Communication, swallowing and feeding in the intensive care unit patient

Batty S

Nurs Crit Care; 14(4): 175-9, 2009 Jul-Aug.
BACKGROUND: It is not uncommon for patients requiring a period of time in the intensive care unit (ICU) to experience difficulties with communication and/or swallowing, either as a result of their illness or as a result of the treatments they receive. These difficulties can be both short term and long term and require timely and appropriate intervention in order to improve the patient’s experience and expedite recovery/rehabilitation.
AIMS: The purpose of this article is to provide critical care nurses with an update on aspects of communication, swallowing and feeding in the ICU. The paper will focus on each area in relation to the current evidence base and factors of ‘best practice’ (as determined by expert opinion).
IMPLICATIONS FOR CRITICAL CARE NURSING PRACTICE: Enabling communication can improve well-being, increase compliance and reduce length of stay; Simple modes of communication, e.g. writing/gesture/pictures can be very effective; Coded eye blinking may be unreliable because of confusion with reflexive blinking; Non-oral nutrition will generally not meet the psychological and physical needs and benefits of oral intake; Not all patients with a tracheostomy in situ will experience dysphagia; however, those considered ‘at risk’ should have their swallow assessed by an appropriately trained professional, e.g. speech and language therapist/dysphagia trained professional; An inflated tracheostomy cuff will not prevent aspiration. The decision to commence oral intake in the presence of an inflated cuff should be made as a team and take into consideration the patient’s medical and psychological status; The use of blue dye to assess the swallow carries a high false-negative rate and cannot be relied on alone to predict either the presence or the absence of aspiration.
CONCLUSION: There is still much more research to be performed and evidence to be gained regarding the input into communication, swallowing and feeding in the ICU; however, a full-team approach to these areas can have very positive effects on the patient’s experience.
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