Atuação fonoaudiológica em pacientes traqueostomizados no contexto da COVID-19
Speech therapy performance in tracheostomized patients in the context of COVID-19
Valdani Dias; Tamires Daros dos Santos; Lisiane Alves Ozório; Jucelaine Arend Birrer; Gabriele Rodrigues Bastilha
Resumo
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Abstract
Purpose: To describe the contributions of speech therapy performance in tracheostomized patients in the context of COVID-19.
Methods: Retrospective descriptive and quantitative analysis research, using medical records to collect clinical and general variables from patients and speech therapy interventions. For statistical analysis, the Pearson or Spearman correlation coefficient was adopted and a significance level of 5% (p< 0.05).
Results: Twenty-eight medical records of patients were included (57.1% male) and an average age of 52 years and 1 month, who were hospitalized for approximately 53.7 days and progressed to tracheostomy after 22.1 days of orotracheal intubation. There were ten speech therapy sessions per patient, which started on average 38.4 days into hospitalization and were requested in 39.3% of cases for the progression of tracheostomy and oral feeding. The tracheostomy cuff was kept deflated on the third intervention, decannulation was suggested seven days after the start an d the patient was given an oral diet after five interventions. When we analyzed the time speech therapy interventions began, it showed a positive correlation with the length of hospital stay (p<0.0001), but not with the decannulation process and the length of time with the tracheostomy. On the other hand, the number of speech therapy interventions had a positive correlation with the length of time the tracheostomy was in use and the time until the oral diet was released.
Conclusion: Speech therapy performance contributes to swallowing rehabilitation and the safe return to oral feeding in patients submitted to tracheostomy in the context of COVID-19.
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Referências
1 WHO: World Health Organization. Coronavirus disease (COVID-19). Geneva: WHO; 2020.
2 Zareifopoulos N, Lagadinou M, Karela A, Karantzogiannis G, Velissaris D. Intubation and mechanical ventilation of patients with COVID-19: what should we tell them? Monaldi Arch Chest Dis. 2020;90(1).
3 Chiang SS, Aboutanos MB, Jawa RS, Kaul SK, Houng AP, Dicker RA, et al. Controversies in tracheostomy for patients with COVID-19: the when, where, and how. Respir Care. 2020 Nov;65(11):1767-72.
4 Rappoport WD, González AT, Capdeville FF, Valdés GF, Rojas PH, Zanolli DL, et al. Traqueostomía en pacientes con COVID-19: recomendaciones actuales. Rev Cir. 2020 Out;72(5):449-54.
5 Oliveira JSD, Quaresma TK, Dornelles S, Berwig LC, Scheeren B. Comparação dos marcadores de alteração na deglutição entre pacientes com e sem COVID-19 pós-intubação orotraqueal. Audiol Commun Res. 2023;28:e2692.
6 Rouhani MJ, Clunie G, Thong G, Lovell L, Roe J, Ashcroft M, et al. A prospective study of voice, swallow, and airway outcomes following tracheostomy for COVID-19. Laryngoscope. 2021;131(6):e1918-25.
7 Ji Y, Fang Y, Cheng B, Li L, Fang X. Tracheostomy timing and clinical outcomes in ventilated COVID-19 patients: a systematic review and meta-analysis. Crit Care. 2022 Fev 8;26(1):40.
8 Barros AP, Portas JG, Queija DS. Implicações da traqueostomia na comunicação e na deglutição. Rev Bras Cirurgia Cabeça Pescoço. 2009;38(3):202-7.
9 Rocha ACA, Gardenghi G. Perfil fonoaudiológico de pacientes infectados por coronavírus decanulados em um hospital público: série de casos. RESC - Revista Eletrônica Saúde e Ciência. 2021;11(1):45-60.
10 Cerqueira SBG, Teixeira JP, Carneiro TC, Ferreira GP, Silva JHSD, Graça LOD, et al. Manejo fonoaudiológico do paciente traqueostomizado no contexto da COVID-19: uma revisão do conhecimento atual. Distúrb Comun. 2021;33(1):178-85.
11 Santos TDS, Gomes FML, Gomes DC, Taquemori LY, Tonelotto A. Speech therapy and tracheostomy rehabilitation in COVID 19: five preliminary case reports. SN Comprehensive Clinical Medicine. 02 Apr 2021. Preprint.
