Arquivo da categoria: Tracheostomy

Electrical pharyngeal stimulation for dysphagia treatment in tracheotomized stroke patients: a randomized controlled trial

Suntrup S, Marian T, Schröder JB, Suttrup I, Muhle P, Oelenberg S, Hamacher C, Minnerup J, Warnecke T, Dziewas R.

Intensive Care Med. 2015 Sep;41(9):1629-37. doi: 10.1007/s00134-015-3897-8. Epub 2015 Jun 13.

eletroestimulacao

Abstract

PURPOSE:

Treatment of post-stroke dysphagia is notoriously difficult with different neurostimulation strategies having been employed with a variable degree of success. Recently, electrical pharyngeal stimulation (EPS) has been shown to improve swallowing function and in particular decrease airway aspiration in acute stroke. We performed a randomized controlled trial to assess EPS effectiveness on swallowing function in severely dysphagic tracheotomized patients.

METHODS:

All consecutive stroke patients successfully weaned from the respirator but with severe dysphagia precluding decannulation were screened for eligibility. Eligible patients were randomized to receive either EPS (N = 20) or sham stimulation (N = 10) over three consecutive days. Primary endpoint was ability to decannulate the patient. Swallowing function was assessed using fiberoptic endoscopy. Patients having received sham stimulation were offered EPS treatment during unblinded follow-up if required. Investigators were blinded to the patient’s study group allocation.

RESULTS:

Both groups were well matched for age, stroke severity, and lesion location. Decannulation after study intervention was possible in 75 % of patients of the treatment group and in 20 % of patients of the sham group (p < 0.01). Secondary outcome parameters did not differ. No adverse events occurred.

CONCLUSION:

In this pilot study, EPS enhanced remission of dysphagia as assessed with fiberoptic endoscopic evaluation of swallowing (FEES), thereby enabling decannulation in 75 % of patients.

Anúncios

Implicações da traqueostomia na comunicação e na deglutição

Barros, Ana Paula Brandão; Portas, Juliana Godoy; Queija, Débora dos Santos

Rev. bras. cir. cabeça pescoço;38(3):202-207, jul.-set. 2009.

tracheostomy

Nas últimas duas décadas, pesquisadores e clínicos têm-se preocupado com o impacto da traqueostomia na respiração, comunicação e deglutição. A traqueostomia está associada ao aumento do risco da aspiração e a decanulação irá melhorar a qualidade das funções. Nos casos de fácil oclusão da traqueostomia, é necessário gradativamente aumentar o tempo de oclusão e observar o quadro clínico respiratório. A sequência irá variar de acordo com a doença de base e as condições respiratórias. O impacto da traqueostomia na fisiologia da deglutição pode ser mecânico e/ou funcional.

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Impacto da aspiração supra-cuff na prevenção da pneumonia associada à ventilação mecânica

Carolina Ramos de Souza; Vivian Taciana Simioni Santana

Rev. bras. ter. intensiva vol.24 no.4 São Paulo Oct./Dec. 2012

RESUMO

O paciente crítico encontra-se intubado ou traqueostomizado por necessitar, na maioria dos casos, de ventilação mecânica invasiva. As cânulas utilizadas possuem o cuff, que pode atuar como um reservatório de secreções da orofaringe, predispondo à pneumonia associada à ventilação mecânica. Estudos têm demonstrado que a aspiração das secreções subglóticas por lúmen dorsal de sucção acima do cuff do tubo orotraqueal retarda e reduz a incidência de pneumonia associada à ventilação mecânica. O objetivo desta revisão foi verificar, na literatura, a importância da utilização da aspiração com dispositivo supra-cuff em pacientes críticos submetidos à intubação orotraqueal ou traqueostomia na prevenção de pneumonia associada à ventilação mecânica. Para tanto, foi realizada revisão bibliográfica entre os anos de 1986 a 2011, por meio de portais de bases de dados nacionais e internacionais. Verificou-se que a aspiração das secreções subglóticas apresenta poucos resultados em relação à diminuição dos dias de ventilação mecânica e de permanência na unidade de terapia intensiva, além de não ser efetiva na diminuição da mortalidade, porém, mostra-se eficaz na redução da incidência da pneumonia associada à ventilação mecânica de início precoce e na redução de seus custos hospitalares. A forma de aspiração das secreções subglóticas contínua mostra-se mais eficiente na remoção de secreções; contudo, a forma intermitente parece ser a menos lesiva. Conclui-se que as cânulas com dispositivo de aspiração supra-cuff permitem a aspiração das secreções subglóticas, proporcionando benefícios aos pacientes críticos, uma vez que reduzem-se a incidência de pneumonia associada à ventilação mecânica e, consequentemente, os custos hospitalares, além de não haver relação com efeitos adversos em larga escala.

