Rodrigues Katia Alonso, Machado Flávia Ribeiro, Chiari Brasília Maria, Rosseti Heloísa Baccaro, Lorenzon Paula, Gonçalves Maria Inês Rebelo
Departamento de Fonoaudiologia, Universidade Federal de São Paulo, São Paulo, SP, Brasil.
Disciplina de Anestesiologia, Dor e Terapia Intensiva, Universidade Federal de São Paulo, São Paulo, SP, Brasil.
Rev Bras Ter Intensiva. 2015 Jan-Mar;27(1):64-71. doi: 10.5935/0103-507X.20150011. Epub 2015 Mar 1.
The aim of the present study was to assess the feasibility of the early implementation of a swallowing rehabilitation program in tracheostomized patients under mechanical ventilation with dysphagia.
This prospective study was conducted in the intensive care units of a university hospital. We included hemodynamically stable patients under mechanical ventilation for at least 48 hours following 48 hours of tracheostomy and with an appropriate level of consciousness. The exclusion criteria were previous surgery in the oral cavity, pharynx, larynx and/or esophagus, the presence of degenerative diseases or a past history of oropharyngeal dysphagia. All patients were submitted to a swallowing rehabilitation program. An oropharyngeal structural score, a swallowing functional score and an otorhinolaryngological structural and functional score were determined before and after swallowing therapy.
We included 14 patients. The mean duration of the rehabilitation program was 12.4 ± 9.4 days, with 5.0 ± 5.2 days under mechanical ventilation. Eleven patients could receive oral feeding while still in the intensive care unit after 4 (2 - 13) days of therapy. All scores significantly improved after therapy.
In this small group of patients, we demonstrated that the early implementation of a swallowing rehabilitation program is feasible even in patients under mechanical ventilation.
本研究旨在评估对机械通气且存在吞咽困难的气管切开患者早期实施吞咽康复计划的可行性。
本前瞻性研究在一家大学医院的重症监护病房进行。我们纳入了在气管切开48小时后接受机械通气至少48小时且意识水平合适、血流动力学稳定的患者。排除标准为口腔、咽、喉和/或食管既往有手术史、存在退行性疾病或有口咽吞咽困难病史。所有患者均接受吞咽康复计划。在吞咽治疗前后测定口咽结构评分、吞咽功能评分以及耳鼻喉结构和功能评分。
我们纳入了14例患者。康复计划的平均持续时间为12.4±9.4天，机械通气时间为5.0±5.2天。11例患者在治疗4（2 - 13）天后仍在重症监护病房时即可接受经口喂养。治疗后所有评分均显著改善。
在这一小群患者中，我们证明即使是机械通气患者，早期实施吞咽康复计划也是可行的。
