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Effects of Swallowing and Oral Care Intervention on Reducing Postextubation Dysphagia among Critically Ill Patients

Naglaa EL Mokadem, Shimaa EL Sayed

Abstract


Background: Endotracheal Intubation (ETI) is a life-sustaining technique required for critically ill patients to support mechanical ventilation. However, postextubation dyphagia is a common complication of ETI. Postextubation dysphagia negatively affects patients’ outcomes, leading to delayed recommencement of oral intake, poor quality of life, aspiration pneumonia, longer ICU and hospital stays, and increased 90-day mortality. Moreover, the high economic burdens on public health care systems. Early identification of patients at risk is necessary to minimize the sequel complications of dysphagia and associated financial burdens. Aim: To evaluate the effects of swallowing and oral care intervention on reducing postextubation dysphagia among critically ill patients. Design: A quasi experimental design (pre/post test) was used. Setting: The study was conducted at Medical, Surgical and Trauma ICUs. Sample: A convenient sample of 65 critically ill patients were recruited to participate in the study. Tools: A Semi Structured Demographic Sheet; Oral Assessment Guide (OAG); Clinical Swallowing Assessment (CSA); Functional Oral Intake Scale (FOIS). Results: There was a statistically significant improvement of dysphagia level and functional oral intake post intervention compared to pre intervention (P<0.001). Also, there was a statistically significant improvement in the total mean score of Oral Assessment Guide (11.32±4.369) which indicate slight to moderate oral problems post intervention compared to (16.34±4.839) pre intervention (P<0.001) which indicate severe oral problems. Recommendations: A systematic routine screening should be performed in all patients at risk and including patients with stroke. Establish a multidisciplinary team for postextubation dysphagia management including a critical care nurse, speech–language pathologist, and dietician. Conducting continuing in-service training programs for critical care nurses about swallowing and oral care protocol to reduce postextubation dysphagia. Implementing this protocol as a routine clinical practice for patients at high risk for postextubation dysphagi

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Oliveira A.C.M., Friche A.A.L., Salomao M.S., et. al. Predictive factors for oropharyngeal dysphagia after prolonged orotracheal intubation. Braz J Otorhinolaryngol.2018; 84(6):722–728. 2

V. De Larminat, V, Philippe Montravers, Jean Marie Desmonts, Alteration in swallowing reflex after extubation in intensive care unit patients: Critical Care Medicine.

; 23:486-490.

Macht M, Wimbisht T, Clark BJ, Burnham EL, Williams SA, Moss M. (2011). Postextubations dysphagia is persistent and associated with poor outcomes in survivors of critical illness. Critical Care. 15:R231.

Schefold JC, Berger D, Zurcher P, Lensch M, Perren A, Jakob SM, et al. (2017). Dysphagia in mechanically ventilated ICU patients (DYnAMICS): a prospective observational trial. Crit Care Med. 45(12):2061–9.

Tsai MH, Ku SC, Wang TG, Hsiao TY, Lee JJ, Chan DC, et al. (2016). Swallowing dysfunction following endotracheal intubation: age matters. Medicine (Baltimore) 95:e3871.

Medeiros GC, Sassi FC, Zambom LS, Andrade CR. (2016). Correlation between the severity of critically ill patients and clinical predictors of bronchial aspiration. J Bras Pneumol. 42(2):114–20

Zuercher P, Moret CS, Dziewas R, Schefold JC. (2019). Dysphagia in the intensive care unit: epidemiology, mechanisms, and clinical management. Crit Care. 23:103.

Kim MJ, Park YH, Park YS, Song YH. (2015). Associations between prolonged intubation and developing postextubation dysphagia and aspiration pneumonia in nonneurologic critically ill patients. Ann Rehabil Med. 39:763–71.

Brodsky MB, Huang M, Shanholtz C, Mendez-Tellez PA, Palmer JB, Colantuoni E, et al. (2017). Recovery from dysphagia symptoms after oral endotracheal intubation in acute respiratory distress syndrome survivors. A 5-year longitudinal study. Ann Am Thorac Soc. 14:376–83.

Ponfick M, Linden R, Nowak DA.(2015). Dysphagia-a common, transient symptom in critical illness polyneuropathy: a fiberoptic endoscopic evaluation of swallowing study. Crit Care Med. 43(2):365–72.

Zielske J, Bohne S, Brunkhorst F, Axer H, Guntinas-Lichius O. (2014). Acute and long-term dysphagia in critically ill patients with severe sepsis: results of a prospective controlled observational study. Eur Arch Otorhinolaryngol. 271(11): 3085–93.

