RESUMO
Introducción: La Fibroscópica de Trastornos Deglutorios (FEES) es una técnica que permite estudiar la fisiología de la deglución. Puede realizarse junto a la cama del paciente, haciendo esta técnica muy atractiva para realizar en Cuidados Intensivos (UCI), evitando el traslado fuera de la unidad para dicha evaluación. Objetivo: Factibilidad de realizar FEES en la cabecera de la cama en la UCI, y evaluar la incidencia de los trastornos deglutorios en pacientes extubados. Materiales y Métodos: Estudio de cohorte prospectiva, analítico y comparativo en pacientes luego de 24 hs post extubación por un periodo de 6 meses evaluación, incluyéndose todos los pacientes en forma consecutiva, que recibieron ventilación mecánica por un periodo ≥ 48 hs comenzando el reclutamiento desde marzo de 2015. Resultados: Se incluyeron en el protocolo 31 pacientes. La incidencia de los trastornos deglutorios en pacientes extubados que requirieron VM fue del 58% IC 95% (0,407-0,735) con 18 trastornos de 31 casos evaluados. Entre los pacientes con y sin trastornos deglutorios definidos por FEES, las diferencias significativas entre los grupos fueron el tiempo post extubación hasta la realización del FEES, la capacidad de tolerar el FEES en posición de 90° vs 60º, la anormalidad en la escala de Langmore y el movimiento anormal de las cuerdas vocales. La complicación registrada en los dos grupos fue la presencia de saturación de pulso < 90%. Conclusión: Este estudio demuestra que la implementación de FEES, como método de detección de trastornos deglutorios (en la cabecera del paciente) se puede aplicar en forma segura.
Introduction: The Fiberoptic Endoscopic Evaluation of Swallowing (FEES) is a technique that allows the study of the physiology of swallowing. This technique can be applied at the patient's bedside, making it a very attractive choice for the critical care unit (CCU), since it is not necessary to transfer the patient to another place in order to carry out the evaluation. Objective: Feasibility to carry out the FEES at the patient's bedside at the CCU and assess the incidence of swallowing disorders in extubated patients. Materials and Methods: Comparative, prospective, analytical cohort study conducted 24 hours after extubation for a period of 6 months, including consecutively all the patients who received mechanical ventilation for a period ≥ 48 hours. The enrollment began in March, 2015. Results: 31 patients were included in the protocol. The incidence of swallowing disorders in extubated patients who required mechanical ventilation (MV) was 58%, 95% CI [confidence interval] (0.407-0.735) with 18 patients presenting disorders out of 31 evaluated cases. The significant differences between the groups of patients with and without swallowing disorders defined by the FEES were: the post-extubation time until the FEES, the capacity to tolerate the FEES at upright sitting position (90°) vs. semi-upright sitting position (60°), the abnormality of the Langmore scale and the abnormal movement of the vocal cords. The complication registered in both groups was the presence of oxygen saturation < 90%. Conclusion: This study shows that the implementation of the FEES as a method for detecting swallowing disorders (at the patient's bedside) is safe.
Assuntos
Transtornos de Deglutição , ExtubaçãoRESUMO
Introduction: The Fiberoptic Endoscopic Evaluation of Swallowing (FEES) is a technique that allows the study of the physiology of swallowing. This technique can be applied at the patient's bedside, making it a very attractive choice for the critical care unit (CCU), since it is not necessary to transfer the patient to another place in order to carry out the evaluation. Objective: Feasibility to carry out the FEES at the patient's bedside at the CCU and assess the incidence of swallowing disorders in extubated patients. Materials and Methods: Comparative, prospective, analytical cohort study conducted 24 hours after extubation for a period of 6 months, including consecutively all the patients who received mechanical ventilation for a period ≥ 48 hours. The enrollment began in March, 2015. Results: 31 patients were included in the protocol. The incidence of swallowing disorders in extubated patients who required mechanical ventilation (MV) was 58%, 95% CI [confidence interval] (0.407-0.735) with 18 patients presenting disorders out of 31 evaluated cases. The significant differences between the groups of patients with and without swallowing disorders defined by the FEES were: the post-extubation time until the FEES, the capacity to tolerate the FEES at upright sitting position (90°) vs. semi-upright sitting position (60°), the abnormality of the Langmore scale and the abnormal movement of the vocal cords. The complication registered in both groups was the presence of oxygen saturation < 90%. Conclusion: This study shows that the implementation of the FEES as a method for detecting swallowing disorders (at the patient's bedside) is safe
