Disfagia orofaríngea em indivíduos com COVID-19 em Unidade de Terapia Intensiva
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Data
2023-03-30
Autores
Brandão, Bárbara Carolina [UNESP]
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Universidade Estadual Paulista (Unesp)
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Introdução: A progressão grave da COVID-19 esteve frequentemente associada ao desenvolvimento da Síndrome Respiratória Aguda Grave com necessidade de distintos meios de suporte respiratório e via alternativa de alimentação, e outros marcadores de risco para disfagia orofaríngea (DO). Objetivo: caracterizar a disfagia orofaríngea em pacientes acometidos pela COVID-19 e comparar os graus da DO com distintos fatores de risco para a deglutição. Método: Participaram desse estudo 130 indivíduos com COVID-19 diagnosticados por meio de exames laboratoriais, internados em leitos de Unidade de Terapia Intensiva do Hospital de Base de São José do Rio Preto, no período de junho de 2020 a julho de 2021, encaminhados para a equipe de Fonoaudiologia seguindo os critérios estabelecidos para risco de DO. Foram coletadas as variáveis idade, sexo, comorbidades, via de alimentação, uso de intubação orotraqueal (IOT), uso de posição prona, ventilação mecânica (VM), traqueostomia, nível de ingestão oral, tempo total de internação e desfecho clínico. Realizada avaliação clínica da deglutição por meio de protocolo específico do Serviço de Fonoaudiologia. Para conclusão diagnóstica foi proposta uma escala de classificação do grau de comprometimento da DO para indivíduos com COVID-19, previamente analisada por um comitê de especialistas. Aplicada a classificação do nível de ingestão oral pela Functional Oral Intake Scale (FOIS - CRARY et al., 2005) e American Speech-Language-Hearing Association National Outcome Measurement System - Swallowing Scale (ASHA NOMS – ROCKVILLE, 1998). Resultados: Verificou-se que 70 (53,8%) indivíduos eram do sexo masculino com média de idade de 56,2 anos. 69 (53,1%) indivíduos apresentavam duas ou mais comorbidades, sendo a hipertensão arterial (HAS) a mais frequente (48,5%), seguida de obesidade (30,8%) e diabetes (30%). Constatou-se que 114 (87,7%) necessitaram de IOT, 62 (48,1%) de posição prona, 27 (20,8%) de traqueostomia e 102 (78,5%) em uso de via alternativa de alimentação. Quanto ao grau de comprometimento da DO, 70 (53,8%) foram classificados como leve, 50 (38,5%) moderado e 10 (7,7%) grave. Os níveis da escala FOIS e ASHA NOMS variaram de 1 a 6, com maior frequência no nível 1 nas duas escalas. O grau de comprometimento da DO se relacionou com IOT, desfecho clínico e com as vias de alimentação. Os níveis de ingestão oral se relacionaram com o tempo de IOT e com as vias de alimentação e não houve relação entre grau de comprometimento da DO e a posição prona. Conclusão: A disfagia orofaríngea no indivíduo com COVID-19 em Unidade de Terapia Intensiva ocorreu em distintos graus de comprometimento, mais frequentemente no grau leve do que moderado e grave, e o uso de IOT, desfecho clínico e vias de alimentação tiveram relação com o grau da disfagia e o nível de ingestão oral nesta população.
