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CC BY 4.0 · Int Arch Otorhinolaryngol 2024; 28(01): e30-e41
DOI: 10.1055/s-0043-1767676
Original Research

Evaluation and Treatment of Dysphagia in Public and Private Intensive Care Units (ICUs) in Greece

Soultana L. Papadopoulou 
1   Department of Speech and Language Therapy, School of Health Sciences, University of Ioannina, Ioannina, Greece
,
Evangelia Kitsanou 
1   Department of Speech and Language Therapy, School of Health Sciences, University of Ioannina, Ioannina, Greece
,
Ermioni Brahimi 
1   Department of Speech and Language Therapy, School of Health Sciences, University of Ioannina, Ioannina, Greece
,
Georgios Papathanakos 
2   Intensive Care Unit, University Hospital of Ioannina, Ioannina, Greece
,
Ioannis Andrianopoulos 
2   Intensive Care Unit, University Hospital of Ioannina, Ioannina, Greece
,
Stavroula J. Theodorou 
3   Department of Radiology, University Hospital of Ioannina, Ioannina, Greece
,
Vasilios Koulouras 
2   Intensive Care Unit, University Hospital of Ioannina, Ioannina, Greece
,
Nafsica Ziavra 
1   Department of Speech and Language Therapy, School of Health Sciences, University of Ioannina, Ioannina, Greece
› Author Affiliations Funding The authors declare that the present research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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Abstract

Introduction Dysphagia is a significant but underrecognized clinical issue in the intensive care unit (ICU), and it is associated with various complications. Despite its clinical importance, there is limited research and no Greek ICU-specific guidelines for managing dysphagic patients. Additionally, only a few ICUs in Greece have dysphagia specialists, specifically speech-language pathologists (SLPs) providing their expertise.

Objective Τo identify the current practices for dysphagia management (screening, assessment, treatment) and gain insight into ICU directors' awareness/perceptions of the prevalence, complications, and risk of dysphagia.

Materials and Methods We identified 138 Greek ICUs. Data were collected from ICU (including pediatric and neonatal) directors, working in public and private hospitals, via a 24-item, anonymous online questionnaire, within a 4-month period.

Results Our survey was completed by 45 ICU directors. Most participants (84.4%) reported that dysphagia is a relevant clinical problem in their ICU, and 51.1% estimated a frequency rate < 20%. Non-instrumental approaches are mainly utilized to screen and diagnose dysphagia, whereas enteral nutrition and diet modifications are used to manage dysphagia. Additionally, 64.4% of ICU directors agreed that SLPs are essential for the management of dysphagic patients, and 66.7%, that awareness of dysphagia in their ICU could be increased.

Conclusion The current study documented the methods and approaches used to manage dysphagic patients in Greek ICUs. The ICU directors seem to recognize the clinical significance of dysphagia and its complications. According to our findings, the employment of SLPs could result in a more comprehensive and intensive approach and improve the quality of care for these patients.

