Clinical findings of speech therapy swallowing assessments in patients with oropharyngeal dysphagia following orotracheal intubation

Introduction: Endotracheal intubation has been associated with oropharyngeal dysphagia. The aim of this study was to identify the prevalence of oropharyngeal dysphagia among patients in an intensive care unit (ICU) by comparing patients requiring orotracheal intubation with those who did not undergo this procedure. Methods: This is a cross-sectional study that analyzed the medical records of 681 patients admitted to the ICU of Hospital de Clínicas de Porto Alegre between 2014 and 2017; inclusion criteria were patients aged 18 years and older who had been assessed by the hospital's Speech Therapy Service. Patients who had undergone tracheostomy, who had incomplete medical records or multiple speech-language assessments were excluded. Results: A total of 380 patients were included in the statistical analysis: 97 (25.5%) had not undergone orotracheal intubation (Group 1), 229 (60.3%) had undergone orotracheal intubation once (Group 2), and 54 (14.2%) had undergone orotracheal intubation on 2 or more occasions (Group 3). Regarding the Functional Oral Intake Scale (FOIS), 61.1% of patients in Group 3 received a FOIS I classification (p = 0.020), whereas 16.5% of patients from Group 1 received a FOIS V. Concerning their outcomes, 40.7% of patients in Group 3 died (p = 0.006), and 82.5% of patients in Group 1 were discharged from the ICU. Considering the severity of oropharyngeal dysphagia according to the Dysphagia Risk Evaluation Protocol (PARD), no statistically significant association was observed between groups (p = 0.261). Conclusions: In this study, the prevalence of oropharyngeal dysphagia was higherin patients who had undergone orotracheal intubation in the ICU. (AU)

High-flow nasal cannula oxygen therapy in acute respiratory failure due to acute exacerbation of fibrotic interstitial lung disease

High flow nasal cannula oxygen therapy (HFNC) has become frequent in the treatment of patients with acute hypoxemic respiratory failure. Methods. Eleven patients with acute exacerbation of fibrotic interstitial lung disease (ILD) were treated with HFNC after failure of conventional therapy (SatO2 < 90% offering 100% FiO2 by non-rebreathing mask or noninvasive ventilation). Ten patients had success with HFNC (not requiring orotracheal intubation) during emergency department admission. HFNC significantly improves clinical variables after 2h: respiratory rate decreased from 33 ± 6 breaths/ min to 23 ± 3 breaths/min; PaO2 increased from 48.7 (38-59) mmHg to 81.1 (76-90) mmHg; PaO2/FiO2 ratio increased from 102.4 ± 32.2 to 136.6 ± 29.4; SatO2 increased from 85 (66-92)% to 96 ± (95-97)%. HFNC could be an effective alternative in the treatment of acute respiratory failure from acute exacerbations of fibrotic ILD.(AU)