Interventions for oropharyngeal dysphagia in acute and critical care: a protocol for a systematic review and meta-analysis

Abstract

BackgroundOropharyngeal dysphagia or swallowing difficulties are common in acute care and critical care, affecting 47% of hospitalised frail elderly, 50% of acute stroke patients and approximately 62% of critically ill patients who have been intubated and mechanically ventilated for prolonged periods. Complications of dysphagia include aspiration leading to chest infection and pneumonia, malnutrition, increased length of hospital stay and re-admission to hospital. To date, most dysphagia interventions in acute care have been tested with acute stroke populations. While intervention studies in critical care have been emerging since 2015, they are limited and so there is much to learn about the type, the delivery and the intensity of treatments in this setting to inform future clinical trials. The aim of this systematic review is to summarise the evidence regarding the relationship between dysphagia interventions and clinically important patient outcomes in acute and critical care settings.MethodsWe will search MEDLINE, EMBASE, CENTRAL, Web of Science, CINAHL and clinical trial registries from inception to the present. We will include studies conducted with adults in acute care settings such as acute hospital wards or units or intensive care units and critical care settings. Studies will be restricted to randomised controlled trials and quasi-randomised controlled trials comparing a new dysphagia intervention with usual care or another intervention. The main outcomes that will be collected include length of time taken to return to oral intake, change in incidence of aspiration and pneumonia, nutritional status, length of hospital stay and quality of life. Key intervention components such as delivery, intensity, acceptability, fidelity and adverse events associated with such interventions will be collected to inform future clinical trials. Two independent reviewers will assess articles for eligibility, data extraction and quality appraisal. A meta-analysis will be conducted as appropriate.DiscussionNo systematic review has attempted to summarise the evidence for oropharyngeal dysphagia interventions in acute and critical care. Results of the proposed systematic review will inform practice and the design of future clinical trials.Systematic review registrationPROSPERO CRD 42018116849 (http://www.crd.york.ac.uk/PROSPERO/)

Preliminary results of a clinical study to evaluate the performance and safety of swallowing in critical patients with COVID-19

“…Breathing and swallowing are physiologically linked to ensure effortless gas exchange during oronasal breathing and to prevent aspiration during swallowing. Besides that, prolonged intubation has been shown to alter the mechanoreceptors and chemoreceptors of pharyngeal and laryngeal mucosae, while also causing muscle atrophy and loss of proprioception (6). Reduced pharyngeal and laryngeal sensation places patients at higher risk of silently aspirating food and fluids into the upper airway (i.e., no cough response when aspiration occurs), which can lead to chest infection and pneumonia, malnutrition, increased length of hospital stay, and readmission to the hospital (7).…”

Interventions for oropharyngeal dysphagia in acute and critical care: a systematic review and meta-analysis

“…We registered the protocol with the International Prospective Register of Systematic Reviews (PROSPERO CRD 42018116849) and published the review protocol in 2019 [18]. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines [19].…”

Evolução funcional da deglutição em pacientes com COVID-19 internados em UTI

“…Recent studies indicate that these patients may present damage to the central and peripheral nervous system as a direct result of the virus or due to the innate and adaptive immune response to infection (3) . Patients, whether due to prolonged intubation or neurological damage, are at high risk of oropharyngeal dysphagia (4)(5)(6)(7)(8) .…”