Introduction: The severe progression of COVID-19 was often associated with the development of Severe Acute Respiratory Syndrome with the need for different means of respiratory support and alternative feeding route, and other risk markers for oropharyngeal dysphagia (OD). Objective: to characterize oropharyngeal dysphagia in patients affected by COVID-19 and compare the degrees of DO with different risk factors for swallowing. Method: The study included 130 individuals with COVID-19 diagnosed through laboratory tests, admitted to beds in the Intensive Care Unit of Hospital de Base de São José do Rio Preto, from June 2020 to July 2021, referred to the Speech-Language Pathology team following the established criteria for the risk of OD. The variables age, gender, comorbidities, feeding route, use of orotracheal intubation (OTI), use of the prone position, mechanical ventilation (MV), tracheostomy, level of oral intake, total length of stay and clinical outcome were collected. Clinical evaluation of swallowing was performed using a specific protocol from the Speech Therapy Service. For diagnostic conclusion, a classification scale of the degree of DO impairment was proposed for individuals with COVID-19, previously analyzed by a committee of specialists. Applied the classification of the level of oral intake by the Functional Oral Intake Scale (FOIS - CRARY et al., 2005) and American Speech-Language-Hearing Association National Outcome Measurement System - Swallowing Scale (ASHA NOMS – ROCKVILLE, 1998). Results: It was found that 70 (53.8%) individuals were male with a mean age of 56.2 years. 69 (53.1%) individuals had two or more comorbidities, with arterial hypertension (SAH) being the most frequent (48.5%), followed by obesity (30.8%) and diabetes (30%). It was found that 114 (87.7%) required OTI, 62 (48.1%) of prone position, 27 (20.8%) of tracheostomy and 102 (78.5%) using alternative feeding route . As for the degree of DO impairment, 70 (53.8%) were classified as mild, 50 (38.5%) moderate and 10 (7.7%) severe. FOIS and ASHA NOMS scale levels ranged from 1 to 6, with a higher frequency at level 1 on both scales. The degree of OD impairment was related to OTI, clinical outcome and feeding pathways. Oral intake levels were related to OTI time and feeding routes, and there was no relationship between the degree of DO impairment and the prone position. Conclusion: Oropharyngeal dysphagia in individuals with COVID19 in the Intensive Care Unit occurred in different degrees of impairment, more often mild than moderate and severe, and the use of OTI, clinical outcome and feeding routes were related to the degree of dysphagia and level of oral intake in this population.
Introduction: The severe progression of COVID-19 was often associated with the development of Severe Acute Respiratory Syndrome with the need for different means of respiratory support and alternative feeding route, and other risk markers for oropharyngeal dysphagia (OD). Objective: to characterize oropharyngeal dysphagia in patients affected by COVID-19 and compare the degrees of DO with different risk factors for swallowing. Method: The study included 130 individuals with COVID-19 diagnosed through laboratory tests, admitted to beds in the Intensive Care Unit of Hospital de Base de São José do Rio Preto, from June 2020 to July 2021, referred to the Speech-Language Pathology team following the established criteria for the risk of OD. The variables age, gender, comorbidities, feeding route, use of orotracheal intubation (OTI), use of the prone position, mechanical ventilation (MV), tracheostomy, level of oral intake, total length of stay and clinical outcome were collected. Clinical evaluation of swallowing was performed using a specific protocol from the Speech Therapy Service. For diagnostic conclusion, a classification scale of the degree of DO impairment was proposed for individuals with COVID-19, previously analyzed by a committee of specialists. Applied the classification of the level of oral intake by the Functional Oral Intake Scale (FOIS - CRARY et al., 2005) and American Speech-Language-Hearing Association National Outcome Measurement System - Swallowing Scale (ASHA NOMS – ROCKVILLE, 1998). Results: It was found that 70 (53.8%) individuals were male with a mean age of 56.2 years. 69 (53.1%) individuals had two or more comorbidities, with arterial hypertension (SAH) being the most frequent (48.5%), followed by obesity (30.8%) and diabetes (30%). It was found that 114 (87.7%) required OTI, 62 (48.1%) of prone position, 27 (20.8%) of tracheostomy and 102 (78.5%) using alternative feeding route . As for the degree of DO impairment, 70 (53.8%) were classified as mild, 50 (38.5%) moderate and 10 (7.7%) severe. FOIS and ASHA NOMS scale levels ranged from 1 to 6, with a higher frequency at level 1 on both scales. The degree of OD impairment was related to OTI, clinical outcome and feeding pathways. Oral intake levels were related to OTI time and feeding routes, and there was no relationship between the degree of DO impairment and the prone position. Conclusion: Oropharyngeal dysphagia in individuals with COVID19 in the Intensive Care Unit occurred in different degrees of impairment, more often mild than moderate and severe, and the use of OTI, clinical outcome and feeding routes were related to the degree of dysphagia and level of oral intake in this population.
Descrição
Palavras-chave
Transtornos de deglutição, Covid-19, Deglutição, Avaliação, Unidade de Terapia Intensiva, Swallowing disorders, Deglutition, Evaluation, Intensive care unit
Como citar
BRANDÃO, Bárbara Carolina. Disfagia orofaríngea em indivíduos com COVID-19 em Unidade de Terapia Intensiva. Universidade Estadual Paulista (Unesp), 2023.