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Journal of Critical Care Feb 2024Dysphagia is common in intensive care unit (ICU) patients, yet it remains underrecognized and often unmanaged despite being associated with life-threatening... (Review)
Review
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.
Topics: Humans; Deglutition Disorders; Expert Testimony; Critical Care; Mass Screening; Intensive Care Units
PubMed: 37924574
DOI: 10.1016/j.jcrc.2023.154447 -
Neurology Feb 2021Introduction and validation of a phenotypic classification of neurogenic dysphagia based on flexible endoscopic evaluation of swallowing (FEES).
OBJECTIVE
Introduction and validation of a phenotypic classification of neurogenic dysphagia based on flexible endoscopic evaluation of swallowing (FEES).
METHODS
A systematic literature review was conducted, searching MEDLINE from inception to May 2020 for FEES findings in neurologic diseases of interest. Based on a retrospective analysis of FEES videos in neurologic diseases and considering the results from the review, a classification of neurogenic dysphagia was developed distinguishing different phenotypes. The classification was validated using 1,012 randomly selected FEES videos of patients with various neurologic disorders. Chi-square tests were used to compare the distribution of dysphagia phenotypes between the underlying neurologic disorders.
RESULTS
A total of 159 articles were identified, of which 59 were included in the qualitative synthesis. Seven dysphagia phenotypes were identified: (1) "premature bolus spillage" and (2) "delayed swallowing reflex" occurred mainly in stroke, (3) "predominance of residue in the valleculae" was most common in Parkinson disease, (4) "predominance of residue in the piriform sinus" occurred only in myositis, motoneuron disease, and brainstem stroke, (5) "pharyngolaryngeal movement disorder" was found in atypical Parkinsonian syndromes and stroke, (6) "fatigable swallowing weakness" was common in myasthenia gravis, and (7) "complex disorder" with a heterogeneous dysphagia pattern was the leading mechanism in amyotrophic lateral sclerosis. The interrater reliability showed a strong agreement (kappa = 0.84).
CONCLUSION
Neurogenic dysphagia is not a symptom, but a multietiologic syndrome with different phenotypic patterns depending on the underlying disease. Dysphagia phenotypes can facilitate differential diagnosis in patients with dysphagia of unclear etiology.
Topics: Deglutition Disorders; Humans; Nervous System Diseases
PubMed: 33318164
DOI: 10.1212/WNL.0000000000011350 -
American Journal of Speech-language... Jan 2022Dysphagia is a common sequela of Parkinson disease (PD) and is associated with malnutrition, aspiration pneumonia, and mortality. This review article synthesized...
PURPOSE
Dysphagia is a common sequela of Parkinson disease (PD) and is associated with malnutrition, aspiration pneumonia, and mortality. This review article synthesized evidence regarding the effectiveness of interventions for dysphagia in PD.
METHOD
Electronic searches were conducted in Ovid MEDLINE, Embase, Cochrane Central Register of Controlled Trials, CINAHL, and speechBITE. Of the 2,015 articles identified, 26 met eligibility criteria: interventional or observational studies with at least five or more participants evaluating dysphagia interventions in adults with PD-related dysphagia, with outcomes measured using videofluoroscopic swallowing study (VFSS), fiberoptic endoscopic evaluation of swallowing (FEES), or electromyography (EMG). Risk of bias (RoB) was evaluated using the Evidence Project tool and predetermined criteria regarding the rigor of swallowing outcome measures.
RESULTS
Interventions were classified as follows: pharmacological ( = 11), neurostimulation ( = 8), and behavioral ( = 7). Primary outcome measures varied across studies, including swallowing timing, safety, and efficiency, and were measured using VFSS ( = 17), FEES ( = 6), and EMG ( = 4). Critical appraisal of study findings for RoB, methodological rigor, and transparency showed the majority of studies failed to adequately describe contrast media used, signal acquisition settings, and rater blinding to time point. Low certainty evidence generally suggested improved swallow timing with exercises with biofeedback and deep brain stimulation (DBS), improved safety with DBS and expiratory muscle strength training, and improved efficiency with the Lee Silverman Voice Treatment and levodopa.
