Strategies of Screening and Treating Post-Extubation Dysphagia: An Overview of the Situation in Greek-Cypriot ICUs
Abstract
:1. Introduction
2. Materials and Methods
2.1. Design and Settings
2.2. Participants
2.3. Data Collection and Instrument
- Demographics
- Domain 1: Current practice
- (a)
- PED management with questions (7 multiple choice, 3 checkboxes and 1 matrix) about the existing protocols for screening, methods used to confirm the presence of PED and responsibilities of every ICU team member for assessing PED.
- (b)
- Prevention of aspiration pneumonia related to PED (2 matrix questions).
- (c)
- PED treatment interventions (1 matrix, 1 checkbox and 1 multiple choice question).
- Domain 2: Scope of the Problem
- Domain 3: Perceived Best Practice
Translation and Cultural Adaptation of the Instrument
2.4. Ethics Approval
2.5. Data Analysis
3. Results
3.1. Current Practices on PED
3.1.1. PED Management
Existing Protocols and Subgroups of Patients Screened
Timing of Screening
- After ICU admission
- After extubation
Methods Used for PED Assessment
Responsibilities of ICU Team Members
3.1.2. Prevention of Aspiration Pneumonia Related to PED
Aspiration/Aspiration Pneumonia Resulting from Liquids/Solid Food
Aspiration Pneumonia Resulting from Saliva Production
3.1.3. Interventions to Treat PED
3.2. Scope of the Problem
3.2.1. Awareness of PED Incidence
3.2.2. Awareness of PED Consequences
3.3. Perceived Best Practices on PED
3.3.1. Protocols and Routine Screening
3.3.2. Availability of Screening and Treating Methods
3.3.3. Barriers to Standardized Screening and Treatment
3.3.4. Facilitators to Standardized Screening and Treatment
4. Discussion
4.1. Current Practices on PED
4.1.1. PED Management
Existing Protocols and Subgroups of Patients Screened
Timing of Screening
- After ICU admission
- After extubation
Methods Used for PED Assessment
Responsibilities of ICU Team Members
4.1.2. Prevention of Aspiration Pneumonia Related to PED
Aspiration/Aspiration Pneumonia Resulting from Liquids/Solid Food
Aspiration Pneumonia Resulting from Saliva Production
4.1.3. Interventions to Treat PED
4.2. Scope of the Problem
4.2.1. Awareness of PED Incidence
4.2.2. Awareness of PED Consequences
4.3. Perceived Best Practices on PED
4.3.1. Protocols and Routine Screening
4.3.2. Availability of Screening and Treating Methods
4.3.3. Barriers to Standardized Screening and Treatment
4.3.4. Facilitators to Standardized Screening and Treatment
5. Limitations
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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ICU Patient Capacity in Beds | ICU Type | Hospital Capacity | SLP/SLT Available | |
---|---|---|---|---|
1 | 5–9 ** | Mixed medical/surgical | <200 | No |
2 | 5–9 * | Mixed medical/surgical/neurosurgical | <200 | No |
3 | 5–9 * | Mixed medical/surgical | 200–499 | No |
4 | 5–9 * | Mixed medical/surgical | <200 | No |
5 | 5–9 ** | Medical/surgical/Neurosurgical/cardiothoracic | <200 | Yes, not ICU-dedicated |
6 | 5–9 ** | Mixed medical/surgical | <200 | No |
7 | 5–9 ** | Medical/surgical/Neurosurgical/cardiothoracic | <200 | Yes, not ICU-dedicated |
8 | 10–14 ** | Mixed medical/surgical | <200 | Yes, not ICU-dedicated |
9 | 10–14 * | Mixed medical/surgical | 200–499 | No |
10 | 10–14 * | Mixed medical/surgical | <200 | Yes, not ICU-dedicated |
11 | 15–19 * | Medical/surgical/Neurosurgical/cardiothoracic | 200–499 | Yes, not ICU-dedicated |
12 | 10–14 * | Coronary Unit | 200–499 | Yes, not ICU-dedicated |
13 | 15–19 * | Mixed medical/surgical | 200–499 | Yes, not ICU-dedicated |
14 | 5–9 * | Burns Unit | 200–499 | Yes, not ICU-dedicated |
Percentage of Patients | |||||||
---|---|---|---|---|---|---|---|
0% | <25% | 25–50% | 51–75% | >75% | Not Available | Unfamiliar with This Intervention | |
Intervention used to treat PED | |||||||
Repetitive swallowing exercises/maneuvers with or without additional resistance (e.g., Mendelsohn or Masako maneuver, supraglottic swallow) | 3 | 1 | 3 | 1 | 1 | 5 | |
