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[拔管后吞咽困难:重症监护病房跨学科协作面临的挑战]

[Postextubation dysphagia : Challenges regarding interdisciplinary collaboration in intensive care units].

作者信息

Glißmann Lena, Bangert-Tobies Katrin

机构信息

Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20251, Hamburg, Deutschland.

出版信息

Med Klin Intensivmed Notfmed. 2025 Jul 22. doi: 10.1007/s00063-025-01304-6.

Abstract

BACKGROUND

Postextubation dysphagia (PED) represents a significant morbidity and mortality factor even in nonneurological intensive care units (ICU), potentially prolonging both ICU and overall hospital stays.

METHODS

A literature review was conducted to access the relevance, diagnostic approaches, and therapeutic options for PED, which were then placed in context using a clinical case study.

RESULTS

Although evidence-based guidelines for PED are lacking in the literature, several articles and recommendations addressing multiprofessional treatment strategies were identified. In addition to the necessity of systematic dysphagia screening and early therapeutic interventions, particular attention should be paid to predictors that can be identified early-for example, through the use of checklists-and addressed by a multiprofessional care team.

CONCLUSION

Interdisciplinary collaboration is essential for the effective diagnosis and management of PED with the potential to improve both clinical outcomes and quality of life in affected patients. In particular, early screening, daily activation of orofacial functions within nursing care, targeted swallowing therapy, mobilization, respiratory therapy and device-supported respiratory therapy may contribute to improved patient trajectories following extubation.

摘要

背景

拔管后吞咽困难(PED)即使在非神经重症监护病房(ICU)也是一个重要的发病和死亡因素,可能会延长ICU住院时间和总体住院时间。

方法

进行文献综述以了解PED的相关性、诊断方法和治疗选择,然后通过临床案例研究将其置于实际情境中。

结果

尽管文献中缺乏关于PED的循证指南,但已确定了几篇涉及多专业治疗策略的文章和建议。除了系统的吞咽困难筛查和早期治疗干预的必要性外,还应特别关注那些可以早期识别的预测因素,例如通过使用检查表,并由多专业护理团队加以处理。

结论

跨学科合作对于PED的有效诊断和管理至关重要,有可能改善受影响患者的临床结局和生活质量。特别是,早期筛查、护理中每日进行口面部功能激活、针对性吞咽治疗、活动、呼吸治疗和设备支持的呼吸治疗可能有助于改善拔管后患者的病程。

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