Disfagia em pacientes neurológicos pós extubação da ventilação mecânica
Autor(a) principal: | |
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Data de Publicação: | 2016 |
Tipo de documento: | Tese |
Idioma: | por |
Título da fonte: | Biblioteca Digital de Teses e Dissertações do UFSM |
Texto Completo: | http://repositorio.ufsm.br/handle/1/21533 |
Resumo: | PURPOSE: To investigate the presence of dysphagia in patients with neurological dysfunctions after they have been extubated in the Intensive Care Unit (ICU). Secondary objectives were: To evaluate the incidence of factors related to dysphagia in patients under treatment in ICU, as well as to make an analysis of variables like Maximal Inspiratory Pressure, number of days under Mechanical Ventilation (MV), number of days in ICU, use of tracheostomy, Glasgow Coma Scale (GCS) and peak cough flow reflex in neurological patients before extubation. METHODS: Firstly, we made a systematic review considering the Cochrane Handbook guidelines. The following question was considered in the research: What is the incidence and related factors to dysphagia in ICU? The research was performed on the databases of PubMed, ScienceDirect and Scopus. The key words used were: “epidemiology”, “incidence”, “deglutition disorders”, “intensive care units”, “airway extubation”, and “artificial respiration”. After that, we conducted a case-control study at the ICU of a public hospital in the south of Brazil, where 38 neurological patientes were evaluated and divided in a group in which dysphagia was present and in a second group without dysphagia. All patients had been on mechanical ventilation for a period longer than 24 hours and were in the imminence of extubation of the endotracheal tube (ETT) or the removal of the tracheostomy. Before the process of extubation, all patients passed through the tests of the strength of the respiratory musculature, GCS and peak cough flow reflex. Between 24 and 48 hours after the removal of the ETT or the tracheostomy, all patients were submitted to a Speech-Language Pathology evaluation based on the Dysphagia Risk Evaluation Protocol. RESULTS: The incidence of dysphagia varied from 38,1% to 93%. Time of Endotracheal Intubation (EI), MV and sepsis were found to be risk factors for dysphagia. We verified that both the groups with dysphagia and without dysphagia had similar outcomes in tests of the strength of the respiratory musculature, GCS and peak cough flow reflex . Age and time of hospitalization had statistic differences between the two groups. Evaluating the group of patients with neurological dysfunction, regardless the presence of dysphagia, there was a correlation, with statistical significance, among the following variables: Maximal Inspiratory Pressure, peak cough flow reflex, motor response (MR) and number of days under MV. The correlation of the use of tracheostomy, number of days under MV and number of days in ICU also presented statistical significance. CONCLUSION: Through the systematic review, it was possible to identify the wide variability of incidence of dysphagia after extubation. Moreover, time of EI, time of MV and sepsis are the most relevant factors related to the development of oropharynx dysphagia among patients in ICU. The neurological patients with dysphagia have more advanced age and need a longer period of time in hospital. All neurological patients, regardless the presence or absence of dysphagia, the use of tracheostomy is related to a decrease in the necessity of time in ICU. Inspiratory muscular strength is related to the peak cough flow. Furthermore, the good motor response in the GCS is related to fewer days under MV considering neurological patients in ICU. |