Muscle-strengthening exercises without swallowing (e.g., chin tuck against resistance or Shaker exercise) | 3 | 3 | 0 | 1 | 2 | 5 | |
Muscle-strengthening exercises using apps on a tablet/iPad | 7 | 1 | 0 | 0 | 1 | 5 | |
Respiratory exercises [e.g., expiratory muscle strength training (EMST)] | 5 | 0 | 0 | 2 | 3 | 4 | |
Neuromuscular electrical stimulation (NEMS) of swallowing muscles | 7 | 1 | 1 | 0 | 0 | 1 | 4 |
Surface EMG (sEMG) biofeedback swallowing training | 8 | 1 | 1 | 4 | |||
Pharyngeal electrical stimulation (PES) | 8 | 2 | 4 |
Survey Item | Proportion in Agreement | Mean (Standard Deviation) | Median (IQR) | Modal Value (Appearance Times) |
---|---|---|---|---|
Oropharyngeal dysphagia influences ICU length of stay | 12/14 (85.7%) | 5.64 (1.33) | 6 (1) | 6 (7) |
Oropharyngeal dysphagia influences hospital length of stay | 10/14 (71.4%) | 4.57 (2.4) | 6 (5) | 6 (6) |
Oropharyngeal dysphagia influences the delay in return to independent physical functioning after critical illness | 14/14 (100%) | 6.57 (0.64) | 7 (1) | 7 (9) |
Oropharyngeal dysphagia influences the need for care at long-term facilities or nursing homes after critical illness | 14/14 (100%) | 6.35 (0.63) | 6 (1) | 6 (7) |
The presence of oropharyngeal dysphagia influences the risk of ICU-readmission | 10/14 (71.4%) | 4.85 (2.03) | 5 (5) | 2, 5, 7 (4 each) |
Water Swallow Test (Including the Yale Swallow Protocol) |
Gugging Swallowing Screen (GUSS) |
Volume-viscosity swallow test |
Oral mechanism exam |
Methylene (Evan’s) blue dye test |
Cervical auscultation |
Video fluoroscopic swallowing study (VFSS) |
Fiberoptic endoscopic evaluation of swallowing (FEES) |
No Need for Dysphagia-Specific Treatment, the Dysphagia will Disappear when the Patient’s Strength Increases |
Protocolized changing in fluid consistency and texture |
Protocolized postural changes (chin down, etc.) |
Repetitive swallowing exercises/maneuvers (e.g., Mendelsohn or Masako maneuver, supraglottic swallow) |
Muscle-strengthening exercises without swallowing (e.g., chin tuck against resistance or Shaker exercise) |
Muscle-strengthening exercises using apps on a tablet/iPad |
Respiratory exercises (e.g., expiratory muscle strength training (EMST)) |
Smaller bore gastric feeding tube |
Change to PEG-tube |
If tracheostomy is present, replace with a smaller cannula tube |
If tracheostomy is present only because of managing airway secretions, remove entirely |
Neuromuscular electrical stimulation (NEMS) of swallowing muscles |
Surface EMG biofeedback swallowing training |
Pharyngeal electrical stimulation |
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© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
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Mpouzika, M.; Iordanou, S.; Kyranou, M.; Iliopoulou, K.; Parissopoulos, S.; Kalafati, M.; Karanikola, M.; Papathanassoglou, E. Strategies of Screening and Treating Post-Extubation Dysphagia: An Overview of the Situation in Greek-Cypriot ICUs. Healthcare 2023, 11, 2283. https://doi.org/10.3390/healthcare11162283
Mpouzika M, Iordanou S, Kyranou M, Iliopoulou K, Parissopoulos S, Kalafati M, Karanikola M, Papathanassoglou E. Strategies of Screening and Treating Post-Extubation Dysphagia: An Overview of the Situation in Greek-Cypriot ICUs. Healthcare. 2023; 11(16):2283. https://doi.org/10.3390/healthcare11162283
Chicago/Turabian StyleMpouzika, Meropi, Stelios Iordanou, Maria Kyranou, Katerina Iliopoulou, Stelios Parissopoulos, Maria Kalafati, Maria Karanikola, and Elizabeth Papathanassoglou. 2023. "Strategies of Screening and Treating Post-Extubation Dysphagia: An Overview of the Situation in Greek-Cypriot ICUs" Healthcare 11, no. 16: 2283. https://doi.org/10.3390/healthcare11162283
APA StyleMpouzika, M., Iordanou, S., Kyranou, M., Iliopoulou, K., Parissopoulos, S., Kalafati, M., Karanikola, M., & Papathanassoglou, E. (2023). Strategies of Screening and Treating Post-Extubation Dysphagia: An Overview of the Situation in Greek-Cypriot ICUs. Healthcare, 11(16), 2283. https://doi.org/10.3390/healthcare11162283