Management of swallowing disorders in ICU patients - A multinational expert opinion.
Critically ill patients
Dysphagia
Dysphagia treatment
Evidence-based clinical recommendations
Expert consensus
ICU
Pharyngeal electrical stimulation
Post-extubation
Swallowing therapy
Tracheostomy
Journal
Journal of critical care
ISSN: 1557-8615
Titre abrégé: J Crit Care
Pays: United States
ID NLM: 8610642
Informations de publication
Date de publication:
02 2024
02 2024
Historique:
received:
11
04
2023
revised:
19
09
2023
accepted:
10
10
2023
medline:
17
12
2023
pubmed:
5
11
2023
entrez:
4
11
2023
Statut:
ppublish
Résumé
Dysphagia is common in intensive care unit (ICU) patients, yet it remains underrecognized and often unmanaged despite being associated with life-threatening complications, prolonged ICU stays and hospitalization. To propose an expert opinion for the diagnosis and management of dysphagia developed from evidence-based clinical recommendations and practitioner insights. A multinational group of dysphagia and critical care experts conducted a literature review using a modified ACCORD methodology. Based on a fusion of the available evidence and the panel's clinical experience, an expert opinion on best practice management was developed. The panel recommends adopting clinical algorithms intended to promote standardized, high-quality care that triggers timely systematic dysphagia screening, assessment, and treatment of extubated and tracheostomized patients in the ICU. Given the lack of robust scientific evidence, two clinical management algorithms are proposed for use by multidisciplinary teams to improve early systematic detection and effective management of dysphagia in ICU patients. Additionally, emerging therapeutic options such as neurostimulation have the potential to improve the quality of ICU dysphagia care.
Sections du résumé
BACKGROUND
Dysphagia is common in intensive care unit (ICU) patients, yet it remains underrecognized and often unmanaged despite being associated with life-threatening complications, prolonged ICU stays and hospitalization.
PURPOSE
To propose an expert opinion for the diagnosis and management of dysphagia developed from evidence-based clinical recommendations and practitioner insights.
METHODS
A multinational group of dysphagia and critical care experts conducted a literature review using a modified ACCORD methodology. Based on a fusion of the available evidence and the panel's clinical experience, an expert opinion on best practice management was developed.
RESULTS
The panel recommends adopting clinical algorithms intended to promote standardized, high-quality care that triggers timely systematic dysphagia screening, assessment, and treatment of extubated and tracheostomized patients in the ICU.
CONCLUSIONS
Given the lack of robust scientific evidence, two clinical management algorithms are proposed for use by multidisciplinary teams to improve early systematic detection and effective management of dysphagia in ICU patients. Additionally, emerging therapeutic options such as neurostimulation have the potential to improve the quality of ICU dysphagia care.
Identifiants
pubmed: 37924574
pii: S0883-9441(23)00196-X
doi: 10.1016/j.jcrc.2023.154447
pii:
doi:
Banques de données
ClinicalTrials.gov
['NCT03840395']
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
154447Informations de copyright
Copyright © 2023. Published by Elsevier Inc.
Déclaration de conflit d'intérêts
Declaration of Competing Interest This publication has been supported by Phagenesis, Ltd. JCS reports that Phagenesis, LTD is the sponsor of the randomized controlled clinical PHINEST trial (NCT03840395). This ongoing clinical study is investigating pharyngeal electrical stimulation in ICU patients and JCS is the principal investigator of this trial.