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2021-07-20T20:10:42Z2021-07-20T20:10:42Z2016-08-17http://repositorio.ufsm.br/handle/1/21533PURPOSE: To investigate the presence of dysphagia in patients with neurological dysfunctions after they have been extubated in the Intensive Care Unit (ICU). Secondary objectives were: To evaluate the incidence of factors related to dysphagia in patients under treatment in ICU, as well as to make an analysis of variables like Maximal Inspiratory Pressure, number of days under Mechanical Ventilation (MV), number of days in ICU, use of tracheostomy, Glasgow Coma Scale (GCS) and peak cough flow reflex in neurological patients before extubation. METHODS: Firstly, we made a systematic review considering the Cochrane Handbook guidelines. The following question was considered in the research: What is the incidence and related factors to dysphagia in ICU? The research was performed on the databases of PubMed, ScienceDirect and Scopus. The key words used were: “epidemiology”, “incidence”, “deglutition disorders”, “intensive care units”, “airway extubation”, and “artificial respiration”. After that, we conducted a case-control study at the ICU of a public hospital in the south of Brazil, where 38 neurological patientes were evaluated and divided in a group in which dysphagia was present and in a second group without dysphagia. All patients had been on mechanical ventilation for a period longer than 24 hours and were in the imminence of extubation of the endotracheal tube (ETT) or the removal of the tracheostomy. Before the process of extubation, all patients passed through the tests of the strength of the respiratory musculature, GCS and peak cough flow reflex. Between 24 and 48 hours after the removal of the ETT or the tracheostomy, all patients were submitted to a Speech-Language Pathology evaluation based on the Dysphagia Risk Evaluation Protocol. RESULTS: The incidence of dysphagia varied from 38,1% to 93%. Time of Endotracheal Intubation (EI), MV and sepsis were found to be risk factors for dysphagia. We verified that both the groups with dysphagia and without dysphagia had similar outcomes in tests of the strength of the respiratory musculature, GCS and peak cough flow reflex . Age and time of hospitalization had statistic differences between the two groups. Evaluating the group of patients with neurological dysfunction, regardless the presence of dysphagia, there was a correlation, with statistical significance, among the following variables: Maximal Inspiratory Pressure, peak cough flow reflex, motor response (MR) and number of days under MV. The correlation of the use of tracheostomy, number of days under MV and number of days in ICU also presented statistical significance. CONCLUSION: Through the systematic review, it was possible to identify the wide variability of incidence of dysphagia after extubation. Moreover, time of EI, time of MV and sepsis are the most relevant factors related to the development of oropharynx dysphagia among patients in ICU. The neurological patients with dysphagia have more advanced age and need a longer period of time in hospital. All neurological patients, regardless the presence or absence of dysphagia, the use of tracheostomy is related to a decrease in the necessity of time in ICU. Inspiratory muscular strength is related to the peak cough flow. Furthermore, the good motor response in the GCS is related to fewer days under MV considering neurological patients in ICU.OBJETIVOS: Investigar a presença de disfagia em pacientes neurológicos pós extubação em Unidade de Terapia Intensiva (UTI). Os objetivos secundários foram: Avaliar a incidência e fatores relacionados à disfagia pós extubação de pacientes em UTI e analisar as variáveis pressão inspiratória máxima (PImáx), dias de ventilação mecânica (VM), uso de traqueostomia (TQT), dias de internação na UTI, Escala de Coma de Glasgow (GCS) e pico de fluxo de tosse reflexa (PFTR) em pacientes neurológicos pré extubação. MÉTODOS: Primeiramente foi feita uma revisão sistemática, levando-se em consideração as diretrizes da Cochrane Handbook. Adotou-se como pergunta de pesquisa: qual a incidência e fatores relacionados à disfagia pós-extubação em UTI? A pesquisa foi realizada nas bases de dados PubMed, ScienceDirect e Scopus. Para a busca dos