Background: Dysphagia occurs commonly in the intensive care unit (ICU). Despite the clinical relevance, there is little worldwide research on prevention, assessment, evaluation, and/or treatment of dysphagia for ICU patients. We aimed to gain insight into this international knowledge gap. Methods:We conducted a multi-center, international online cross-sectional survey of adult ICUs. Local survey distribution champions were recruited through professional and personal networks. The survey was administered from November 2017 to June 2019 with three email and a final telephone reminder. Results:Responses were received from 746 ICUs (26 countries). In patients intubated >48 hours, 17% expected a >50% chance that dysphagia would develop. This proportion increased to 43% in patients intubated >7 days, and to 52% in tracheotomized patients. Speech-language pathologist (SLP) consultation was available in 66% of ICUs, only 4% reported a dedicated SLP.Although 66% considered a routine post-extubation dysphagia protocol important, most (67%) did not have a protocol. Few ICUs routinely assessed for dysphagia after 48 hours intubation (30%) or tracheostomy (41%). A large proportion (46%) used water swallow screening tests to determine aspiration, few (8%) used instrumental assessments (i.e., flexible endoscopic evaluation of swallowing). Swallowing exercises were used for dysphagia management by 30% of ICUs.Conclusions: There seems to be limited awareness among ICU practioners that patients are at risk of dysphagia, particularly as ventilation persists, protocols, routine assessment and instrumental assessments are generally not used. We recommend the development of a research agenda to increase the quality of evidence and ameliorate the implementation of evidence-based dysphagia protocols by dedicated SLPs.

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This study investigated the systemic inflammatory response and mechanism of pulmonary lesions induced by Crotalus durissus cascavella venom in murine in the state of Bahia. In order to investigate T helper Th1, Th2 and Th17 lymphocyte profiles, we measured interleukin (IL) -2, IL-4, IL-6, IL-10, IL-17, tumor necrosis factor (TNF) and interferon gamma (IFN-γ) levels in the peritoneal fluid and macerated lungs of mice and histopathological alterations at the specific time windows of 1h, 3h, 6h, 12h, 24h and 48h after inoculation with Crotalus durissus cascavella venom. The data demonstrated an increase of acute-phase cytokines (IL-6 and TNF) in the first hours after inoculation, with a subsequent increase in IL-10 and IL-4, suggesting immune response modulation for the Th2 profile. The histopathological analysis showed significant morphological alterations, compatible with acute pulmonary lesions, with polymorphonuclear leukocyte (PMN) infiltration, intra-alveolar edema, congestion, hemorrhage and atelectasis. These findings advance our understanding of the dynamics of envenomation and contribute to improve clinical management and antiophidic therapy for individuals exposed to venom.

El fi brolipoma es la más prevalente de las variaciones histológicas del lipoma. Clínicamente, se asemeja mucho al lipoma y por eso muchas veces es subdiagnosticado. Es una lesión de comportamiento benigno, que raras veces se desarrolla en la cavidad oral y que suele ser asintomática. Estos factores asociados contribuyen para que la mayoría de los pacientes sólo busquen tratamiento cuando las lesiones presentan grandes dimensiones, están ulceradas y/o causan difi cultades en la masticación y deglución. El objetivo de este estudio es relatar tres casos de fi brolipoma en cavidad oral. Los tres casos relatados son de mujeres, con edades entre 38 y 49 años, que presentaban una lesión nodular, indolora, en región de mucosa yugal y con dimensiones variables entre 1 y 2 cm. En todos los casos las sospechas diagnósticas iniciales fueron de fi broma o lipoma, pero el análisis histopatológico concluyó que se trataban de fi brolipomas. Los fi brolipomas son lesiones raras en la cavidad oral y presentan características clínicas semejantes a diversas lesiones, de modo que suelen ser diagnosticados como una de estas entidades. De este modo, se resalta la importancia de la ejecución del estudio histopatológico, para que se pueda realizar un correcto diagnóstico de esta patología.

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