Swallowing characteristics and oral intake before and after speech therapy follow-up of tracheostomized patients admitted to a university hospital
DOI:
https://doi.org/10.23925/2176-2724.2022v34i3e52646Keywords:
Speech, Language and Hearing Sciences, Tracheostomy, Swallowing disordersAbstract
Introduction: Tracheostomy may impact swallowing and generate neurophysiological and mechanical alterations. Objective: To analyze the swallowing functionality in tracheostomized patients admitted to a university hospital, before and after speech-language therapy intervention through the analysis of the service protocols - Adapted Protocol (based on the FOIS scale and Dysphagia Risk Assessment Protocol - PARD). Method: Cross-sectional, retrospective, analytical observational study, with a quantitative approach. We analyzed 114 swallowing assessment protocols, and checked the degree of dysphagia according to O’Neil’s classification and FOIS scale over a four-year period. Research approved by the Institution’s Research Ethics Committee (29894920.5.0000.5349). Results: After analyzing the protocols it was found that the majority were male with a mean age of 54.55 years. A predominance of the following previous health comorbidities was observed: pneumonia, systemic arterial hypertension and ischemic stroke. After the speech-language therapy follow-up there was an improvement in swallowing biomechanics with more patients presenting functional swallowing - one (0.9%) to 12 (10.5%), reduction in the number of subjects with severe dysphagia - 32 (28.1%) to 17 (14.9%) and greater oral intake - 79 (69.3%) of the patients increased the level of oral intake according to the FOIS scale. Most of the sample showed good tolerance to tracheostomy occlusion and 60 (52.6%) progressed to decannulation. Conclusion: The presence of a tracheostomy had an impact on swallowing functionality, since most patients had some degree of dysphagia. We emphasize the importance of speech therapy in the swallowing rehabilitation process, helping in the decannulation process.
Downloads
Metrics
References
Silva CR, Cunha HPS. Ocorrência de broncoaspiração de saliva em pacientes traqueostomizados [trabalho de conclusão de curso]. Porto Velho (Rondônia): Centro Universitário São Lucas de Porto Velho; 2016.
Côrte MMD, Vicente LCC, Friche AAL. Decanulação: indicadores sociodemográficos, clínicos e fonoaudiológicos preditivos de sucesso. Audiol. Commun. Res. 2019; 24(e): 1-9. doi: 10.1590/2317-6431-2018-2103.
Medeiros GC, Sassi FC, Lirani-Silva C, Andrade CRF. Critérios para decanulação da traqueostomia: revisão de literatura. CoDAS. 2019; 31(6): 44-50. doi: .1590/2317-1782/20192018228.
Dedivitis RA, Santoro PP, Sugueno LA. Manual prático de disfagia: diagnóstico e tratamento. 1th. ed. Rio de Janeiro: Revinter; 2017.
Crary MA, Mann GD, Groher ME. Initial psychometric assessment of a functional oral intake scale for dysphagia in stroke patients. Arch Phys Med Rehab. 2005; 86(8):1516-20. doi: 10.1016/j.apmr.2004.11.049.
Padovani AR, Moraes DP, Mangili LD, Andrade CRF. Protocolo fonoaudiológico de avaliação do risco para disfagia (PARD). Rev. soc. bras. fonoaudiol. 2007; 12(3): 199-205.
Thompson-Henry, S., Braddock, B. The modified Evan’s blue dye procedure fails to detect aspiration in the tracheostomized patient: Five case reports. Dysphagia. 1995; 10(3): 172-4.Doi: 10.1007/BF00260973
O’Neil KH, Purdy M, Falk J, Gallo L. The dysphagia outcome and severity scale. Dysphagia. 1999; 14(3): 139-45. doi: 10.1007 / PL00009595.
Abe T, Madotto F, Pham T, Nagata I, Uchida M, Tamiya N et al. Epidemiology and patterns of tracheostomy practice in patients with acute respiratory distress syndrome in ICUs across 50 countries. Critical Care. 2018; 22(195): 1-16. doi: 10.1186/s13054-018-2126-6.
