ABSTRACT
Abstract Objective: To investigate the clinical and swallowing indicators related to a successful decannulation process during the hospital stay. Methods: A retrospective cohort clinical study. The study sample comprised a heterogeneous patient population who had submitted to a tracheostomy procedure in a tertiary hospital. Patients were divided into two groups (dec-annulated vs. non-decannulated) and compared not only in terms of demographic and clinical data but also the results of a swallowing assessment and intervention outcome. Results: Sixty-four patients were included in the present study: 25 (39%) who had been successfully decannulated, and 39 (61%) who could not be decannulated. Between-group comparisons indicated that both groups presented similar clinical and demographic characteristics. The groups also presented similar swallowing assessment results prior to intervention. However, significant differences were observed regarding the time to begin swallowing rehabilitation. The decannulated group was assessed nine days earlier than the non-decannulated group. Other significant differences included the removal of the alternate feeding method (72.0% of decannulated patients vs. 5.1% of non-decannulated patients) and the reintroduction of oral feeding (96.0% of decannulated patients vs. 41.0% of non-decannulated patients) and functional swallowing level at patient disclosure. The non-decannulated patient group presented higher death rates at disclosure. Conclusion: The results of the present study indicated that the following parameters were associated with a successful decannulation process: early swallowing assessment, swallowing rehabilitation, and improvement in the swallowing functional level during the hospital stay. The maintenance of low swallowing functional levels was found to be negatively associated with successful decannulation. HIGHLIGHTS Deccanulation indicators were investigated in patients who were submitted to a tracheostomy procedure. Early swallowing evaluation and rehabilitation were associated with a successful decannulation process. Low swallowing functional levels were negatively associated with the success of decannulation.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Pneumonia, Viral/physiopathology , Deglutition Disorders/etiology , Deglutition Disorders/physiopathology , Coronavirus Infections/physiopathology , Betacoronavirus , Intubation, Intratracheal/adverse effects , Pneumonia, Viral/complications , Pneumonia, Viral/therapy , Time Factors , Sex Factors , Prospective Studies , Risk Factors , Age Factors , Critical Illness , Coronavirus Infections/complications , Coronavirus Infections/therapy , Pandemics , Airway Extubation/adverse effects , SARS-CoV-2 , COVID-19 , Intensive Care UnitsABSTRACT
ABSTRACT INTRODUCTION: Aspects of the neuroanatomical representation of swallowing have been investigated in humans through brain mapping techniques, such as functional magnetic resonance imaging (fMRI). OBJECTIVE: This critical qualitative review of the literature analyzed international scientific publications in the PubMed database that investigated the activation of the central nervous system in humans during the act of swallowing. METHODS: This investigation was limited to articles that investigated adults older than 18 years, published in English or Portuguese, between January 2002 and December 2013. Publications that did not have access to the full text, that were repeated by overlapping keywords, case studies, literature reviews, letters to the editor, and those not directly related to the topic of the investigation were excluded. RESULTS: A total of 649 articles were identified, of which 21 matched the inclusion criteria. CONCLUSION: The main purpose of the manuscripts that investigate the swallowing process through fMRI were: to characterize swallowing in different pathologies; to compare swallowing in different age groups; to describe brain activation in different stimulation conditions. These studies indicate multiple cortical regions involved in swallowing control. Overall, the studies indicate that fMRI is a non-invasive and quantitative method that allows the investigation of characteristics that are quite often not clinically visible.
RESUMO INTRODUÇÃO: Aspectos da representação neuroanatômica do funcionamento cortical que controla a deglutição têm sido investigados e identificados em humanos, utilizando-se técnicas de mapeamento cerebral, como a Ressonância Magnética funcional (RNMf). OBJETIVO: Esta revisão crítica qualitativa da literatura levantou publicações científicas sobre a funcionalidade do sistema nervoso central durante tarefas de deglutição, por meio da base de dados PubMed. MÉTODO: O levantamento realizado limitou-se a seres humanos, com idade superior a 18 anos, nos idiomas inglês e português, entre janeiro de 2002 e dezembro de 2013. Publicações sem acesso completo, repetidas por sobreposição das palavras chave, estudos de caso, revisões de literatura, cartas ao editor e não relacionadas diretamente ao tema foram excluídas. RESULTADO: Identificou-se 649 estudos, sendo que somente 21 se enquadraram aos critérios estabelecidos. CONCLUSÃO: Foram encontrados artigos que objetivaram, por meio da RNMf, estudar a função de deglutição em patologias; comparar a deglutição em diferentes idades; descrever a ativação cerebral em diferentes situações de estimulação. Estes estudos apontam múltiplas regiões corticais que participam no controle da deglutição. Conclui-se que a RNMf é um método não invasivo, quantitativo, que demonstra respostas, muitas vezes, não visíveis clinicamente.