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Speech pathology assessment of dysphagia post endotracheal extubation: A service-model evaluation. | LitMetric

AI Article Synopsis

  • The study focused on the effectiveness of a referral protocol for assessing postextubation dysphagia (PED) in patients who were intubated for 48 hours or more, which is linked to severe health issues like pneumonia and higher mortality rates.
  • Over a two-year period, 96% of eligible patients were assessed, revealing that 89% had PED, with 26% experiencing profound severity.
  • The results highlighted quick assessment and management by speech pathologists, with patients recovering from dysphagia within a median of 7 days, demonstrating the importance of early intervention for this high-risk group.

Article Abstract

Background: As postextubation dysphagia (PED) is correlated with pneumonia, feeding-tube placement, and in-hospital mortality, early identification is paramount. Endotracheal intubation duration of ≥48 h is independently predictive for PED. Therefore, a blanket intensive care unit (ICU) referral protocol was implemented to conduct PED assessment of patients intubated for ≥48 h.

Objectives: The objective of this study was to review outcomes of an established blanket referral model for PED assessment in patients intubated for ≥48 h. Outcomes of the model were examined over a 2-year period (June 2015-June 2017) for (i) numbers and clinical characteristics of patients meeting criteria and referred for speech pathology (SP) assessment; (ii) frequency identified with PED on clinical swallow examination; (iii) severity and duration of PED; and (iv) SP management within the ICU.

Results: There was 96% adherence to the pathway with 108 participants (68% male) assessed. Median intubation duration was 142 h (mode = 61; interquartile range [IQR] = 131.75), and median ICU admission was 9 days (mode = 8; IQR = 6.75). SP referral occurred at a median of 19.5 h (mode = 4; IQR = 18.75) after extubation. Dysphagia assessment occurred at a median of 22 h (mode = 4; IQR = 19), with 34% assessed on the same day and 77% within 24 h of extubation. PED was observed in 89%, with 26% exhibiting profound PED. Dysphagia recovery occurred at a median of 7 days (mode = 2; IQR = 11). Dysphagia severity was associated with duration to swallow recovery (p = 0.001). A median of two occasions of service and 90 min clinical time was spent by the speech pathologist in the ICU.

Conclusion: The blanket referral model enabled timely triage and assessment of dysphagia in a patient cohort at high risk of PED in our facility.

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Source
http://dx.doi.org/10.1016/j.aucc.2023.07.041DOI Listing

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