CONCLUSIONS
Studies with lower RoB and greater experimental rigor showed potential benefit in improving swallowing efficiency but not safety. Further research investigating discrete changes in swallowing pathophysiology post-intervention is warranted to guide dysphagia management in PD.
SUPPLEMENTAL MATERIAL
https://doi.org/10.23641/asha.17132162.
Topics: Adult; Biofeedback, Psychology; Deep Brain Stimulation; Deglutition; Deglutition Disorders; Exercise Therapy; Humans; Parkinson Disease; Physical Therapy Modalities
PubMed: 34890260
DOI: 10.1044/2021_AJSLP-21-00145 -
Ugeskrift For Laeger Feb 2019Dysphagia is the medical term for the symptom of difficulty in swallowing. It is a common symptom in a wide group of patients, causing significant consequences for both...
Dysphagia is the medical term for the symptom of difficulty in swallowing. It is a common symptom in a wide group of patients, causing significant consequences for both patients and community. Patients with undiagnosed dysphagia are at high risk of aspiration and malnutrition, thus reducing quality of life and expanding health costs. Thorough examination is important, and implementation of a treatment strategy should be based on evaluation by a multidisciplinary team. Despite the implications of dysphagia, knowledge and focus are limited in both the primary and the secondary sectors of the Danish healthcare system. Consequently, many patients are not treated adequately.
Topics: Deglutition Disorders; Humans
PubMed: 30799809
DOI: No ID Found -
The Nurse Practitioner Jul 2020Dysphagia is a common symptom with several differential diagnoses ranging from benign and functional to life threatening. Given the potential severity, it is essential... (Review)
Review
Dysphagia is a common symptom with several differential diagnoses ranging from benign and functional to life threatening. Given the potential severity, it is essential to obtain an accurate and pointed history to dictate appropriate diagnostic testing. This article differentiates between oropharyngeal and esophageal dysphagia before outlining a systematic approach to subsequent testing, including when to refer to a specialist.
Topics: Deglutition Disorders; Diagnosis, Differential; Humans
PubMed: 32568790
DOI: 10.1097/01.NPR.0000669120.41930.5e -
Deutsches Arzteblatt International May 2022
Topics: Deglutition Disorders; Dyspnea; Humans
PubMed: 35974461
DOI: 10.3238/arztebl.m2022.0055 -
Clinics in Geriatric Medicine May 2018Geriatric dysphagia is an unrecognized and underdiagnosed problem with significant morbidity and potential mortality. It requires diligence by the clinician and a team... (Review)
Review
Geriatric dysphagia is an unrecognized and underdiagnosed problem with significant morbidity and potential mortality. It requires diligence by the clinician and a team approach for successful management. Careful history-taking is the key in the treatment of these patients and determines further workup, as well as treatment.
Topics: Aged; Deglutition Disorders; Geriatric Assessment; Humans; Patient Care Management; Pneumonia, Aspiration
PubMed: 29661331
DOI: 10.1016/j.cger.2018.01.007 -
BMC Geriatrics Jul 2021Dysphagia is highly prevalent condition in older adults living in nursing homes. There is also evidence indicating that aspiration is one of the major health risks for... (Review)
Review
BACKGROUND
Dysphagia is highly prevalent condition in older adults living in nursing homes. There is also evidence indicating that aspiration is one of the major health risks for these older adults, which is more likely to result in respiratory infections, aspiration pneumonia and sudden bolus death. Evidence syntheses have demonstrated the effectiveness of interventions for prevention of aspiration among hospitalized older people. The aim of this scoping review is to describe the current spread of interventions to prevent or reduce aspiration in older adults with dysphagia with a specific focus on those who reside in nursing homes.