Keywords

dysphagia - critical care - intensive care units - survey


Publication History

Received: 13 September 2022

Accepted: 05 December 2022

Article published online:
05 February 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Perren A, Zürcher P, Schefold JC. Clinical Approaches to Assess Post-extubation Dysphagia (PED) in the Critically Ill. Dysphagia 2019; 34 (04) 475-486
    CrossrefPubMedGoogle Scholar
  • 2 Dylczyk-Sommer A. Dysphagia. Part 1: General issues. Anaesthesiol Intensive Ther 2020; 52 (03) 226-232
    CrossrefPubMedGoogle Scholar
  • 3 Macht M, Wimbish T, Bodine C, Moss M. ICU-acquired swallowing disorders. Crit Care Med 2013; 41 (10) 2396-2405
    CrossrefPubMedGoogle Scholar
  • 4 Macht M, Wimbish T, Clark BJ. et al. Postextubation dysphagia is persistent and associated with poor outcomes in survivors of critical illness. Crit Care 2011; 15 (05) R231
    CrossrefPubMedGoogle Scholar
  • 5 Skoretz SA, Flowers HL, Martino R. The incidence of dysphagia following endotracheal intubation: a systematic review. Chest 2010; 137 (03) 665-673
    CrossrefPubMedGoogle Scholar
  • 6 Schefold JC, Berger D, Zürcher P. et al. Dysphagia in Mechanically Ventilated ICU Patients (DYnAMICS): A Prospective Observational Trial. Crit Care Med 2017; 45 (12) 2061-2069
    CrossrefPubMedGoogle Scholar
  • 7 Zuercher P, Moret CS, Dziewas R, Schefold JC. Dysphagia in the intensive care unit: epidemiology, mechanisms, and clinical management. Crit Care 2019; 23 (01) 1-11
    CrossrefPubMedGoogle Scholar
  • 8 Brodsky MB, Levy MJ, Jedlanek E. et al. Laryngeal Injury and Upper Airway Symptoms After Oral Endotracheal Intubation With Mechanical Ventilation During Critical Care: A Systematic Review. Crit Care Med 2018; 46 (12) 2010-2017
    CrossrefPubMedGoogle Scholar
  • 9 Zielske J, Bohne S, Brunkhorst FM, Axer H, Guntinas-Lichius O. Acute and long-term dysphagia in critically ill patients with severe sepsis: results of a prospective controlled observational study. Eur Arch Otorhinolaryngol 2014; 271 (11) 3085-3093
    CrossrefPubMedGoogle Scholar
  • 10 Tsai MH, Ku SC, Wang TG. et al. Swallowing dysfunction following endotracheal intubation: Age matters. Medicine (Baltimore) 2016; 95 (24) e3871
    CrossrefPubMedGoogle Scholar
  • 11 Zuercher P, Schenk NV, Moret C, Berger D, Abegglen R, Schefold JC. Risk Factors for Dysphagia in ICU Patients After Invasive Mechanical Ventilation. Chest 2020; 158 (05) 1983-1991
    CrossrefPubMedGoogle Scholar
  • 12 Kim MJ, Park YH, Park YS, Song YH. Associations Between Prolonged Intubation and Developing Post-extubation Dysphagia and Aspiration Pneumonia in Non-neurologic Critically Ill Patients. Ann Rehabil Med 2015; 39 (05) 763-771
    CrossrefPubMedGoogle Scholar
  • 13 Saito T, Hayashi K, Nakazawa H, Yagihashi F, Oikawa LO, Ota T. A Significant Association of Malnutrition with Dysphagia in Acute Patients. Dysphagia 2018; 33 (02) 258-265
    CrossrefPubMedGoogle Scholar
  • 14 Macht M, King CJ, Wimbish T. et al. Post-extubation dysphagia is associated with longer hospitalization in survivors of critical illness with neurologic impairment. Crit Care 2013; 17 (03) R119
    CrossrefPubMedGoogle Scholar
  • 15 Brodsky MB, Huang M, Shanholtz C. et al. Recovery from Dysphagia Symptoms after Oral Endotracheal Intubation in Acute Respiratory Distress Syndrome Survivors. A 5-Year Longitudinal Study. Ann Am Thorac Soc 2017; 14 (03) 376-383
    CrossrefPubMedGoogle Scholar
  • 16 Macht M, White SD, Moss M. Swallowing dysfunction after critical illness. Chest 2014; 146 (06) 1681-1689
    CrossrefPubMedGoogle Scholar
  • 17 Patel DA, Krishnaswami S, Steger E. et al. Economic and survival burden of dysphagia among inpatients in the United States. Dis Esophagus 2018; 31 (01) 1-7 https://academic.oup.com/dote/article/doi/10.1093/dote/dox131/4636765 cited 2022Jul26 [Internet]
    CrossrefPubMedGoogle Scholar
  • 18 Brodsky MB, Nollet JL, Spronk PE, González-Fernández M. Prevalence, Pathophysiology, Diagnostic Modalities, and Treatment Options for Dysphagia in Critically Ill Patients. Am J Phys Med Rehabil 2020; 99 (12) 1164-1170
    CrossrefPubMedGoogle Scholar
  • 19 Zuercher P, Dziewas R, Schefold JC. Dysphagia in critical care: focus on therapeutical interventions. Intensive Care Med 2020; 46 (10) 1972-1973