Supannee Rassameehiran, Saranapoom Klomjit, Charoen Mankong paisarnrung & Ariwan Rakvit (2015). Postextubation Dysphagia, Baylor University Medical Center Proceedings, 28:1, 18-20,

Crary, M., Carnaby. G., LaGorio, L., & Carvajal, P. (2012). Functional and Physiological Outcomes from an Exercise-Based Dysphagia Therapy: A Pilot Investigation of the McNeil Dysphagia Therapy Program. Archives of Physical Medicine and Rehabilitation, 93(7), 1173-1178.

Burkhead LM, Sapienza CM, Rosenbek JC. (2007). Strength-training exercise in dysphagia rehabilitation: principles, procedures, and directions for future research. Dysphagia; 22:251-65.

Antunes, E.B. & Lunet, N. (2012). The effects of the head lift exercise on the swallow function: A systematic review. Gerodontology, 29, 247-257.

Eilers J, Berger AM, Petersen MC. (1988). Development, testing, and application of the oral assessment guide. Oncol Nurs Forum;15:325–330.

Andersson P., Persson L., Rahm Hallberg I.-L. & Renvert S. (1999).Testing an oral assessment guide during chemotherapy treatment in a Swedish care setting: a pilot study. Journal of Clinical Nursing. 8, 150–158.

Rockville MD. (1998). American Speech-Language-Hearing Association National Outcome Measurement System (NOMS). Adult Speech- Language Pathology training manual, ASHA,

Padovani AR, Moraes DP, Mangilli LD, Andrade CRF. (2012). Protocolo de avaliac¸a˜o fonoaudiolo´gica de risco para disfagia (PARD). In: Andrade CRF, Limongi SCO (Eds). Disfagia – pra´tica baseada em evideˆncias, 1 ed. Sa˜o Paulo: Sarvier. p.62-73.

Chen CC, Wu KH, Ku SC, Chan DC, Lee JJ, Wang TG, et al. (2018). Bedside screen for oral cavity structure, salivary flow, and vocal production over the 14 days following endotracheal extubation. J Crit Care. 45:1–6.

Omura K, Komine A, Yanagigawa M, Chiba N, Osada M. (2018). Frequency and outcome of post-extubation dysphagia using nurse-performed swallowing screening protocol. British Association of Critical Care Nurses. 24(2):70–75.

Wu CP, Xu YJ, Wang TG, Ku SC, Chan DC, Lee JJ, Wei YC, Hsiao TY, Chen CC. (2019). Effects of a swallowing and oral care intervention for patients following endotracheal extubation: a pre- and post-intervention study. Crit Care. 23(1):350.

El Gharib, A., Berretin-Felix, G., Rossoni , D., Yamada ,S., (2019). Effectiveness of Therapy on Post-Extubation Dysphagia: Clinical and Electromyographic Findings. Clin Med Insights Ear Nose Throat; Volume 12: 1–6

Balou M, Herzberg EG, Kamelhar D, Molfenter SM. (2019). An intensive swallowing exercise protocol for improving swallowing physiology in older adults with radiographically confirmed dysphagia Volume 14 Pages 283—288

Kang JH, Park RY, Lee SJ, Kim JY, Yoon SR, Jung KI. (2012). The effect of bedside exercise program on stroke patients with Dysphagia. Ann Rehabil Med. 36:512–20.

Affoo RH, Trottier K, Garrick R, Mascarenhas T, Jang Y, Martin RE. (2018). The effects of tooth brushing on whole salivary flow rate in older adults. Biomed Res Int. 3904139.

Su H, Hsiao TY, Ku SC, Wang TG, Lee JJ, Tzeng WC, et al. (2015). Tongue weakness and somatosensory disturbance following oral endotracheal extubation. Dysphagia. 30:188–95.

Boliek CA, Rieger JM, Li SY, Mohamed Z, Kickham J, Amundsen K. (2007). Establishing a reliable protocol to measure tongue sensation. J Oral Rehabil. 34:433–41.

Rech RS, Baumgarten A, Colvara BC, Brochier CW, de Goulart BNG, Hugo FN, et al. (2018). Association between oropharyngeal dysphagia, oral functionality, and oral sensorimotor alteration. Oral Dis. 24:664–72.

Sarkar A, Andablo-Reyes E, Bryant M, Dowson D, Neville A. (2019). Lubrication of soft oral surfaces. Curr Opin Colloid Interface Sci. 39:61–75.

Haggard P, deBoer L. (2014). Oral somatosensory awareness. Neurosci Biobehav Rev. 47:469–84.

Park T, Kim Y. (2016). Effects of tongue pressing effortful swallow in older healthy individuals. Arch Gerontol Geriatr.66:127–133.

Robbins JA, Gangnon RE, Theis SM, (.2005). The effects of lingual exercise on swallowing in older adults. J Am Geriatr Soc; 53:1483–9.




DOI: https://doi.org/10.37628/ijncc.v6i2.1462

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