Comparison between the functional aspects of swallowing and clinical markers in ICU patients with Traumatic Brain Injury (TBI)
Comparação dos aspectos funcionais da deglutição e indicadores clínicos em pacientes com traumatismo cranioencefálico em UTI
Juliana Lopes Ferrucci; Fernanda Chiarion Sassi; Gisele Chagas de Medeiros; Claudia Regina Furquim de Andrade
Abstract
Purpose: To characterize and compare the functional aspects of swallowing and clinical markers in intensive care patients with traumatic brain injury (TBI) in Intensive Care Unit (ICU). Methods: Participants of this study were 113 adults diagnosed with TBI. Data collection stage involved: clinical assessment of the risk for bronchoaspiration performed by a speech-language therapist; assessment of the functional level of swallowing (American Speech-Language-Hearing Association National Outcome Measurement System – ASHA NOMS); assessment of the patient’ health status (Sequential Organ Failure Assessment - SOFA). Results: After the inclusion criteria were applied, patients were grouped according to their swallowing functional level: levels 1 and 2 – ASHA1 (n=25); levels 3, 4 and 5 – ASHA2 (n=37); levels 6 and 7 – ASHA3 (n=51). The statistical analyses indicated the following significant results: the ASHA3 group presented lower severity levels of TBI at the clinical assessment of bronchoaspiration, remained less time intubated (approximately um third less than the more severe group), remained fewer days in hospital and needed less therapy sessions to return to safe oral feeding. The clinical predictor signs for bronchoaspiration that best characterized the groups were the presence of altered auscultation and the presence of coughing after swallowing. Patients in the ASHA3 group presented these signs less frequently. Conclusion: The score obtained on the SOFA and the time of orotracheal intubation were identified as the prognostic indicators of functional swallowing. The presence of altered cervical auscultation and coughing were clinical predictors of dysphagia.
Keywords
Resumo
Objetivo: caracterizar e comparar os aspectos funcionais da deglutição e indicadores clínicos na população com traumatismo cranioencefálico (TCE) em unidade de terapia intensiva. Método: Participaram do estudo 113 adultos com diagnóstico de TCE. As etapas de coleta de dados envolveram: a avaliação fonoaudiológica clínica do risco de broncoaspiração, determinação do nível funcional da deglutição (American Speech-Language-Hearing Association National Outcome Measurement System – ASHA NOMS), determinação da gravidade clínica do indivíduo de acordo com a Sequential Organ Failure Assessment (SOFA). Resultados: Após a aplicação dos critérios de inclusão, os pacientes selecionados foram agrupados de acordo com os níveis funcionais de deglutição: níveis 1 e 2 – ASHA1 (n=25); níveis 3, 4 e 5 – ASHA2 (n=37); níveis 6 e 7 – ASHA3 (n=51). As análises estatísticas indicaram os seguintes resultados significantes: o grupo ASHA3 apresentou menor gravidade do TCE no momento da avaliação fonoaudiológica, menor tempo de intubação orotraqueal (um terço a menos que o grupo mais grave), ficou menos tempo hospitalizado e necessitou de menos sessões de atendimento fonoaudiológico para o retorno seguro para via oral de alimentação. Os sinais clínicos preditores de broncoaspiração que mais diferenciaram os grupos foi a presença de ausculta cervical alterada e presença de tosse após a deglutição, sendo que o grupo ASHA3 apresentou esses sinais com menor frequência. Conclusão: O escore SOFA e o tempo de intubação orotraqueal foram indicadores do prognóstico da funcionalidade da deglutição. A presença ausculta cervical alterada e tosse foram preditores clínicos de disfagia.
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Referências
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Submetido em:
22/01/2018
Aceito em:
19/09/2018
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