Correlation between the severity of critically ill patients and clinical predictors of bronchial aspiration

Abstract

Objective: To determine whether the severity of non-neurological critically ill patients correlates with clinical predictors of bronchial aspiration. Methods: We evaluated adults undergoing prolonged orotracheal intubation (> 48 h) and bedside swallowing assessment within the first 48 h after extubation. We collected data regarding the risk of bronchial aspiration performed by a speech-language pathologist, whereas data regarding the functional level of swallowing were collected with the American Speech-Language-Hearing Association National Outcome Measurement System (ASHA NOMS) scale and those regarding health status were collected with the Sequential Organ Failure Assessment (SOFA). Results: The study sample comprised 150 patients. For statistical analyses, the patients were grouped by ASHA NOMS score: ASHA1 (levels 1 and 2), ASHA2 (levels 3 to 5); and ASHA3 (levels 6 and 7). In comparison with the other patients, those in the ASHA3 group were significantly younger, remained intubated for fewer days, and less severe overall clinical health status (SOFA score). The clinical predictors of bronchial aspiration that best characterized the groups were abnormal cervical auscultation findings and cough after swallowing. None of the patients in the ASHA 3 group presented with either of those signs. Conclusions: Critically ill patients 55 years of age or older who undergo prolonged orotracheal intubation (≥ 6 days), have a SOFA score ≥ 5, have a Glasgow Coma Scale score ≤ 14, and present with abnormal cervical auscultation findings or cough after swallowing should be prioritized for a full speech pathology assessment.

Clinical swallowing prognostic indicators in patients with acute ischemic stroke

“…The study sample consisted of 295 participants. For the purposes of statistical analysis, the patients were grouped according to the ASHA NOMS score obtained in the initial speech-language evaluation as follows: levels 1 and 2 -ASHA1 (51 participants); levels 3, 4 and 5 -ASHA2 (96 participants); and levels 6 and 7 -ASHA3 (148 participants) 12,13 . Table 1 shows the comparison of demographic variables and GCS scores between the groups.…”

Avaliação e classificação da disfagia pós-extubação em pacientes críticos.

“…In our hospital, the risk of bronchoaspiration is determined based on the Speech-Language Dysphagia Risk Evaluation Protocol (DREP) 13 . Based on the study by Medeiros et al 14 The results indicated a statistically significant difference for the following variables: age, mortality, OTI days, number of speech therapy sessions and days to hospital discharge. Statistical analysis by the Kruskal-Wallis test indicated that patients with ASHA3 functional deglutition level were significantly younger when compared with the other groups (ASHA1 -p=0.001; ASHA2 -p=0.014).…”

“…Therefore, dysphagia has a significant impact on hospital stay time, which is an indicator of poor prognosis 13 . In addition, the literature also indicates that age (>55 years) and the presence of dysphagia after extubation increase mortality during hospitalization 11,14,15 .…”

Dysphagia in the intensive care unit: epidemiology, mechanisms, and clinical management

“…In general medical populations, the overall burden of dysphagia on public health care system is considered high. Dysphagia-associated complications include increased risk for aspiration, aspiration-induced pneumonia [6, 9–26], delayed resumption of oral intake/malnutrition [3, 10–13, 27, 28], decreased quality of life [21, 27], prolonged ICU and/or hospital length of stay [3, 8, 11, 14, 29], and increased morbidity and mortality [3, 6, 8, 9, 13, 27, 30–33].…”