Evidenzbasierte Praxis im sprachtherapeutischen klinischen Alltag – Falldarstellung einer komplexen Trachealkanülen-Entwöhnung

Anhand des Falles einer Patientin mit schwerer neurogener Dysphagie und erschwertem Dekanülierungsverlauf wird der Behandlungsprozess entlang der Prinzipien evidenzbasierter Praxis dargestellt. Neben Anamnese, klinischer Schluckfunktionsuntersuchung, bildgebender Diagnostik und Berücksichtigung multiprofessioneller Aspekte wird erläutert, welche Evidenzen den Behandlungsverlauf leiten. Dabei sind die einzelnen Teilschritte immer wieder anzupassen und zu evaluieren.

Abstract

This article describes a case of a patient with severe neurogenic dysphagia and a prolonged decannulation process. This process is described according to the principles of evidence-based practice. In addition to a precise medical history, the performance of a KSU, an instrumental exam and the consideration of multi-professional aspects, evidence guiding the treatment path is explained. It is emphasized that the individual steps in the course of treatment should be continuously adapted and evaluated to the clinical process itself.

Schlüsselwörter

Evidenzbasierte Praxis - Dysphagie - Dekanüloerungsmanagement

Key Words

Evidence based practice - Dysphagia - decannulation management

Publication History

Article published online:
24 January 2025

• Literatur

• 1 Guyatt GH. Evidence-Based Medicine. ACP Journal Club 1991; 114: A16
• 2 Pluschinski P, Duchac S. Evidenzbasiertes Arbeiten in der Dysphagietherapie – noch Mythos oder schon Realität? Ein Fazit nach über 25 Jahren Einführen der evidenzbasierten Praxis/Medizin. Logos 2023; 31: 103-112
• 3 Gagnier JJ, Kienle G, Altman DG. et al. CARE Group. The CARE guidelines: consensus-based clinical case report guideline development. J Clin Epidemiol 2014; 67: 46-51
• 4 Daniels SK, Huckabee ML, Gozdzikowska K. Dysphagia following stroke. 2nd ed. Plural Publishing; 2019
• 5 Rangarathnam B, Kamarunas E, McCullough GH. Role of cerebellum in deglutition and deglutition disorders. Cerebellum 2014; 13: 767-776
• 6 Malandraki GA, Sutton BP, Perlman AL. et al. Neural activation of swallowing and swallowing-related tasks in healthy young adults: An attempt to separate the components of deglutition. Human Brain Mapping 2009; 30: 3209-3226
• 7 Sellars C, Bowie L, Bagg J. et al. Risk factors for chest infection in acute stroke: a prospective cohort study. Stroke 2007; 38: 2284-2291
• 8 Langmore SE, Terpenning MS, Schork A. et al. Predictors of aspiration pneumonia: How important is dysphagia?. Dysphagia 1998; 13: 69-81
• 9 Schwegler H. Trachealkanülenmanagement: In sicheren Schritten Richtung Dekanülierung. Schulz-Kirchner; 2020
• 10 Brodsky MB, Pandian V, Needham DM. Post-extubation dysphagia: a problem needing multidisciplinary efforts. Intensive Care Medicine 2020; 46: 93-96
• 11 Gerschke M, Schöttker-Königer T, Förster A. et al. Validation of the German version of the Yale pharyngeal residue severity rating scale. Dysphagia 2019; 34: 308-314
• 12 Pluschinski P, Zaretsky Y, Almahameed A. et al. Secretion scale by Murray et al. for FEES®: comparison of reliability and validity of the German long and short version. Nervenarzt 2014; 85: 1582-1587
• 13 Robbins A, Butler SG, Daniels SK. et al. Swallowing and Dysphagia Rehabilitation: Translating Principles of Neural Plasticity Into Clinically Oriented Evidencs. J Speech Lang Hear Res 2008; 51: S276-S300
• 14 Neff A, Riechmann M. (Lenkungsgruppe). DGMKG S3-Leitlinie: Kiefergelenkluxation. 2022, Langversion 1.0, AWMF-Registernummer 007/063. Im Internet (Stand 29.11.2024): www.awmf.org/leitlinien/detail/ll/007-063.html
• 15 Leigh JH, Oh BM, Seo HG. et al. Influence of the chin-down and chin-tuck maneuver on the swallowing kinematics of healthy adults. Dysphagia 2015; 30: 89-98
• 16 Kahrilas PJ, Logemann JA, Krugler C. et al. Volitional augmentation of upper esophageal sphincter opening during swallowing. Am J Physiol 1991; 260: G450-G456
• 17 Alamer A, Melese H, Nigussie F. Effectiveness of neuromuscular electrical stimulation on post-stroke dysphagia: a systematic review of randomized controlled trials. Clin Interv Aging 2020; 15: 1521