Programa de Pós-graduação em Ciências Médicas, Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS), Brasil.
Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre - Porto Alegre (RS), Brasil.
Codas. 2021 Apr 26;33(2):e20190246. doi: 10.1590/2317-1782/20202019246. eCollection 2021.
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.
验证言语治疗在经口气管插管后吞咽障碍患者早期恢复经口进食中的疗效。
这是一项为期两年的双盲随机对照试验，研究对象为医院重症监护病房的患者。纳入标准为气管插管>48 小时、年龄≥18 岁、临床稳定和吞咽困难。排除标准为气管切开术、功能性经口摄食量表（FOIS）评分 4-7 分、神经障碍。患者随机分为言语治疗组或对照组（随访 10 天）。治疗组（TG）接受指导、治疗技术、气道保护和操作、口面肌肉功能和发声练习、饮食介绍；对照组（CG）接受假治疗。主要结局是经口进食进展、吞咽困难严重程度和管饲持续时间。
在研究的初始阶段，评估了 240 名患者，其中 40 名（16.6%）有吞咽困难。其中，32 名患者符合纳入标准，其中 17 名（53%）接受了言语治疗。TG 的管饲持续时间明显短于 CG（中位数 3 天比 10 天）（p=0.004）。干预对管饲持续时间的效应大小在组间具有统计学意义（Cohen's d=1.21）。与 CG 相比，TG 在 FOIS 评分上有进展（p=0.005）。TG 还在吞咽障碍协议的严重程度级别上有进展（从中度到轻度吞咽困难）（p<0.001）。
言语治疗有利于经口气管插管后吞咽障碍患者早期经口进食的进展。临床试验注册：RBR-9829jk。