Favero SR, Scheeren B, Barbosa L, Hoher JA, Cardoso MCAF. Complicações clínicas da disfagia em pacientes internados em uma UTI. Distúrb Comun. 2017; 29(4); 654-62. doi: 0.23925/2176-2724.2017v29i4p654-662.
Lopes AVR. Perfil epidemiológico e o sucesso/insucesso da ventilação mecânica. Rev. Cient. X SIMPAC; 6 Jun 2018; Viçosa, MG. ANAIS SIMPAC; 10(1): 74-9; 2018.
Rodrigues KA, Machado FR, Chiari BM, Rosseti HB, Lorenzon P, Gonçalves MI. Reabilitação da deglutição em pacientes traqueostomizados disfágicos sob ventilação mecânica em unidades de terapia intensiva: um estudo de factibilidade. Rev. Bras. Ter. Intensiva. 2015; 27(1): 64-71. doi: 10.5935/0103-507X.20150011.
Junior JGS, Silveira JM. Influência da traqueostomia no tempo de ventilação mecânica. Ver. Amazônia Science & Health. 2017; 5(1): 35-9. doi: 10.18606/2318-1419.
Zanini, Martini TF, Santos FS, Rovedder PE, Stein R. Associação da função pulmonar e capacidade funcional com o tempo de ventilação mecânica invasiva após cirurgia de revascularização do miocárdio. Arq. Ciênc. Saúde. 2018; 25(2): 42-6. doi: 10.17696/2318-3691.25.2.2018.896.
Mateus AP, Ruivo EAB, Troncoso EAM, Kubayashi V, Ferreira LL, Werneck AL. Desmame de traqueostomia em pacientes neurológicos responsivos e arresponsivos [periódico na internet]. Arq. Ciênc. Saúde. 2017 [acesso em 29 Jun 2020]; 24(2): [6p.]. Disponível em: https://www.cienciasdasaude.famerp.br/index.php/racs/article/view/613/689 .
Jesus SC. Silva BCA, Queiroz CA. Desfecho clínico de pacientes submetidos à traqueostomia precoce e tardia. 17º Congr. Inic. Cient. FASB. Mai 10; Barreiras, Ba; 2019.
Freeman BD. Tracheostomy update. Crit. Clin. Care. 2016; 33(2): 311-22.
Mah JW, Staff II, Fisher SR, Butler KL. Improving decannulation and swallowing function: A comprehensive, multidisciplinary approach to post-tracheostomy care. Resp. Care. 2017; 62(2): 137-43. doi: 10.4187/respcare.04878.
Oliveira EL, Rocha CR, Vanvos-sem MR. Critérios para decanulação eficaz: uma revisão de literatura. Rev. Insp. 2017; 14(4): 43-7. ISSN: 2175-537X.
Mallmann LP. Manejo do paciente traqueostomizado e decanulação – o papel do intensivista além da UTI. REINPEC. 2019; 5(2): 112-34. doi: 10.20951/2446-6778/v5n2a9.
Medved DMS, Marques AHB. Eficácia da remoção da cânula de traqueostomia por equipe interdisciplinar: série de casos. Ceafi. No prelo 2019; 1-9.
Belafsky PC, Blumenfeld L, Lepage A, Nahrstedt K. The accuracy of the modified Evan’s blue dye test in predicting aspiration. Laryngoscope. 2003;113(11):1969-72. doi: 10.1097/00005537-200311000-00021.
Billington J, Luckett A. Care of the critically ill patient with a tracheostomy. Cardiorespiratory. 2019; 34(2): 59-65. doi: 10.7748/ns.2019.e11297.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2022 Jainara Medina Teixeira, Karen de Oliveira dos Passos, Sheila Petry Rockenbach
This work is licensed under a Creative Commons Attribution 4.0 International License.