METHODS
The Joanna Briggs Institute methods and PRISMA-ScR guidelines were used to inform this review. MEDLINE, CINAHL, EMBASE, Cochrane Library, Joanna Briggs Institute EBP Database and Web of Science were searched for related articles from 2010 to 2020 as well as Chinese databases (CNKI, WANFANG DATA and VIP) and databases for unpublished material. A three-step search strategy was utilized, including the use of citation software to manage search results and de-duplication, abstract review and full-text review by two reviewers. Details of included studies were then extracted using a prepared data extraction tool. The resulting map was displayed in tabular form along with a narrative summary.
RESULTS
Although 637 articles were located, 19 papers were included in the final analysis. Interventions to prevent aspiration in older adults with dysphagia living in nursing homes included: more bedside evaluation, modification of dietary, creating an appropriate environment for swallowing, providing appropriate feeding assistance, appropriate posture or maneuver for swallowing, appropriate rehabilitation program, medication treatment, and stimulation treatment.
CONCLUSION
Nursing homes, particularly those in developing countries, require more support for staff training and necessary equipment. Professional interventions provided by speech and language therapists are still limited in the setting of nursing homes. Modification of dietary was the most frequently used intervention to prevent or reduce aspiration. Multi-disciplinary interventions had the best results for aspiration management, but for many nursing homes, access to such teams is limited. Nursing home residents respond well to person-centered interventions that have a comprehensive consideration of their degree of aspiration risk, health condition, individual feelings and cognitive state.
Topics: Aged; Deglutition; Deglutition Disorders; Humans; Nursing Homes
PubMed: 34273953
DOI: 10.1186/s12877-021-02366-9 -
The Surgical Clinics of North America Apr 2022Esophageal dysphagia presents acutely, most frequently as a food impaction, or in a progressive fashion. Anatomic changes are frequently responsible. Although the... (Review)
Review
Esophageal dysphagia presents acutely, most frequently as a food impaction, or in a progressive fashion. Anatomic changes are frequently responsible. Although the history may be suggestive, diagnosis is made from imaging or endoscopic studies. In asymptomatic cases, observation is most appropriate. Treatment is frequently accomplished endoscopically. Strictures, cricopharyngeal hyperfunction, and Zenker diverticulum are potential etiologic causes. For the purpose of this article focused on upper esophageal dysphagia, delineation between the upper and lower parts is the crossing of the aortic arch but also includes the most distal aspects of the hypopharynx including the inferior pharyngeal constrictors and upper esophageal sphincter.
Topics: Deglutition Disorders; Esophageal Sphincter, Upper; Humans; Zenker Diverticulum
PubMed: 35344692
DOI: 10.1016/j.suc.2021.12.002 -
Seminars in Neurology Aug 2023Dysphagia is a common symptom in many neurologic disorders. Patients with oropharyngeal dysphagia present with difficulties when they start to swallow, often with...
Dysphagia is a common symptom in many neurologic disorders. Patients with oropharyngeal dysphagia present with difficulties when they start to swallow, often with coughing and choking; whereas patients with esophageal dysphagia describe the feeling that swallowed food stops in the chest. Chronic neurologic diseases such stroke, Parkinson's disease, or dementia often have dysphagia as a symptom, particularly oropharyngeal dysphagia, and the term "neurogenic dysphagia" is often used. A disruption of the sophisticated, integrated sensorimotor swallowing system is usually the main reason behind dysphagia. Dysphagia can be associated with aspiration leading to aspiration pneumonia, and chronic dysphagia can lead to weight loss and malnutrition. Patients with dysphagia, when accurately and promptly diagnosed through medical history, physical examination, and diagnostic tests, often can be treated and experience improved quality of life. The pathophysiological mechanisms behind dysphagia, its diagnosis, and potential treatments are discussed in this manuscript.
Topics: Humans; Deglutition Disorders; Quality of Life; Deglutition; Parkinson Disease; Stroke
PubMed: 37579785
DOI: 10.1055/s-0043-1771458