Tempo de intubação orotraqueal e disfagia: incidência, intervenção fonoaudiológica e indicadores de prognóstico na reabilitação
Data
2018-02-22
Autores
Lobrigate, Nadia Lais 
Orientadores
Goncalves, Maria Ines Rebelo
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
OBJETIVOS: Avaliar a incidência da disfagia segundo tempo de intubação
orotraqueal; verificar a eficiência da reabilitação fonoaudiológica segundo o tempo de
intubação orotraqueal, além de verificar os indicadores de prognóstico dos pacientes
disfágicos que atingiram níveis funcional ou normal nas escalas durante a reabilitação.
MÉTODO: Estudo observacional, analítico e retrospectivo, realizado no Serviço
Integrado de Fonoaudiologia (SIF) do Hospital São Paulo, por meio da análise dos
prontuários de 91 pacientes que estiveram internados na UTI geral entre os anos de
2014 e 2016, submetidos à intubação orotraqueal por período superior a 24 horas e
sem alterações neurológicas. Os pacientes foram divididos em GI, GII e GIII, de
acordo com o tempo de intubação orotraqueal e foram submetidos à avaliação inicial e
final visando a classificação da funcionalidade da alimentação e gravidade da disfagia,
de acordo com as Escalas FOIS e DOSS. O banco de dados coletado foi registrado no
programa EXCEL e os dados foram analisados estatisticamente por meio dos testes tindependente
e os testes de ANOVA, conforme conveniência. RESULTADOS: 48,35%
da amostra total apresentaram disfagia após a extubação. A reabilitação
fonoaudiológica foi benéfica para a maioria dos pacientes (n=36; 81,81%), uma vez
que conseguiram evoluir o nível de ingestão de alimento por via oral e reduzir a
gravidade da disfagia. O número de terapias e a ausência de intercorrências durante o
tratamento foi significante para a melhora dos pacientes nas escalas, sendo que os
pacientes que melhoraram receberam, significantemente, maior número de terapias e
apresentaram menos presença de intercorrências, comparandoos
às pessoas que
não melhoraram. O indicador significante de prognóstico de bons resultados de
tratamento foi a ausência de intercorrências durante a reabilitação. CONCLUSÕES:
Pacientes submetidos à intubação orotraqueal, independente de sua duração. A
reabilitação fonoaudiológica foi eficiente em todos os grupos. Os indicadores de
prognóstico que influenciaram na melhora da deglutição foram: maior número de
sessões de fonoterapia e ausência de intercorrências durante o período da
reabilitação. O tempo de IOT foi diretamente proporcional ao tempo de uso de VAA e
ao tempo de internação hospitalar. O reestabelecimento da deglutição até os níveis
funcional e normal foi possível nos pacientes que apresentaram menor número de
intercorrências. As escalas FOIS e DOSS apresentaram nível de associação
significante.
PURPOSE:This study aims at assessing the incidence of dysphagia according to orotracheal intubation duration; investigating the speech and language therapy rehabilitation effectiveness according to the duration of orotracheal intubation, as well as investigating the prognostic indicators of dysphagic patients who reached functional or normal levels in the scales during rehabilitation. METHODS: Observational, analytical and retrospective study performed at Speech and Language Integrated Service (SIF) at Hospital São Paulo, through the analysis of the medical records of 91 patients who were hospitalized at the general ICU between 2014 and 2016, submitted to orotracheal intubation for more than 24 hours and without neurological diagnoses. The patients were divided into GI, GII and GIII according to the duration of orotracheal intubation and were submitted to initial and final swallowing assessment in order to classify the feeding functionality and severity of dysphagia, according to the FOIS and DOSS Scales. Data collected was registered in the EXCEL program and were analyzed statistically through the independent ttests and the ANOVA tests, according to convenience. RESULTS: 48.35% of the total sample presented dysphagia after extubation. Speech and language therapy rehabilitation was beneficial for most patients (n = 36; 81.81%), as they were able to improve oral intake levels and reduce the severity of dysphagia. The number of therapies and the absence of clinical complications during the treatment were significant for the improvement in the scales, given that the patients who improved received a greater number of therapies and presented less clinical complications, in comparison to those who did not improved. The significant prognostic indicator of good treatment results was the absence of intercurrences during rehabilitation. CONCLUSIONS: Patients submitted to orotracheal intubation, regardless of duration, may present dysphagia. Speech and language therapy rehabilitation was efficient in all groups. The prognostic indicators that influenced the swallowing improvement were: a greater number of speech therapy sessions and absence of clinical complications during the rehabilitation period. The duration of orotracheal intubation was directly proportional to the time of tube feeding and the length of hospital stay. The reestablishment of swallowing up to functional and normal levels was possible in the patients who presented a few number of clinical complications. The FOIS and DOSS scales showed a significant association level.
PURPOSE:This study aims at assessing the incidence of dysphagia according to orotracheal intubation duration; investigating the speech and language therapy rehabilitation effectiveness according to the duration of orotracheal intubation, as well as investigating the prognostic indicators of dysphagic patients who reached functional or normal levels in the scales during rehabilitation. METHODS: Observational, analytical and retrospective study performed at Speech and Language Integrated Service (SIF) at Hospital São Paulo, through the analysis of the medical records of 91 patients who were hospitalized at the general ICU between 2014 and 2016, submitted to orotracheal intubation for more than 24 hours and without neurological diagnoses. The patients were divided into GI, GII and GIII according to the duration of orotracheal intubation and were submitted to initial and final swallowing assessment in order to classify the feeding functionality and severity of dysphagia, according to the FOIS and DOSS Scales. Data collected was registered in the EXCEL program and were analyzed statistically through the independent ttests and the ANOVA tests, according to convenience. RESULTS: 48.35% of the total sample presented dysphagia after extubation. Speech and language therapy rehabilitation was beneficial for most patients (n = 36; 81.81%), as they were able to improve oral intake levels and reduce the severity of dysphagia. The number of therapies and the absence of clinical complications during the treatment were significant for the improvement in the scales, given that the patients who improved received a greater number of therapies and presented less clinical complications, in comparison to those who did not improved. The significant prognostic indicator of good treatment results was the absence of intercurrences during rehabilitation. CONCLUSIONS: Patients submitted to orotracheal intubation, regardless of duration, may present dysphagia. Speech and language therapy rehabilitation was efficient in all groups. The prognostic indicators that influenced the swallowing improvement were: a greater number of speech therapy sessions and absence of clinical complications during the rehabilitation period. The duration of orotracheal intubation was directly proportional to the time of tube feeding and the length of hospital stay. The reestablishment of swallowing up to functional and normal levels was possible in the patients who presented a few number of clinical complications. The FOIS and DOSS scales showed a significant association level.
Descrição
Citação
LOBRIGATE, Nádia Laís. Tempo de intubação orotraqueal e disfagia: incidência, intervenção fonoaudiológica e indicadores de prognóstico na reabilitação. 2018. 50 f. Dissertação (Mestrado) – Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, 2018.