trabalhos publicados, os descritores adotados foram: “epidemiology”, “incidence”, “deglutition disorders”, “intensive care units”, “airway extubation”, “respiration artificial”. Após, realizou-se um estudo caso controle, na UTI de um hospital público da Região Sul. Foram avaliados 38 pacientes neurológicos, divididos em grupo disfágico e não disfágico, que estiveram em VM por um período maior que 24 horas e que estavam em processo de extubação do tubo orotraqueal (TOT) ou em desmame da TQT. Anteriormente ao processo de extubação, o paciente passou pelos testes de força da musculatura respiratória, GCS e PFTR. Entre 24 e 48 horas após a extubação ou desmame da TQT, os pacientes foram submetidos à avaliação clínica-fonoaudiológica pelo Protocolo de Avaliação de Risco de Disfagia (PARD). RESULTADOS: A incidência de disfagia variou entre 38,1 e 93%. Tempo de intubação orotraqueal (IOT), VM e sepse foi encontrado como fatores relacionados à disfagia. Foi possível verificar que os grupos disfágicos e não disfágicos apresentaram semelhança quanto à força muscular respiratória, GCS e PFTR. Já idade e tempo de internação hospitalar apresentaram diferenças estatísticas significativas entre os dois grupos. Avaliando o grupo de pacientes neurológicos, sem divisão quanto à disfagia, houve correlação com significância estatística entre as variáveis: PIMáx e PFTR, resposta motora (RM) e dias de VM. A correlação entre o uso ou não uso da TQT, dias de VM e dias de UTI também apresentou significância estatística. CONCLUSÕES: Por meio da revisão sistemática foi possível identificar a grande variabilidade de incidência de disfagia pósextubação. Além disso, tempo de IOT, tempo de VM e sepse foram fatores relacionados de maior relevância para o desenvolvimento da disfagia orofaríngea nos sujeitos internados em UTI. Os pacientes neurológicos disfágicos possuem idade mais avançada e necessitam maior tempo de internação hospitalar. Na totalidade dos pacientes neurológicos, sem divisão quanto à presença ou não de disfagia, a utilização da TQT se relaciona com a necessidade de menos tempo de internação na UTI. Força muscular inspiratória está relacionada com o pico de fluxo da tosse. Além disso, a boa resposta motora na GCS teve relação com a diminuição de dias de VM em pacientes neurológicos internados na UTI.porUniversidade Federal de Santa MariaCentro de Ciências da SaúdePrograma de Pós-Graduação em Distúrbios da Comunicação HumanaUFSMBrasilFonoaudiologiaAttribution-NonCommercial-NoDerivatives 4.0 Internationalhttp://creativecommons.org/licenses/by-nc-nd/4.0/info:eu-repo/semantics/openAccessTranstornos da deglutiçãoAVC (Acidente Vascular Cerebral)Unidade de terapia intensivaTraqueostomiaRespiração artificialDeglution disordersStrokeIntensive care unitsTracheostomyRespiration artificialCNPQ::CIENCIAS DA SAUDE::FONOAUDIOLOGIADisfagia em pacientes neurológicos pós extubação da ventilação mecânicaDysphagia in neurological patients post extubation mechanical ventilationinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/doctoralThesisMancopes, Renatahttp://lattes.cnpq.br/9897341072714640Pereira, Marisa BastosPasqualoto, Adriane SchmidtSilva, Antônio Marcos Vargas daBolzan, Geovana de PaulaAlmeida, Sheila Tamanini dehttp://lattes.cnpq.br/2354641883849274Werle, Roberta Weber400700000003600600600600600600600600d7ce0251-a99c-477a-baaf-6ed8e04d6156a5d1a825-9b6a-4517-bb90-a793a628a6b2be1ead51-5192-4200-8280-1c98297a349b9fda494b-68ad-4f61-9328-589bc584f8193c843ae6-11d5-472c-9049-c153e80647c03cc91ce0-8b10-47b8-89f4-af4e5b053ce1aa9102e5-5cfa-47ab-9c1a-4a2c39e1d4c7reponame:Biblioteca Digital de Teses e Dissertações do UFSMinstname:Universidade Federal de Santa Maria (UFSM)instacron:UFSMCC-LICENSElicense_rdflicense_rdfapplication/rdf+xml; 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dc.title.por.fl_str_mv |
Disfagia em pacientes neurológicos pós extubação da ventilação mecânica |
dc.title.alternative.eng.fl_str_mv |
Dysphagia in neurological patients post extubation mechanical ventilation |
