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. 2015 Jan-Mar;27(1):64-71.
doi: 10.5935/0103-507X.20150011. Epub 2015 Mar 1.

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

[Article in English, Portuguese]
Katia Alonso Rodrigues  1 , Flávia Ribeiro Machado  2 , Brasília Maria Chiari  1 , Heloísa Baccaro Rosseti  2 , Paula Lorenzon  3 , Maria Inês Rebelo Gonçalves  1
Affiliations

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

[Article in English, Portuguese]
Katia Alonso Rodrigues et al. Rev Bras Ter Intensiva. 2015 Jan-Mar.

Abstract
in English, Portuguese

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.

Objetivo: Avaliar a factibilidade da implantação precoce de um programa de reabilitação da deglutição em pacientes traqueostomizados com disfagia e sob ventilação mecânica.

Métodos: Estudo prospectivo realizado em unidades de terapia intensiva de um hospital universitário. Incluímos pacientes hemodinamicamente estáveis e submetidos à ventilação mecânica por pelo menos 48 horas e há no mínimo 48 horas com traqueostomia e nível adequado de consciência. Os critérios de exclusão foram cirurgia prévia na cavidade oral, faringe, laringe e/ou esôfago, presença de doenças degenerativas ou história pregressa de disfagia orofaríngea. Todos os pacientes foram submetidos a um programa de reabilitação da deglutição. Antes e após o tratamento de reabilitação da deglutição, foram determinados um escore estrutural orofaríngeo, um escore funcional de deglutição, e um escore otorrinolaringológico estrutural e funcional.

Resultados: Foram incluídos 14 pacientes. A duração média do programa de reabilitação foi de 12,4 ± 9,4 dias, com média de 5,0 ± 5,2 dias sob ventilação mecânica. Onze pacientes puderam receber alimentação por via oral enquanto ainda permaneciam na unidade de terapia intensiva após 4 (2 - 13) dias de tratamento. Todos os escores apresentaram melhora significante após o tratamento.

Conclusão: Neste pequeno grupo de pacientes, a implantação de um programa precoce de reabilitação da deglutição foi factível, mesmo em pacientes sob ventilação mecânica.

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Conflict of interest statement

Conflicts of interest: None.

Figures

Figure 1
Figure 1
Comparison between the oropharyngeal structural score, swallowing functional score and otorhinolaryngological structural and functional score pre and post treatment. OSS - oropharyngeal structural score; SFS - swallowing functional score; OSFS - otorhinolaryngological structural and functional score. Results show the significant reduction of all scores; OSS, p = 0.007, SFS, p = 0.001 and OSFS, p = 0.004. (OSS and OSFS - paired t test, SFS - Wilcoxon paired test).
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