The effects of thrombolysis and endovascular clot retrieval on dysphagia: a scoping review

Minchell, Ellie; Finch, Emma; Rumbach, Anna F.

doi:10.1080/2050571x.2019.1660460

Cited by 5 publications

(6 citation statements)

References 42 publications

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“…Unfortunately, studies exploring the effect of reperfusion therapy on swallowing are scarce, with little to no research focusing on the impact of EVT on PSD ( 20 , 21 ). Hence, the influence of GA, EVT or the stroke itself on swallowing physiology remains unclear.…”

Section: Introductionmentioning

confidence: 99%

Dysphagia assessment in ischemic stroke after mechanical thrombectomy: When and how?

et al. 2022

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BackgroundDysphagia is a frequent symptom in acute ischemic stroke (AIS). Endovascular treatment (EVT) has become the standard of care for acute stroke secondary to large vessel occlusion. Although standardized guidelines for poststroke dysphagia (PSD) management exist, they do not account for this setting in which patients receive EVT under general anesthesia. Therefore, the aim of this study was to evaluate PSD prevalence and severity, as well as an appropriate time point for the PSD evaluation, in patients undergoing EVT under general anesthesia (GA).MethodsWe prospectively included 54 AIS patients undergoing EVT under GA. Fiberoptic Endoscopic Evaluation of Swallowing (FEES) was performed within 24 h post-extubation in all patients. Patients presenting significant PSD received a second FEES-assessment to determine the course of dysphagia deficits over time. Dysphagia severity was rated according the Fiberoptic Dysphagia Severity Scale (FEDSS).ResultsAt first FEES (FEES 1) assessment, performed in the median 13 h (IQR 5–17) post-extubation, 49/54 patients (90.7%) with dysphagia were observed with a median FEDSS of 4 (IQR 3–6). Severe dysphagia requiring tube feeding was identified in 28/54 (51.9%) subjects, whereas in 21 (38.9%) patients early oral diet with certain food restrictions could be initiated. In the follow up FEES examination conducted in the median 72 h (IQR 70–97 h) after initial FEES 34/49 (69.4%) patients still presented PSD. Age (p = 0.030) and ventilation time (p = 0.035) were significantly associated with the presence of PSD at the second FEES evaluation. Significant improvement of dysphagia frequency (p = 0.006) and dysphagia severity (p = 0.001) could be detected between the first and second dysphagia assessment.ConclusionsPSD is a frequent finding both immediately within 24 h after extubation, as well as in the short-term course. In contrast to common clinical practice, to delay evaluation of swallowing for at least 24 h post-extubation, we recommend a timely assessment of swallowing function after extubation, as 50% of patients were safe to begin oral intake. Given the high amount of severe dysphagic symptoms, we strongly recommend application of instrumental swallowing diagnostics due to its higher sensitivity, when compared to clinical swallowing examination. Furthermore, advanced age, as well as prolonged intubation, were identified as significant predictors for delayed recovery of swallowing function.

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Section: Introductionmentioning

confidence: 99%

Dysphagia assessment in ischemic stroke after mechanical thrombectomy: When and how?

et al. 2022

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“…Finally, this systematic review excluded letters to editors which may potentially have included useful information about trials, however, none were retrieved during the screening. Despite these limitations, an important purpose of systematic reviews is to demonstrate when evidence is lacking in a particular area to guide future research [ 82 ] as observed in previous studies [ 83 ]. According to the Cochrane Collaboration, although a minimum of two studies is required to complete a meta-analysis, there is no minimum number necessary to complete a systematic review, as long as relevant studies have been retrieved [ 84 – 87 ].…”