    CrossrefPubMedGoogle Scholar
  • 20 Brodsky MB, Suiter DM, González-Fernández M. et al. Screening Accuracy for Aspiration Using Bedside Water Swallow Tests: A Systematic Review and Meta-Analysis. Chest 2016; 150 (01) 148-163
    CrossrefPubMedGoogle Scholar
  • 21 O'Horo JC, Rogus-Pulia N, Garcia-Arguello L, Robbins J, Safdar N. Bedside diagnosis of dysphagia: a systematic review. J Hosp Med 2015; 10 (04) 256-265
    CrossrefPubMedGoogle Scholar
  • 22 Johnson KL, Speirs L, Mitchell A. et al. Validation of a Postextubation Dysphagia Screening Tool for Patients After Prolonged Endotracheal Intubation. Am J Crit Care 2018; 27 (02) 89-96
    CrossrefPubMedGoogle Scholar
  • 23 Lynch YT, Clark BJ, Macht M. et al. The accuracy of the bedside swallowing evaluation for detecting aspiration in survivors of acute respiratory failure. J Crit Care 2017; 39: 143-148
    CrossrefPubMedGoogle Scholar
  • 24 Leder SB, Warner HL, Suiter DM. et al. Evaluation of Swallow Function Post-Extubation: Is It Necessary to Wait 24 Hours?. Ann Otol Rhinol Laryngol 2019; 128 (07) 619-624
    CrossrefPubMedGoogle Scholar
  • 25 Marvin S. Evaluation and Treatment of Post-Extubation Dysphagia: The Importance of the Speech Pathologist in the Intensive Care Unit. Perspect ASHA Spec Interest Groups 2022; 7 (01) 174-180
    CrossrefGoogle Scholar
  • 26 Baumgartner CA, Bewyer E, Bruner D. Management of communication and swallowing in intensive care: the role of the speech pathologist. AACN Adv Crit Care 2008; 19 (04) 433-443
    PubMedGoogle Scholar
  • 27 Giraldo-Cadavid LF, Leal-Leaño LR, Leon-Basantes GA. et al. Accuracy of endoscopic and videofluoroscopic evaluations of swallowing for oropharyngeal dysphagia. Laryngoscope 2017; 127 (09) 2002-2010
    CrossrefPubMedGoogle Scholar
  • 28 Langmore SE. Evaluation of oropharyngeal dysphagia: which diagnostic tool is superior?. Curr Opin Otolaryngol Head Neck Surg 2003; 11 (06) 485-489
    CrossrefPubMedGoogle Scholar
  • 29 Dylczyk-Sommer A. Dysphagia. Part 2: Dysphagia in intensive care patients. Anaesthesiol Intensive Ther 2020; 52 (03) 233-236
    CrossrefPubMedGoogle Scholar
  • 30 Duncan S, Gaughey JM, Fallis R, McAuley DF, Walshe M, Blackwood B. Interventions for oropharyngeal dysphagia in acute and critical care: a protocol for a systematic review and meta-analysis. Syst Rev 2019; 8 (01) 1-8
    CrossrefPubMedGoogle Scholar
  • 31 McRae J. The role of speech and language therapy in critical care. ICU Manag Pract 2018; 18 (02) 128-131
    Google Scholar
  • 32 Marian T, Dünser M, Citerio G, Koköfer A, Dziewas R. Are intensive care physicians aware of dysphagia? The MADICU survey results. Intensive Care Med 2018; 44 (06) 973-975
    CrossrefPubMedGoogle Scholar
  • 33 Spronk PE, Spronk LEJ, Egerod I. , et al. Dysphagia in Intensive Care Evaluation (DICE): An International Cross-Sectional Survey. Dysphagia [Internet]. 2022 Jan 29 [cited 2022 Jul 31]; Available from: https://link.springer.com/10.1007/s00455-021-10389-y
  • 34 van Snippenburg W, Kröner A, Flim M. et al. Awareness and Management of Dysphagia in Dutch Intensive Care Units: A Nationwide Survey. Dysphagia 2019; 34 (02) 220-228
    CrossrefPubMedGoogle Scholar
  • 35 Zuercher P, Moret C, Schefold JC. Dysphagia in the intensive care unit in Switzerland (DICE) – results of a national survey on the current standard of care. Swiss Med Wkly [Internet]. 2019 Jul 22 [cited 2022 Jul 7]; Available from: https://doi.emh.ch/smw.2019.20111
    Google Scholar
  • 36 Rowland S, Mills C, Walshe M. Perspectives on speech and language pathology practices and service provision in adult critical care settings in Ireland and international settings: A cross-sectional survey. Int J Speech Lang Pathol 2022; 15: 1-12
    Google Scholar
  • 37 Macht M, Wimbish T, Clark BJ. et al. Diagnosis and treatment of post-extubation dysphagia: results from a national survey. J Crit Care 2012; 27 (06) 578-586
    CrossrefPubMedGoogle Scholar
  • 38 Cardinal LA, Freeman-Sanderson A, Togher L. The speech pathology workforce in intensive care units: Results from a national survey. Aust Crit Care 2020; 33 (03) 250-258
    CrossrefPubMedGoogle Scholar