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Implicações da traqueostomia na comunicação e na deglutição: Revisão

Barros, Ana Paula Brandão; Portas, Juliana Godoy; Queija, Débora dos Santos

Rev. bras. cir. cabeça pescoço;38(3):202-207, jul.-set. 2009.

ABSTRACT:

Nas últimas duas décadas, pesquisadores e clínicos têm-se preocupado com o impacto da traqueostomia na respiração, comunicação e deglutição. A traqueostomia está associada ao aumento do risco da aspiração e a decanulação irá melhorar a qualidade das funções. Nos casos de fácil oclusão da traqueostomia, é necessário gradativamente aumentar o tempo de oclusão e observar o quadro clínico respiratório. A sequência irá variar de acordo com a doença de base e as condições respiratórias. O impacto da traqueostomia na fisiologia da deglutição pode ser mecânico e/ou funcional.

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Decannulation and assessment of deglutition in the tracheostomized patient in non-neurocritical intensive care

Alvo A, Olavarría C.

Acta Otorrinolaringol Esp. 2013 Mar

Abstract

With intensive care patients, decannulation and deglutition disorders are frequent reasons for otorhinolaryngological assessment. The objective of a tracheostomy is to maintain a patent airway. It does not necessarily prevent episodes of aspiration and may even favour them. When the cause that led to the tracheostomy resolves, a decannulation may be proposed. Deglutition is a complex act involving the coordinated interaction of several structures of the aerodigestive tract. Fibre-optic endoscopy and videofluoroscopy are 2 useful, complementary tools for the evaluation of patients with swallowing disorders. In managing these patients, a thorough knowledge of laryngeal and swallowing physiology, as well as of the different therapeutic alternatives, is required. Although it is not uncommon for swallowing disorders to coexist in tracheostomy patients, decannulation evaluation is not synonymous with deglutition assessment. A patient could be a candidate for decannulation and have a swallowing disorder, or a tracheostomy patient could swallow adequately. Knowing and understanding these concepts will lead to more efficient management and help to clarify communication between the intensive care physician and the otorhinolaryngologist. Ideally, a multidisciplinary team should be formed to evaluate and manage these patients.

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A clinical audit of the management of patients with a tracheostomy in an Australian tertiary hospital intensive care unit: Focus on speech-language pathology

Freeman-Sanderson A; Togher L; Phipps P; Elkins M

Int J Speech Lang Pathol;13(6):518-25, 2011 Dec.

Speech-language pathologists manage communication and swallowing disorders, both of which can occur in patients after tracheostomy insertion. An audit on the incidence and timing of speech-language pathology intervention for adults with tracheostomies has not previously been published. Data were retrospectively extracted from the medical records of all patients who were tracheostomized at Royal Prince Alfred Hospital, NSW, Australia, from October 2007 for 1 year. Extracted data included diagnosis, date and type of tracheostomy, time to speech-language pathologist involvement, time to phonation, and time to oral intake. Among the 140 patients (mean age 58 years, range 16-85), diagnoses were neurological (32%), head and neck (25%), cardiothoracic (24%), respiratory (6%), and other (13%). Speech-language pathology was involved with 78% of patients, with initial assessment on average 14 days after tracheostomy insertion (14 days to 166 days). Median time from tracheostomy insertion to phonation was 12 days (range 1-103). Median time from tracheostomy insertion to oral intake was 15 days (range 1-142). Only 20% of patients returned to verbal communication within 1 week after tracheostomy insertion. Further research into access to and timing of speech-language pathology intervention in the critical care setting is warranted.

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Facilitating speech in the patient with a tracheostomy

Hess DR

Respir Care; 50(4): 519-25, 2005 Apr.
ABSTRACT:
A tracheostomy tube decreases the ability of the patient to communicate effectively. The ability to speak provides an important improvement in the quality of life for a patient with a tracheostomy. In mechanically ventilated patients, speech can be provided by the use of a talking tracheostomy tube, using a cuff-down technique with a speaking valve, and using a cuff-down technique without a speaking valve. Speech can be facilitated in patients with a tracheostomy tube who are breathing spontaneously by use of a talking tracheostomy tube, by using a cuff-down technique with finger occlusion of the proximal tracheostomy tube, and with the use of a cuff-down technique with a speaking valve. Teamwork between the patient and the patient care team (respiratory therapist, speech-language pathologist, nurse, and physician) can result in effective restoration of speech in many patients with a long-term tracheostomy.