The efficacy and effectiveness of early interventions for swallowing to improve swallowing outcomes in patients in the ICU with dysphagia: A Systematic Review
Citation:
Eleni Spanoudaki, 'The efficacy and effectiveness of early interventions for swallowing to improve swallowing outcomes in patients in the ICU with dysphagia: A Systematic Review', [thesis], Trinity College Dublin. School of Linguistic Speech & Comm Sci. Discipline of Clin Speech & Language Studies, 2022, Trinity College Dublin thesesDownload Item:
Abstract:
Background
Oropharyngeal dysphagia is observed frequently in patients in intensive care units
(ICUs). Τhere are a number of risk factors that might lead to the development of
dysphagia and the consequences can affect the physiology, functional and
psychological aspects of the patient’s life. While early intervention has proven to
improve the overall medical status of the patients, few studies have examined the
impact of early dysphagia intervention in patients in critical care.
Aims
The primary aim of this review is to determine the efficacy and effectiveness of
early intervention compared to late intervention for improving the swallowing
outcomes of patients in critical care. As swallowing outcomes, we refer to the time
for oral intake resumption, the improvement of oral intake, the change in
respiratory status, the length of ICU stay, the change in the levels of secretions,
and the appearance of any adverse events.
Methods
We searched in 10 electronic databases for published and unpublished randomised
control trials (RCTs), quasi-experimental trials, observational studies and
systematic reviews and bibliography lists of included studies to March 2022. Two
independent viewers evaluated articles for eligibility, and conflicts were resolved
by consensus. The primary reviewer conducted data extraction, quality
assessment, and bias risk. The risk of bias was assessed with the Cochrane
Collaboration's Risk of Bias (RoB) 2 tool for RCTs and the checklist by Joanna
Briggs Institute Critical Appraisal tools for cohort studies. Meta-analysis was not
performed due to incomparable results; therefore, the findings were described
narratively. Preferred Reporting Items for Systematic Research and MetaAnalyses (PRISMA) criteria were used to perform this review.
Results
The search identified n=6 studies eligible for the inclusion criteria of this review.
Of these four studies were RCTs and two studies were observational. The studies
were divided into two groups based on the intervention they applied, three studiesapplied only rehabilitation techniques and three included apart from
rehabilitation exercises, compensatory strategies, and/or diet modification and/or
usual care. The appropriate timing of the intervention was unable to be defined
due to insufficient data. Dysphagia intervention presented small improvement in
functional oral intake, in respiratory conditions, but no significant difference in
the time to return to oral intake, and in the length of ICU stay in days. The risk of
bias in the included studies was found to significantly impacts the quality of the
findings.
Conclusion
A firm conclusion was unable to be made due to the high heterogeneity of the
included studies and lack of quality evidence. There is a necessity for further
research regarding early interventions and their timing for improving swallowing
outcomes in ICU patients.
Author: Spanoudaki, Eleni
Advisor:
Walshe, MargaretQualification name:
MSc Clinical Speech & Language StudiesPublisher:
Trinity College Dublin. School of Linguistic Speech & Comm Sci. Discipline of Clin Speech & Language StudiesType of material:
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