12 BRASPEN-SBNPE: Sociedade Brasileira de Nutrição Parenteral e Enteral. A importância do fonoaudiólogo no combate ao COVID-19: Orientações aos fonoaudiólogos atuantes no ambiente hospitalar e Unidades de Terapia Intensiva quanto aos cuidados durante a pandemia de COVID-19 [Internet]. São Paulo: BRASPEN-SBNPE; 2020 [cited 2023 July 2]. Available from:
13 Manzano-Aquiahuatl C, Tobar-Fredes R, Zavala-Solares MR, Salle-Levy D, Imamura R, Morales-Fernández R, et al. Posicionamiento de la Sociedad Latinoamericana de Disfagia para el manejo de la disfagia orofaríngea y esofágica durante la pandemia COVID-19. Rev Gastroenterol Mex. 2021;87(1):63-79.
14 ASHA: American Speech-Language-Hearing Association. ASHA Guidance for SLPs on Aerosol Generating Procedures. Rockville: ASHA; 2020.
15 Zaga CJ, Pandian V, Brodsky MB, Wallace S, Cameron TS, Chao C, et al. Speech-Language Pathology Guidance for Tracheostomy During the COVID-19 Pandemic: an international multidisciplinary perspective. Am J Speech Lang Pathol. 2020;29(3):1320-34.
16 Medeiros GCD, Sassi FC, Silva CL, Andrade CRFD. Critérios para decanulação da traqueostomia: revisão de literatura. CoDAS. 2019;31(6):e20180228.
17 EBSERH: Empresa Brasileira de Serviços Hospitalares. Procedimento Operacional Padrão da Unidade Multiprofissional - Fonoaudiologia. Versão 2. Emissão. Santa Maria: EBSERH; 2022.
18 Padovani AR, Moraes DP, Mangili LD, Furquim de Andrade CR. Protocolo Fonoaudiológico de Avaliação do Risco para Disfagia (PARD). Rev Soc Bras Fonoaudiol. 2007;12(3):199-205.
19 Crary MA, Mann GDC, Groher ME. Initial Psychometric Assessment of a Functional Oral Intake Scale for Dysphagia in Stroke Patients. Arch Phys Med Rehabil. 2005;86(8):1516-20.
20 Tornari C, Surda P, Takhar A, Amin N, Dinham A, Harding R, et al. Tracheostomy, ventilatory wean, and decannulation in COVID-19 patients. Eur Arch Otorhinolaryngol. 2021 Maio;278(5):1595-604.
21 Ten-Caten F, Gonzalez-Dias P, Castro Í, Ogava RLT, Giddaluru J, Silva JCS, et al. In-depth analysis of laboratory parameters reveals the interplay between sex, age, and systemic inflammation in individuals with COVID-19. Int J Infect Dis. 2021 Abr;105:579-87.
22 Fabião J, Sassi B, Pedrollo EF, Gerchman F, Kramer CK, Leitão CB, et al. Why do men have worse COVID-19-related outcomes? A systematic review and meta-analysis with sex adjusted for age. Braz J Med Biol Res. 2022 Fev 16;55:e11711.
23 Clayton NA, Walker E, Freemane-Sanderson A. Clinical profile and recovery pattern of dysphagia in the COVID-19 patient: A prospective observational cohort within NSW. Aust Crit Care. 2023 Mar;36(2):262-8.
24 Rocha LFI, Motter AA. Correlação entre a obesidade e o COVID-19: revisão integrativa. ASSOBRAFIR Ciênc. 2021;12:e43015.
25 Archer SK, Iezzi CM, Gilpin L. Swallowing and voice outcomes in patients hospitalized with COVID-19: an observational cohort study. Arch Phys Med Rehabil. 2021;102(6):1084-90.
26 Schultz MJ, Teng MS, Brenner MJ. Timing of tracheostomy for patients with COVID-19 in the ICU-setting precedent in unprecedented times. JAMA Otolaryngol Head Neck Surg. Oct 146(10):887-8.
27 Cavalli E, Belfiori G, Molinari G, Peghetti A, Zanoni A, Chinelli E. Does a decannulation protocol exist in COVID-19 patients? The importance of working in a multiprofessional team. Discov Health Systems. 2023;2(1):14.
28 Osbeck Sandblom H, Dotevall H, Svennerholm K, Tuomi L, Finizia C. Characterization of dysphagia and laryngeal findings in COVID-19 patients treated in the ICU-An observational clinical study. PLoS One. 2021 Jun 4;16(6):e0252347.
29 Dawson C, Capewell R, Ellis S, Matthews S, Adamson S, Wood M, et al. Dysphagia presentation and management following COVID-19: an acute care tertiary centre experience. J Laryngol Otol. 2020 Nov;10(11):1-6.
30 Dziewas R, Warnecke T, Zürcher P, Schefold JC. Dysphagia in COVID-19 -multilevel damage to the swallowing network? Eur J Neurol. 2020 Set;27(9):e46-7.
Submetido em:
31/08/2023
Aceito em:
06/01/2024
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