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Meta-Analysis
. 2020 Jul;46(7):1326-1338.
doi: 10.1007/s00134-020-06126-y. Epub 2020 Jun 8.

Interventions for oropharyngeal dysphagia in acute and critical care: a systematic review and meta-analysis

Sallyanne Duncan  1 , Daniel F McAuley  2 , Margaret Walshe  3 , Jennifer McGaughey  4 , Rohan Anand  2 , Richard Fallis  5 , Bronagh Blackwood  2
Affiliations
Meta-Analysis

Interventions for oropharyngeal dysphagia in acute and critical care: a systematic review and meta-analysis

Sallyanne Duncan et al. Intensive Care Med. 2020 Jul.

Abstract

Purpose: To determine the effectiveness of dysphagia interventions compared to standard care in improving oral intake and reducing aspiration for adults in acute and critical care.

Methods: We searched electronic literature for randomised and quasi-randomised trials and bibliography lists of included studies to March 2020. Study screening, data extraction, risk of bias and quality assessments were conducted independently by two reviewers. Meta-analysis used fixed effects modelling. The systematic review protocol is registered and published.

Results: We identified 22 studies (19 stroke, 2 intensive care stroke and 1 general intensive care) testing 9 interventions and representing 1700 patients. Swallowing treatment showed no evidence of a difference in the time to return to oral intake (n = 33, MD (days) - 4.5, 95% CI - 10.6 to 1.6, 1 study, P = 0.15) (very low certainty) or in aspiration following treatment (n = 113, RR 0.79, 95% CI 0.44 to 1.45, 4 studies, I2 = 0%, P = 0.45) (low certainty). Swallowing treatment showed evidence of a reduced risk of pneumonia (n = 719, RR 0.71, 95% CI 0.56 to 0.89, 8 studies, I2 = 15%, P = 0.004) (low certainty) but no evidence of a difference in swallowing quality of life scores (n = 239, MD - 11.38, 95% CI - 23.83 to 1.08, I 2 = 78%, P = 0.07) (very low certainty).

Conclusion: There is limited evidence for the effectiveness of swallowing treatments in the acute and critical care setting. Clinical trials consistently measuring patient-centred outcomes are needed.

Keywords: Critical care; Deglutition disorders; Dysphagia; Dysphagia rehabilitation; Intensive care; Swallowing therapy.

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Conflict of interest statement

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Figures

Fig. 1:
Fig. 1:
PRISMA flowchart
Fig. 2:
Fig. 2:
Swallowing therapy versus standard care: aspiration incidence post-intervention
Fig. 3:
Fig. 3:
Swallowing therapy versus standard care: incidence of pneumonia
See this image and copyright information in PMC

Comment in

References

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