Prognostic indicators of functional outcomes in first time documented acute stroke patients following standard dysphagia treatment

McMicken, Betty L.; Muzzy, Cheryl L

doi:10.3109/09638280902956894

Cited by 18 publications

(15 citation statements)

References 23 publications

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“…Moreover, subjects were limited to those requiring assistance and presenting swallowing level ≤4 according to the American Speech-Language-Hearing Association National Outcome Measurement System (ASHA NOMS) [18,26,34]. Patients were excluded if they (1) were making use of a tracheostomy tube, (2) presented neurologic diseases, (3) presented esophageal dysphagia and (4) had been submitted to surgical procedures involving the head and neck.…”

Section: Methodsmentioning

confidence: 99%

“…However, only patients who are clinically stable undergo a complete BSE. Based on the existing literature [18], we included in our study patients who had initial poor swallowing levels. Although these patients were clinically stable, they still depended on alternative feeding methods or had moderate diet restriction.…”

Section: Methodsmentioning

confidence: 99%

“…Patients in this study were assisted by various staff SLPs with experience in the area of dysphagia and trained to apply the same treatment program. The amount of treatment was recorded in revenue value units (RVUs) [18]. According to the literature, each RVU represents 15 minutes of actual therapy time.…”

Section: Methodsmentioning

confidence: 99%

“…A clearer understanding of prognostic indicators has the potential to enable the rehabilitation team to better predict recovery and facilitates appropriate and cost-effective care for individuals with swallowing disorders [18,19]. Studies have examined general prognostic indicators of swallowing function in different diseases.…”

Section: Introductionmentioning

confidence: 99%

“…Studies have examined general prognostic indicators of swallowing function in different diseases. These indicators include: age [20,21]; severity of the disease [22-24]; cognitive status [18,25]; dysphagia severity level at hospital admission and/or discharge [22,26-28]; presence of feeding tube [29]; time to achieve oral feeding status [14,17,30]; time to tracheostomy weaning [14,31]; ventilator status [17,25]; amount of treatment [14,18,26]; and length of hospital stay [12,32]. …”

Section: Introductionmentioning

confidence: 99%

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Clinical prognostic indicators of dysphagia following prolonged orotracheal intubation in ICU patients

et al. 2013

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IntroductionThe development of postextubation swallowing dysfunction is well documented in the literature with high prevalence in most studies. However, there are relatively few studies with specific outcomes that focus on the follow-up of these patients until hospital discharge. The purpose of our study was to determine prognostic indicators of dysphagia in ICU patients submitted to prolonged orotracheal intubation (OTI).MethodsWe conducted a retrospective, observational cohort study from 2010 to 2012 of all patients over 18 years of age admitted to a university hospital ICU who were submitted to prolonged OTI and subsequently received a bedside swallow evaluation (BSE) by a speech pathologist. The prognostic factors analyzed included dysphagia severity rate at the initial swallowing assessment and at hospital discharge, age, time to initiate oral feeding, amount of individual treatment, number of orotracheal intubations, intubation time and length of hospital stay.ResultsAfter we excluded patients with neurologic diseases, tracheostomy, esophageal dysphagia and those who were submitted to surgical procedures involving the head and neck, our study sample size was 148 patients. The logistic regression model was used to examine the relationships between independent variables. In the univariate analyses, we found that statistically significant prognostic indicators of dysphagia included dysphagia severity rate at the initial swallowing assessment, time to initiate oral feeding and amount of individual treatment. In the multivariate analysis, we found that dysphagia severity rate at the initial swallowing assessment remained associated with good treatment outcomes.ConclusionsStudies of prognostic indicators in different populations with dysphagia can contribute to the design of more effective procedures when evaluating, treating, and monitoring individuals with this type of disorder. Additionally, this study stresses the importance of the initial assessment ratings.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Clinical prognostic indicators of dysphagia following prolonged orotracheal intubation in ICU patients

et al. 2013

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Pilot Study of an Oral Care Protocol on PostStroke Survivors

Chipps¹,

Gatens²,

Genter³

et al. 2014

Rehabilitation Nursing

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Tracheostomy in Stroke Patients

Bösel

2013

Curr Treat Options Neurol

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Patients with severe ischemic and hemorrhagic stroke may require tracheostomy in the course of their disease. This may apply to stroke unit patients whose deficits include a severe dysphagia posing such risk of aspiration as it cannot be sufficiently counteracted by tube feeding and swallowing therapy alone. More often, however, tracheostomy is performed in stroke patients so severely afflicted that they require intensive care unit treatment and mechanical ventilation. In these, long-term ventilation and prolonged insufficient airway protection are the main indications for tracheostomy. Accepted advantages are less pharyngeal and laryngeal lesions than with prolonged orotracheal intubation, better oral hygiene and nursing care, and higher patient comfort. Optimal timing of tracheostomy is unclear, in general, as in stroke intensive care unit patients. Potential benefits of early tracheostomy concerning ventilation duration and length of stay, respirator weaning, airway safety, rate of pneumonia, and other complications, outcome and mortality have been suggested in studies on non-neurologic subgroups of critical care patients. Stroke patients have hardly been investigated with regard to these aspects, and mainly retrospectively. A single randomized pilot trial on early tracheostomy in 60 ventilated patients with severe hemorrhagic and ischemic stroke demonstrated feasibility, safety, and less need of sedation. Regarding the technique, bedside percutaneous dilational tracheostomy should be preferred over surgical tracheostomy because of several reported advantages. As the procedural risk is low and early tracheostomy does not seem to worsen the clinical course of the ventilated stroke patient, it is reasonable to assess the need of further ventilation at the end of the first week of intensive care and proceed to tracheostomy if extubation is not feasible. Reliable prediction of prolonged ventilation need and outcome benefits of early tracheostomy, however, await further clarification. Decannulation of stroke patients after discontinued ventilation has to follow reliable confirmation of swallowing ability, as by endoscopy.

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Prognostic indicators of functional outcomes in first time documented acute stroke patients following standard dysphagia treatment

Cited by 18 publications

References 23 publications

Clinical prognostic indicators of dysphagia following prolonged orotracheal intubation in ICU patients

Clinical prognostic indicators of dysphagia following prolonged orotracheal intubation in ICU patients

Pilot Study of an Oral Care Protocol on PostStroke Survivors

Tracheostomy in Stroke Patients

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