Danielle Pedroni Moraes

Protocolo fonoaudiológico de avaliação do risco para disfagia (PARD)

PURPOSE: The aim of this study was to constitute a pilot protocol proposal to risk identification of dysphagia. This protocol is proposed to identify and to interpret the swallowing disorders, to characterize the penetration or aspiration clinical signals, to define promptly the dysphagia severity and to establish the management based in the results of the evaluation. METHODS: The Dysphagia Risk Evaluation Protocol is based in extensive literature about dysphagia. The common points were maintained and the points with no literature consensus were dismissed. RESULTS: The Dysphagia Risk Evaluation Protocol is constituted by three parts: water swallowing test, puree deglutition test, dysphagia severity scale and management. CONCLUSION: The Dysphagia Risk Evaluation Protocol is based in a theoretical proposition and depends of its application on population basis for its validation. Also contributes to a full beside evaluation that guides the speech-language pathologists and consolidate the evidence-based practice. The next step of this research will be experimental.

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

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.

Indicadores de qualidade para o gerenciamento da disfagia em Unidades de Internação Hospitalar

This article proposes a panel of quality indicators for the management of swallowing rehabilitation (SR) therapy in a hospital setting. There were four stages in developing these indicators: identifying procedures to be managed; generating indicators and standardizing data collection; identifying the correlation among indicators; and formulating the panel of indicators. The following 12 quality indicators were developed: swallowing evaluation index; individual care index; speech-language pathologist (SLP) care index; number of assisted patients index; severity rate; swallowing diagnosis rate per hospital unit; swallowing rehabilitation demand index; time until first swallowing evaluation; SLP index per hospital bed; time until removal of feeding tube; time until reintroduction of oral feeding; and time until decannulation. The proposed indicators were designed to improve the management of dysphagia in a hospital setting. Measuring these indicators is essential to understanding the patients needs and providing quality care. Managing care using these indicators will make it easier to track the patients rehabilitation process, measure the effectiveness of new therapeutic processes and technologies, and evaluate the performance of hospital units relative to other providers in the area. The management of SR using quality indicators allows the effectiveness and efficiency of rehabilitation programs to be clearly evaluated

Avaliação clínica da deglutição em unidade de terapia intensiva

OBJETIVO: Relatar os resultados da avaliacao clinica completa da degluticao em pacientes criticos de um hospital de ensino de grande porte na cidade de Sao Paulo. METODOS: Foi realizado um estudo prospectivo, descritivo, no periodo de setembro a novembro de 2009, em uma unidade de terapia intensiva de emergencias clinicas de trinta leitos, de um hospital terciario de grande porte do Brasil. Foram encaminhados 35 pacientes para a avaliacao fonoaudiologica clinica da degluticao. Para a avaliacao clinica completa da degluticao na unidade de terapia intensiva, foram preconizados os seguintes protocolos: Protocolo de Avaliacao Preliminar (PAP), Protocolo de Avaliacao do Risco para Disfagia (PARD) e Protocolo de Introducao e Transicao da Alimentacao por Via Oral (PITA). RESULTADOS: Neste estudo, foi constatada uma prevalencia de 63% de disfagia orofaringea (DO) na UTI, sendo a maioria destas classificadas como moderada e moderada-grave (39%). Entre os pacientes encaminhados para avaliacao da degluticao, 74% apresentaram intubacao orotraqueal previa. A analise estatistica revelou as variaveis que poderiam classificar corretamente os pacientes como tendo ou nao DO nos testes clinicos. Esses indicadores clinicos incluiram: forca da tosse, coordenacao pneumofonoarticulatoria, gravidade da disfonia e elevacao laringea. Vinte e seis pacientes (74%) completaram todos os protocolos. Desse total, 38% retornaram a dieta regular. CONCLUSAO: A pratica com protocolos padronizados mostra-se como uma importante opcao no gerenciamento da disfagia orofaringea na unidade de terapia intensiva.