podem influenciar a possibilidade de ofertar dieta por via oral.

Assuntos