Changes in Swallowing after Prolonged Orotracheal Intubation: Prevalence and Evolution
DOI:
https://doi.org/10.25759/spmfr.303Keywords:
Deglutition Disorders/rehabilitation, Deglutition Disorders/therapy, Intubation, IntratrachealAbstract
Introduction: Prolonged orotracheal intubation may induce dysphagia and lead to dehydration, malnutrition, aspiration pneumonia and death. A case study was developed to evaluate the presence of post-prolonged orotracheal intubation dysphagia and the importance of early diagnosis to avoid complications.
Material and Methods: For 12 months, between September 2016 and August 2017, patients submitted to prolonged orotracheal intubation were evaluated, with “STOP Dysphagia” protocol, between 24-72 hours and 6-8 weeks post-extubation,. The gender, age, comorbidities, admission diagnosis, severity indices at 24 hours APACHE II and SAPS II, time of prolonged orotracheal intubation, degree of dysphagia and complications were recorded. Patients with pathology involving swallowing physiology, unable to use the oral cavity for feeding or non-colaborative, were excluded
Results: Fifty patients were evaluated, aged 20-83 years. The mean time of prolonged orotracheal intubation was 173 hours and 43 hours till evaluation. Twenty one (42%) patients had no dysphagia, 15 (30%) needed nectar, 5 (10%) honey, 7 (14%) pudding and 2 (4%) nasogastric intubation. A statistically significant difference was found between the presence of dysphagia and age (p=0.006) and severity indexes (APACHE II p=0.016, SAPS II p=0.014) and a moderate correlation between dysphagia severity and age (p=0.427 p=0.002)), APACHE-II (p=0.458 (p=0.001)) and SAPS II (p=0.428 (p=0.002)). No significant statistic correlation was found between prolonged orotracheal intubation and time of orotracheal intubation (p=0.385). Forty-one patients were reassessed 6-8 weeks after the first evaluation and only one still had dysphagia.
Discussion: Post-prolonged orotracheal intubation dysphagia is a frequent complication and the early diagnosis allow to take adequate care and prevent complications. It has a good short-term prognosis with tendency to full resolution.
Conclusion: Post-prolonged orotracheal intubation dysphagia must be excluded before oral feeding, to allow preventive measures and to avoid complications.
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