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Development of a modified swallowing screening tool to manage post‐extubation dysphagia

Published on Mar 1, 2018in Nursing in Critical Care1.639
· DOI :10.1111/nicc.12333
Martin Christensen14
Estimated H-index: 14
(QUT: Queensland University of Technology),
Michaela Trapl1
Estimated H-index: 1
Abstract
: Post-extubation dysphagia is a condition that is becoming a growing concern. The condition occurs in 3-62% of extubated patients and can be related to mixed aetiologies, such as neuromuscular impairment, critical illness and laryngeal damage. The risk factors for developing dysphagia in critically ill patients are under-diagnosed and perhaps underestimated. Recent studies recommend the implementation of a standardized swallowing screen to prevent aspiration and decrease pneumonia rate and mortality. The aim of this quality improvement initiative was the development of a bedside swallowing screening tool to assess effective swallowing post-endotracheal extubation. Post-extubation dysphagia can result in a delay in re-feeding, with the potential for malnutrition as well as overt and covert aspiration if swallowing is not effectively screened. It is apparent that ICU nurses commence the initial screen for swallowing in the absence of an evidence base of care. A review of current local and international practice guidelines excludes the process of an effective swallowing screen of the extubated patient. Previously, a referral to speech and language therapists would be required to assess swallowing only after an initial review by the ICU medical team. This often leads to delays if the referral is made outside normal working practice, such as weekends or evenings. The initial development of a swallowing screening tool is the first step to promoting a nurse-led/-initiated bedside swallow screening tool that will enhance patient care and patient safety. There is growing body of evidence regarding the incidence of post-extubation dysphagia. Currently, there are very few recognized bedside swallowing screening tools to identify patients at risk. The most serious complication associated with post-extubation dysphagia is aspiration pneumonia, which is the leading cause of nosocomial infection in the critically ill patient.
  • References (26)
  • Citations (4)
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References26
Newest
#1Jacqueline M. Kruser (NU: Northwestern University)H-Index: 5
#2Hallie C. Prescott (UM: University of Michigan)H-Index: 19
3 CitationsSource
#1Kay Choong See (NUS: National University of Singapore)H-Index: 4
#2Si Yu Peng (NUS: National University of Singapore)H-Index: 1
Last. Johncy ConcepcionH-Index: 1
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Background Swallowing difficulties are common, and dysphagia occurs frequently in intensive care unit (ICU) patients after extubation. Yet, no guidelines on postextubation swallowing assessment exist. We aimed to investigate the safety and effectiveness of nurse-performed screening (NPS) for postextubation dysphagia in the medical ICU.
5 CitationsSource
#1Dimitra KarabatsouH-Index: 1
#2Maria TsironiH-Index: 1
Last. G. Baltopoulos (UoA: National and Kapodistrian University of Athens)
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Summary Intensive care unit (ICU) costs account for a great part of a hospital's expenses. The objective of the present study was to measure the patient-specific cost of ICU treatment, to identify the most important cost drivers in ICU and to examine the role of various contributing factors in cost configuration. A retrospective cost analysis of all ICU patients who were admitted during 2011 in a Greek General, seven-bed ICU and stayed for at least 24 hours was performed, by applying bottom-up a...
8 CitationsSource
#1Rebecca Scheel (BMC: Boston Medical Center)H-Index: 4
#2Jessica M. Pisegna (BU: Boston University)H-Index: 8
Last. Susan E. Langmore S E (BU: Boston University)H-Index: 33
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Objectives:The purpose of this study was to identify the frequency of swallowing dysfunction after extubation in a sample of patients with no preexisting dysphagia.Methods:Mechanically ventilated patients in the ICU with no prior history of dysphagia received a flexible endoscopic evaluation of swallowing (FEES) exam within 72 hours after extubation. The FEES was then analyzed for variables related to swallowing patterns and laryngeal pathology. Univariate analyses were performed to identify rel...
25 CitationsSource
Rationale: Endotracheal intubation is associated with postextubation swallowing dysfunction, but no guidelines exist for postextubation swallowing assessments.Objectives: We evaluated the prevalence, patient demographic and clinical factors, and intensive care unit (ICU) and hospital organizational factors associated with swallowing assessment after oral endotracheal intubation and mechanical ventilation in patients with acute lung injury (ALI).Methods: We performed a secondary analysis of a pro...
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Following cardiovascular (CV) surgery, prolonged mechanical ventilation of >48 h increases dysphagia frequency over tenfold: 51 % compared to 3–4 % across all durations. Our primary objective was to identify dysphagia frequency following CV surgery with respect to intubation duration. Our secondary objective was to explore characteristics associated with dysphagia across the entire sample. Using a retrospective design, we stratified all consecutive patients who underwent CV surgery in 2009 at ou...
35 CitationsSource
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Last. Steven B. Leder (Yale University)H-Index: 34
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The purpose of this prospective, double-blinded, multirater, systematic replication study was to investigate agreement for aspiration risk, in the same individual, between videofluoroscopic swallow studies (VFSS) and the Yale Swallow Protocol. Participants were 25 consecutive adults referred for dysphagia testing who met the inclusion criteria of completion of a brief cognitive assessment, oral mechanism examination, and no tracheotomy tube. First, all participants were administered the Yale Swa...
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OBJECTIVES: To elucidate independent risk factors for dysphagia after prolonged orotracheal intubation. METHODS: The participants were 148 consecutive patients who underwent clinical bedside swallowing assessments from September 2009 to September 2011. All patients had received prolonged orotracheal intubations and were admitted to one of several intensive care units of a large Brazilian school hospital. The correlations between the conducted water swallow test results and dysphagia risk levels ...
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RISK FACTORS FOR DYSPHAGIA IN CRITICALLY-ILL PATIENTS WITH PROLONGED OROTRACHEAL INTUBATION Kara Nicole Nizolek Dysphagia after prolonged orotracheal intubation is reported to increases a patient’s risk for aspiration, leading to increased risk for morbidity and mortality. Identification of specific risk factors that may predispose a patient to post-extubation dysphagia and aspiration risk is important. However, previous studies have not consistently identified concrete risk factors of post-extu...
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The COVID-19 is a global pandemic. Its rapid dissemination and serious course require a novel approach to healthcare practices. Severe disease progression is often associated with the development of the Acute Respiratory Distress Syndrome and may require some form of respiratory support, including endotracheal intubation, mechanical ventilation, and enteral nutrition through a�nasogastric tube. These conditions increase the risk of dysphagia, aspiration, and aspiration pneumonia. The data on the...
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