Effect of Oral Care Intervention and Safe-Swallowing Education on Dysphagia among ICU Patients Post Endotracheal Extubation

Abstract

Background: Post Extubation Dysphagia (PED) can potentially cause life-threatening consequences, early detection of PED is essential to reduce complications. Understanding the treatment modalities of PED is essential to minimize complications and improve quality of treatment. Oral care intervention and safe-swallowing education are valuable to improve and prevent dysphagia in vulnerable patients' post-extubation. The aim of this study is to assess the effect of oral care intervention and safe-swallowing education on dysphagia among ICU patients post endotracheal extubation. Subjects and Method: Design: A quasi-experimental design was utilized. Setting; Medical intensive care units (ICUs) in Emergency hospital affiliated to Tanta University hospitals. Sample: A purposive sample of 40 adult patients, who underwent emergency oral endotracheal intubation for at least 48 hours. Tool 1: Bio socio-demographic data questionnaire; Tool 2: Modified Standardized Swallow Assessment (MSSA). Data was collected through three phases; assessment, implementation and evaluation through 10 months. Results: there is a dramatic improvement in in MSSA score and in the satisfactory level of MSSA post intervention in the study group which are highly statistically significant, compared to a slight gradual improvement in MSSA score post intervention in addition; there are no significant differences in the satisfactory level of MSSA scores throughout the study period in the control group. Conclusion: oral care intervention along with safe-swallowing education for the patients and their family care giver reduces dysphagia of ICU patients post endotracheal extubation. Recommendation: Nurses can play an important role in reducing dysphagia among ICU patients post endotracheal extubation by include the oral care intervention and safe-swallowing education in the daily routine care provided for patients post endotracheal intubation.

Effect of Oral Care and Swallowing Interventions on Post extubation Dysphagia among Children at Pediatric Intensive Care Units

“…In addition, previous research (29) clarified that there was a statistically significant improvement in the total mean score of oral assessment guide that indicate slight to moderate oral problems post intervention compared to pre intervention. Moreover, another previous research (7) showed that there was a dramatic improvement in oral assessment score in the study group on post intervention. In relation to Bazaz dysphagia scale score regarding severity of dysphagia, the current finding revealed that, more than half of the studied children in the study group were having moderate dysphagia after 7 th days and absence of dysphagia after 14 th days of practicing swallowing exercises.…”

“…(4,5) It includes any incapability or difficulty to efficiently and properly move food and drinks from the mouth to the esophagus. (6) Algendy & Bahgat (7) mentioned that up to 62% of intensive care unit patients experience dysphagia after extubation. This prevalence rate of dysphagia may potentially be higher in children due to anatomical variations in the size and physical relationship of the oral structures.…”

“…Also, comprehending the therapy methods of postextubation dysphagia is crucial to reduce problems and raise the standard of care. (7) So, swallowing intervention is one of the treatment modalities that can help to enhance swallowing function, preserve the capacity to consume food & liquids safely, and reduce swallowing problems that may develop after extubation. (12) In addition, swallowing and oral care interventions including oral lubrication, perform massage to the upper & lower jaw and oral range of motion exercises for the lips, tongue, jaw, and cheeks would speed up the process of resuming oral intake and enhance saliva flow and would improve oral lubrication and strength in the lips, tongue, jaw, and cheeks.…”

Swallowing and Oral Care Intervention on Dysphagia among Post- Extubation Patients

“…Amongst swallowing and oral intervention is one of the effective management as brushing of teeth/massaging of salivary glands would improve oral lubrication and oral sensation by mechanically stimulating oral sensory receptors and increasing salivary flow [19,20]. Oral care intervention also includes a range of motion exercises for the lips, tongue, jaw, and cheeks [21]. Oral motor exercise can alleviate lip weakness, tongue strength, lingual agility, and mouth opening by strengthening lips, tongue, jaw, and cheeks [22,23].…”