Section: Discussionmentioning

confidence: 99%

Exercise-based dysphagia rehabilitation for adults with oesophageal cancer: a systematic review

et al. 2022

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Background Dysphagia is prevalent in oesophageal cancer with significant clinical and psychosocial complications. The purpose of this study was i) to examine the impact of exercise-based dysphagia rehabilitation on clinical and quality of life outcomes in this population and ii) to identify key rehabilitation components that may inform future research in this area. Methods Randomised control trials (RCT), non-RCTs, cohort studies and case series were included. 10 databases (CINAHL Complete, MEDLINE, EMBASE, Web of Science, CENTRAL, and ProQuest Dissertations and Theses, OpenGrey, PROSPERO, RIAN and SpeechBITE), 3 clinical trial registries, and relevant conference abstracts were searched in November 2020. Two independent authors assessed articles for eligibility before completing data extraction, quality assessment using ROBINS-I and Downs and Black Checklist, followed by descriptive data analysis. The primary outcomes included oral intake, respiratory status and quality of life. All comparable outcomes were combined and discussed throughout the manuscript as primary and secondary outcomes. Results Three single centre non-randomised control studies involving 311 participants were included. A meta-analysis could not be completed due to study heterogeneity. SLT-led post-operative dysphagia intervention led to significantly earlier start to oral intake and reduced length of post-operative hospital stay. No studies found a reduction in aspiration pneumonia rates, and no studies included patient reported or quality of life outcomes. Of the reported secondary outcomes, swallow prehabilitation resulted in significantly improved swallow efficiency following oesophageal surgery compared to the control group, and rehabilitation following surgery resulted in significantly reduced vallecular and pyriform sinus residue. The three studies were found to have ‘serious’ to ‘critical’ risk of bias. Conclusions This systematic review highlights a low-volume of low-quality evidence to support exercise-based dysphagia rehabilitation in adults undergoing surgery for oesophageal cancer. As dysphagia is a common symptom impacting quality of life throughout survivorship, findings will guide future research to determine if swallowing rehabilitation should be included in enhanced recovery after surgery (ERAS) programmes. This review is limited by the inclusion of non-randomised control trials and the reliance on Japanese interpretation which may have resulted in bias. The reviewed studies were all of weak design with limited data reported.

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“…Whilst research has typically focussed on general/functional outcome measures following reperfusion therapies including modified Rankin Scale (mRS), National Institutes of Health Stroke Scale (NIHSS), and mortality rates, there is limited research describing the effects of reperfusion therapies on dysphagia [ 9 ]. A 2021 retrospective chart review in Australia found 50.26% of patients ( n = 97/193) presented with dysphagia on initial clinical swallowing examination by SLPs [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Acute Dysphagia Following Reperfusion Therapies: A Prospective Pilot Cohort Study

et al. 2023

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Dysphagia is a well-documented sequela of stroke. Recent advancements in medical treatments for stroke include reperfusion therapies (endovascular thrombectomy (EVT) and thrombolysis). As outcomes following reperfusion therapies are typically measured via general functional scales, the pattern and progression of acute dysphagia following reperfusion therapies is less known. To determine the progression of acute dysphagia (0–72 h) following reperfusion therapies and relationships between various stroke parameters and dysphagia, twenty-six patients were prospectively recruited across two EVT and thrombolysis centres in Brisbane, Australia. Dysphagia was screened via the Gugging Swallowing Screen (GUSS) at the bedside at three timepoints: 0–24 h, 24–48 h, and 48–72 h post-reperfusion therapies. Across three groups (EVT only, thrombolysis only, or both), the incidence of any dysphagia within the first 24 h of reperfusion therapy was 92.31% (n = 24/26), 91.30% (n = 21/23) by 48 h, and 90.91% (n = 20/22) by 72 h. Fifteen patients presented with severe dysphagia at 0–24 h, 10 at 24–48 h, and 10 at 48–72 h. Whilst dysphagia was not significantly correlated to infarct penumbra/core size, dysphagia severity was significantly related to the number of passes required during EVT (p = 0.009).Dysphagia continues to persist in the acute stroke population despite recent advancements in technology aimed to reduce morbidity and mortality post-stroke. Further research is required to establish protocols for management of dysphagia post-reperfusion therapies.

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The effects of thrombolysis and endovascular clot retrieval on dysphagia: a scoping review

Cited by 5 publications

References 42 publications

Dysphagia assessment in ischemic stroke after mechanical thrombectomy: When and how?

Dysphagia assessment in ischemic stroke after mechanical thrombectomy: When and how?

Exercise-based dysphagia rehabilitation for adults with oesophageal cancer: a systematic review

Acute Dysphagia Following Reperfusion Therapies: A Prospective Pilot Cohort Study

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