  • 39 Brodsky MB, Pandian V, Needham DM. Post-extubation dysphagia: a problem needing multidisciplinary efforts. Intensive Care Med 2020; 46 (01) 93-96
    CrossrefPubMedGoogle Scholar
  • 40 Kim MM, Barnato AE, Angus DC, Fleisher LA, Kahn JM. The effect of multidisciplinary care teams on intensive care unit mortality. Arch Intern Med 2010; 170 (04) 369-376
    CrossrefPubMedGoogle Scholar
  • 41 Tobin AE, Santamaria JD. An intensivist-led tracheostomy review team is associated with shorter decannulation time and length of stay: a prospective cohort study. Crit Care 2008; 12 (02) R48
    CrossrefPubMedGoogle Scholar
  • 42 Yoo EJ, Edwards JD, Dean ML, Dudley RA. Multidisciplinary Critical Care and Intensivist Staffing: Results of a Statewide Survey and Association With Mortality. J Intensive Care Med 2016; 31 (05) 325-332
    CrossrefPubMedGoogle Scholar
  • 43 Faculty of Intensive Care Medicine (FICM), Intensive Care Society (ICS). Guidelines for the Provision of Intensive Care Services. [Internet]. 2nd ed. 2019. Available from: https://www.ficm.ac.uk/sites/ficm/files/documents/2021-10/gpics-v2.pdf
    Google Scholar
  • 44 National Confidential Enquiry into Patient Outcomes and Death (NCEPOD). On the Right Trach? A review of the care received by patients who underwent a tracheostomy [Internet]. 2014 . Available from: https://www.ncepod.org.uk/2014tc.html
    PubMedGoogle Scholar
  • 45 Royal College of Speech and Language Therapists (RCSLT). Speech and language therapy in adult critical care - position paper. [Internet]. 2014 . Available from: https://studylib.net/doc/18891681/position-paper-speech-and-language-therapy-in-adult-criti
    PubMedGoogle Scholar
  • 46 Centers for Medicare and Medicaid Services. Covered Medical and Other Health Services. In Medicare benefit policy manual [Internet]. 2012 . Available from: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/bp102c15.pdf
    PubMedGoogle Scholar
  • 47 Freeman-Sanderson A, Cardinal L, Togher L. Speech pathology in ICU – a varied national workforce. Aust Crit Care 2020; 33: S7
    CrossrefGoogle Scholar
  • 48 See KC, Peng SY, Phua J, Sum CL, Concepcion J. Nurse-performed screening for postextubation dysphagia: a retrospective cohort study in critically ill medical patients. Crit Care 2016; 20 (01) 1-8
    CrossrefPubMedGoogle Scholar
  • 49 Turra GS, Schwartz IVD, Almeida ST, Martinez CC, Bridi M, Barreto SSM. Efficacy of speech therapy in post-intubation patients with oropharyngeal dysphagia: a randomized controlled trial. CoDAS 2021; 33 (02) e20190246
    CrossrefPubMedGoogle Scholar
  • 50 Brodsky MB, Mayfield EB, Gross RD. Clinical Decision Making in the ICU: Dysphagia Screening, Assessment, and Treatment. Semin Speech Lang 2019; 40 (03) 170-187
    Article in Thieme ConnectPubMedGoogle Scholar
  • 51 McRae J, Montgomery E, Garstang Z, Cleary E. The role of speech and language therapists in the intensive care unit. J Intensive Care Soc 2020; 21 (04) 344-348
    CrossrefPubMedGoogle Scholar
  • 52 American Speech-Language-Hearing Association (ASHA). Speech-Language Pathologists as the Preferred Providers for Dysphagia Services [Internet]. American Speech-Language-Hearing Association. American Speech-Language-Hearing Association; 2021 [cited 2022 Jul 27]. Available from: https://www.asha.org/slp/clinical/speech-language-pathologists-as-the-preferred-providers-for-dysphagia-services/
    Google Scholar
  • 53 American Speech-Language-Hearing Association (ASHA). SLP Health Care Survey [Internet]. 2021 . Available from: https://www.asha.org/research/memberdata/healthcare-survey/
    PubMedGoogle Scholar
  • 54 Malandraki GA, Markaki V, Georgopoulos VC, Psychogios L, Nanas S. Postextubation Dysphagia in Critical Patients: A First Report From the Largest Step-Down Intensive Care Unit in Greece. Am J Speech Lang Pathol 2016; 25 (02) 150-156
    CrossrefPubMedGoogle Scholar
  • 55 Sharma A, Minh Duc NT, Luu Lam Thang T. et al. A Consensus-Based Checklist for Reporting of Survey Studies (CROSS). J Gen Intern Med 2021; 36 (10) 3179-3187
    CrossrefPubMedGoogle Scholar
  • 56 Hafner G, Neuhuber A, Hirtenfelder S, Schmedler B, Eckel HE. Fiberoptic endoscopic evaluation of swallowing in intensive care unit patients. Eur Arch Otorhinolaryngol 2008; 265 (04) 441-446
    CrossrefPubMedGoogle Scholar