Abstract
BackgroundOropharyngeal dysphagia or swallowing difficulties are common in acute care and critical care, affecting 47% of hospitalised frail elderly, 50% of acute stroke patients and approximately 62% of critically ill patients who have been intubated and mechanically ventilated for prolonged periods. Complications of dysphagia include aspiration leading to chest infection and pneumonia, malnutrition, increased length of hospital stay and re-admission to hospital. To date, most dysphagia interventions in acute care have been tested with acute stroke populations. While intervention studies in critical care have been emerging since 2015, they are limited and so there is much to learn about the type, the delivery and the intensity of treatments in this setting to inform future clinical trials. The aim of this systematic review is to summarise the evidence regarding the relationship between dysphagia interventions and clinically important patient outcomes in acute and critical care settings.MethodsWe will search MEDLINE, EMBASE, CENTRAL, Web of Science, CINAHL and clinical trial registries from inception to the present. We will include studies conducted with adults in acute care settings such as acute hospital wards or units or intensive care units and critical care settings. Studies will be restricted to randomised controlled trials and quasi-randomised controlled trials comparing a new dysphagia intervention with usual care or another intervention. The main outcomes that will be collected include length of time taken to return to oral intake, change in incidence of aspiration and pneumonia, nutritional status, length of hospital stay and quality of life. Key intervention components such as delivery, intensity, acceptability, fidelity and adverse events associated with such interventions will be collected to inform future clinical trials. Two independent reviewers will assess articles for eligibility, data extraction and quality appraisal. A meta-analysis will be conducted as appropriate.DiscussionNo systematic review has attempted to summarise the evidence for oropharyngeal dysphagia interventions in acute and critical care. Results of the proposed systematic review will inform practice and the design of future clinical trials.Systematic review registrationPROSPERO CRD 42018116849 (http://www.crd.york.ac.uk/PROSPERO/)
Highlights
Oropharyngeal dysphagia or swallowing difficulties are common in acute care and critical care, affecting 47% of hospitalised frail elderly, 50% of acute stroke patients and approximately 62% of critically ill patients who have been intubated and mechanically ventilated for prolonged periods
Other individuals with dysphagia who may present in these settings include patients with traumatic injuries to brain or cervical spine, patients with progressive symptoms in line with their neurodegenerative or neuromuscular condition necessitating an intensive care or acute care stay and frail elderly patients hospitalised for acute illness and presenting with sarcopenia, a loss of skeletal muscle mass and function due to aging [2,3,4]
Oropharyngeal dysphagia is common in acute and critical care, affecting 47% of frail elderly, 50% of acute stroke and 62% of critically ill patients
Summary
Oropharyngeal dysphagia or swallowing difficulties are common in acute care and critical care, affecting 47% of hospitalised frail elderly, 50% of acute stroke patients and approximately 62% of critically ill patients who have been intubated and mechanically ventilated for prolonged periods. Description of the condition In acute and critical care settings, a patient’s medical, neurological, respiratory and cognitive status can alter from day to day impacting on swallow function. This provides a challenge for professionals seeking to intensively remediate swallowing difficulties. Other individuals with dysphagia who may present in these settings include patients with traumatic injuries to brain or cervical spine, patients with progressive symptoms in line with their neurodegenerative or neuromuscular condition necessitating an intensive care or acute care stay and frail elderly patients hospitalised for acute illness and presenting with sarcopenia, a loss of skeletal muscle mass and function due to aging [2,3,4]. Dysphagia is the consequence of such loss of function in the skeletal muscles of swallowing
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