CLINICAL PRACTICE GUIDELINES FOR DYSPHAGIA MANAGEMENT IN INTENSIVE CARE UNIT: A SPEECH-LANGUAGE PATHOLOGIST’S FRAMEWORK
DOI:
https://doi.org/10.18623/rvd.v23.n4.4866Keywords:
Dysphagia, Speech Language Pathologist, Postural Adjustment, Critical Care, Neuromuscular Electrical Stimulation (NMES)Abstract
Objective: This study aims at assessing the feasibility of the involvement of speech language pathologists in the identification and intervention of dysphagia in ICU patients. This brings the need of making a comparison of the procedures and using of diagnostic instruments like the FEES and VFSS. The goal of the study is to assess the effects of early identification and assessment of aspiration pneumonia, to explore available therapeutic options like NMES and postural adjustments, as well as to determine how integrated interprofessional approach can help to improve the quality of dysphagia management within the ICU population. Methods: The development of Clinical Practice Guideline (CPG) was done with the assistance of a development committee and advisory committee. The CPG development group comprised three Neurophysicians, three Otolaryngologists, three Nurses and four Speech-Language Pathologists (SLPs). It was agreed that all members contributed to the identification of the evidence to be presented and deliberation of the recommendations in response to the Key Questions (KQs) to ensure that the guideline formulated is holistic and evidence based for use in the ICU in managing dysphagia. Then Literature review was done by an extensive search of papers using some of the most popular search databases including; Pubmed, Embase, and the Cochrane library. Specifically, research with patients in an adult ICU was considered and considered to be meeting inclusion criteria. Results: Early dysphagia screening and evaluation with FEES yields improved patient performance. Electrical Stimulation and postural changes improved the efficacy of the swallow, leading to a highly significant benefit. In addition, the component that implements a multidisciplinary care model enhanced the general well-being of patients admitted in the ICU by doing away with factors such as aspiration pneumonia. Conclusion: This research underscore the importance of speech-language pathologists and interdisciplinary teams in the assessment and managements of dysphagia in ICU. Adoption of more limited diagnostic and therapeutic intervention in the individual patient as a means of patient safety and improved quality of care. Therefore, early intervention and multidisciplinary approach for critically ill patients reduce the time and cost of hospital stay.
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