title |
Disfagia em pacientes neurológicos pós extubação da ventilação mecânica |
spellingShingle |
Disfagia em pacientes neurológicos pós extubação da ventilação mecânica Werle, Roberta Weber Transtornos da deglutição AVC (Acidente Vascular Cerebral) Unidade de terapia intensiva Traqueostomia Respiração artificial Deglution disorders Stroke Intensive care units Tracheostomy Respiration artificial CNPQ::CIENCIAS DA SAUDE::FONOAUDIOLOGIA |
title_short |
Disfagia em pacientes neurológicos pós extubação da ventilação mecânica |
title_full |
Disfagia em pacientes neurológicos pós extubação da ventilação mecânica |
title_fullStr |
Disfagia em pacientes neurológicos pós extubação da ventilação mecânica |
title_full_unstemmed |
Disfagia em pacientes neurológicos pós extubação da ventilação mecânica |
title_sort |
Disfagia em pacientes neurológicos pós extubação da ventilação mecânica |
author |
Werle, Roberta Weber |
author_facet |
Werle, Roberta Weber |
author_role |
author |
dc.contributor.advisor1.fl_str_mv |
Mancopes, Renata |
dc.contributor.advisor1Lattes.fl_str_mv |
http://lattes.cnpq.br/9897341072714640 |
dc.contributor.advisor-co1.fl_str_mv |
Pereira, Marisa Bastos |
dc.contributor.referee1.fl_str_mv |
Pasqualoto, Adriane Schmidt |
dc.contributor.referee2.fl_str_mv |
Silva, Antônio Marcos Vargas da |
dc.contributor.referee3.fl_str_mv |
Bolzan, Geovana de Paula |
dc.contributor.referee4.fl_str_mv |
Almeida, Sheila Tamanini de |
dc.contributor.authorLattes.fl_str_mv |
http://lattes.cnpq.br/2354641883849274 |
dc.contributor.author.fl_str_mv |
Werle, Roberta Weber |
contributor_str_mv |
Mancopes, Renata Pereira, Marisa Bastos Pasqualoto, Adriane Schmidt Silva, Antônio Marcos Vargas da Bolzan, Geovana de Paula Almeida, Sheila Tamanini de |
dc.subject.por.fl_str_mv |
Transtornos da deglutição AVC (Acidente Vascular Cerebral) Unidade de terapia intensiva Traqueostomia Respiração artificial |
topic |
Transtornos da deglutição AVC (Acidente Vascular Cerebral) Unidade de terapia intensiva Traqueostomia Respiração artificial Deglution disorders Stroke Intensive care units Tracheostomy Respiration artificial CNPQ::CIENCIAS DA SAUDE::FONOAUDIOLOGIA |
dc.subject.eng.fl_str_mv |
Deglution disorders Stroke Intensive care units Tracheostomy Respiration artificial |
dc.subject.cnpq.fl_str_mv |
CNPQ::CIENCIAS DA SAUDE::FONOAUDIOLOGIA |
description |
PURPOSE: To investigate the presence of dysphagia in patients with neurological dysfunctions after they have been extubated in the Intensive Care Unit (ICU). Secondary objectives were: To evaluate the incidence of factors related to dysphagia in patients under treatment in ICU, as well as to make an analysis of variables like Maximal Inspiratory Pressure, number of days under Mechanical Ventilation (MV), number of days in ICU, use of tracheostomy, Glasgow Coma Scale (GCS) and peak cough flow reflex in neurological patients before extubation. METHODS: Firstly, we made a systematic review considering the Cochrane Handbook guidelines. The following question was considered in the research: What is the incidence and related factors to dysphagia in ICU? The research was performed on the databases of PubMed, ScienceDirect and Scopus. The key words used were: “epidemiology”, “incidence”, “deglutition disorders”, “intensive care units”, “airway extubation”, and “artificial respiration”. After that, we conducted a case-control study at the ICU of a public hospital in the south of Brazil, where 38 neurological patientes were evaluated and divided in a group in which dysphagia was present and in a second group without dysphagia. All patients had been on mechanical ventilation for a period longer than 24 hours and were in the imminence of extubation of the endotracheal tube (ETT) or the removal of the tracheostomy. Before the process of extubation, all patients passed through the tests of the strength of the respiratory musculature, GCS and peak cough flow reflex. Between 24 and 48 hours after the removal of the ETT or the tracheostomy, all