Efficacy of speech therapy in post-intubation patients with oropharyngeal dysphagia: a randomized controlled trial.

Giovana Sasso Turra,Sérgio Saldanha Menna Barreto,Chenia Caldeira Martinez,Sheila Tamanini De Almeida,Maristela Bridi,Ida Vanessa Doederlein Schwartz

doi:10.1590/2317-1782/20202019246

Abstract

to verify the efficacy of speech therapy in the early return of oral intake in patients with post-orotracheal intubation dysphagia. It was a double-blinded randomized controlled trial for two years with patients of intensive care units of a hospital. Study inclusion criteria were orotracheal intubation>48hours, age≥18 years old, clinical stability, and dysphagia. Exclusion criteria were tracheotomy, score 4 to 7 in the Functional Oral Intake Scale (FOIS), neurological disorders. Patients were randomized into speech treatment or control group (ten days of follow-up). The treated group (TG) received guidance, therapeutic techniques, airway protection and maneuvers, orofacial myofunctional and vocal exercises, diet introduction; the control group (CG) received SHAM treatment. Primary outcomes were oral intake progression, dysphagia severity, and tube feeding permanence. In the initial period of study, 240 patients were assessed and 40 (16.6%) had dysphagia. Of this, 32 patients met the inclusion criteria, and 17 (53%) received speech therapy. Tube feeding permanence was shorter in TG (median of 3 days) compared to CG (median of 10 days) (p=0.004). The size effect of the intervention on tube feeding permanence was statistically significant between groups (Cohen's d=1.21). TG showed progress on FOIS scores compared to CG (p=0.005). TG also had a progression in severity levels of Dysphagia protocol (from moderate to mild dysphagia) (p<0.001). Speech therapy favors an early progression of oral intake in post-intubation patients with dysphagia. Clinical Trial Registration: RBR-9829jk.

Highlights

Prolonged orotracheal intubation is considered a risk factor for oropharyngeal dysphagia[1,2,3,4,5,6,7]
The main purpose of this study was to verify the efficacy of speech therapy in the early return of oral intake in Intensive Care Unit (ICU) patients with post-orotracheal intubation dysphagia
Exclusion criteria were patients with a neurological disorder prior to the event that led to intubation, those whose event that led to the intubation was of neurological origin; those who showed neurological diseases in the period of extubation; tracheotomy; total oral diet with defined by Functional Oral Intake Scale (FOIS)(16), with scores between 4 to 7 in this scale

Summary

Introduction

Prolonged orotracheal intubation is considered a risk factor for oropharyngeal dysphagia[1,2,3,4,5,6,7]. Studies present that dysphagia is considered a variety of oropharyngeal compromises in post-intubation patients, and a specific type of disorder. These characteristics may be related to decrease in oral sensitivity, poor oral control of bolus, excess of oral or pharyngeal residues, and laryngeal penetration and aspiration[1,3,4,6,8,9]. Studies suggest swallow-related muscle weakness[10], suppression of coughing reflex[11], reduced laryngeal sensitivity[11], and decreased proprioception[12]

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Conclusion