patients were submitted to a Speech-Language Pathology evaluation based on the Dysphagia Risk Evaluation Protocol. RESULTS: The incidence of dysphagia varied from 38,1% to 93%. Time of Endotracheal Intubation (EI), MV and sepsis were found to be risk factors for dysphagia. We verified that both the groups with dysphagia and without dysphagia had similar outcomes in tests of the strength of the respiratory musculature, GCS and peak cough flow reflex . Age and time of hospitalization had statistic differences between the two groups. Evaluating the group of patients with neurological dysfunction, regardless the presence of dysphagia, there was a correlation, with statistical significance, among the following variables: Maximal Inspiratory Pressure, peak cough flow reflex, motor response (MR) and number of days under MV. The correlation of the use of tracheostomy, number of days under MV and number of days in ICU also presented statistical significance. CONCLUSION: Through the systematic review, it was possible to identify the wide variability of incidence of dysphagia after extubation. Moreover, time of EI, time of MV and sepsis are the most relevant factors related to the development of oropharynx dysphagia among patients in ICU. The neurological patients with dysphagia have more advanced age and need a longer period of time in hospital. All neurological patients, regardless the presence or absence of dysphagia, the use of tracheostomy is related to a decrease in the necessity of time in ICU. Inspiratory muscular strength is related to the peak cough flow. Furthermore, the good motor response in the GCS is related to fewer days under MV considering neurological patients in ICU. |
publishDate |
2016 |
dc.date.issued.fl_str_mv |
2016-08-17 |
dc.date.accessioned.fl_str_mv |
2021-07-20T20:10:42Z |
dc.date.available.fl_str_mv |
2021-07-20T20:10:42Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/doctoralThesis |
format |
doctoralThesis |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://repositorio.ufsm.br/handle/1/21533 |
url |
http://repositorio.ufsm.br/handle/1/21533 |
dc.language.iso.fl_str_mv |
por |
language |
por |
dc.relation.cnpq.fl_str_mv |
400700000003 |
dc.relation.confidence.fl_str_mv |
600 600 600 600 600 600 600 600 |
dc.relation.authority.fl_str_mv |
d7ce0251-a99c-477a-baaf-6ed8e04d6156 a5d1a825-9b6a-4517-bb90-a793a628a6b2 be1ead51-5192-4200-8280-1c98297a349b 9fda494b-68ad-4f61-9328-589bc584f819 3c843ae6-11d5-472c-9049-c153e80647c0 3cc91ce0-8b10-47b8-89f4-af4e5b053ce1 aa9102e5-5cfa-47ab-9c1a-4a2c39e1d4c7 |
dc.rights.driver.fl_str_mv |
Attribution-NonCommercial-NoDerivatives 4.0 International http://creativecommons.org/licenses/by-nc-nd/4.0/ info:eu-repo/semantics/openAccess |
rights_invalid_str_mv |
Attribution-NonCommercial-NoDerivatives 4.0 International http://creativecommons.org/licenses/by-nc-nd/4.0/ |
eu_rights_str_mv |
openAccess |
dc.publisher.none.fl_str_mv |
Universidade Federal de Santa Maria Centro de Ciências da Saúde |
dc.publisher.program.fl_str_mv |
Programa de Pós-Graduação em Distúrbios da Comunicação Humana |
dc.publisher.initials.fl_str_mv |
UFSM |
dc.publisher.country.fl_str_mv |
Brasil |
dc.publisher.department.fl_str_mv |
Fonoaudiologia |
publisher.none.fl_str_mv |
Universidade Federal de Santa Maria Centro de Ciências da Saúde |
dc.source.none.fl_str_mv |
reponame:Biblioteca Digital de Teses e Dissertações do UFSM instname:Universidade Federal de Santa Maria (UFSM) instacron:UFSM |
instname_str |
Universidade Federal de Santa Maria (UFSM) |
instacron_str |
UFSM |
institution |
UFSM |
reponame_str |
Biblioteca Digital de Teses e Dissertações do UFSM |
collection |
Biblioteca Digital de Teses e Dissertações do UFSM |
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MD5 MD5 MD5 MD5 MD5 |
repository.name.fl_str_mv |
Biblioteca Digital de Teses e Dissertações do UFSM - Universidade Federal de Santa Maria (UFSM) |
repository.mail.fl_str_mv |
atendimento.sib@ufsm.br||tedebc@gmail.com |
_version_ |
1791086231876009984 |