Background: Dysphagia and aspiration in intensive care unit patients with acute traumatic brain injury (TBI) is a frequent and potentially life-threatening problem. Risk factors for abnormal swallowing include: lower admission Glasgow Coma Scale (GCS), presence of a tracheostomy, and ventilation time longer than 2 weeks. In severe TBI patients the oral intake of food is also related to cognitive functioning. The purpose of the present study was to investigate the incidence swallowing disorders in intensive care unit TBI patients and its relationship with cognitive level. Method: We reviewed the courses of twenty-seven patients, mean age 32.1 years, with severe TBI (GCS within 24 hour between 3 and 8), ventilation time within 2 weeks, and tracheostomy admitted in intensive care unit. All subjects were undergone a clinical bedside swallow evaluation and, within 24 +/- 6 hours, fiberoptic endoscopic evaluation of swallowing (FEES). As cognitive responses we used the Rancho Los Amigos (RLA) levels. The medication takes was also investigated. Results: Ten (37%) of 27 subjects swallowed successfully and were able to take an oral diet: 7 subjects a soft diet, and 3 a regular diet. Seventeen of 27 (63%) subjects exhibited pharyngeal stage dysphagia with aspiration and were not permitted an oral based diet. Swallow rehabilitation treatment was given to patients recruited with dysphagia. At discharge to acute care 7 of 17 patients with dyspagia required nutritional supplement. There was significative correlation between the onset of oral feeling and cognitive state recovery time: RLA scores for patients with swallowed successfully was 3.3 (mean) (SD 0.9), while for patients with abnormal swallowing was 2.3 (mean) (DS 0.4). All patients regardless of the presence or absence of abnormal swallowing needed an RLA level IV at the initiation of oral feeding while an RLA level VI was needed for total oral feeding. Finally, the medication at normally therapeutic doses did not significantly affect the swallowing. Conclusions: Swallowing disorders and behavioral/cognitive skills are frequently present in patients with severe TBI and significantly affect oral intake of food. The impact of cognition is often non-appreciated within the medical community as significantly interfering with preventing oral intake. Instead our study confirms that when the cognitive status improves the patient frequently to starts eating earlier.

Swallowing disorders in brain injury: cognitive status impact

MASIERO, STEFANO;FERRARO, CLAUDIO;ORTOLANI, MARCO
2003

Abstract

Background: Dysphagia and aspiration in intensive care unit patients with acute traumatic brain injury (TBI) is a frequent and potentially life-threatening problem. Risk factors for abnormal swallowing include: lower admission Glasgow Coma Scale (GCS), presence of a tracheostomy, and ventilation time longer than 2 weeks. In severe TBI patients the oral intake of food is also related to cognitive functioning. The purpose of the present study was to investigate the incidence swallowing disorders in intensive care unit TBI patients and its relationship with cognitive level. Method: We reviewed the courses of twenty-seven patients, mean age 32.1 years, with severe TBI (GCS within 24 hour between 3 and 8), ventilation time within 2 weeks, and tracheostomy admitted in intensive care unit. All subjects were undergone a clinical bedside swallow evaluation and, within 24 +/- 6 hours, fiberoptic endoscopic evaluation of swallowing (FEES). As cognitive responses we used the Rancho Los Amigos (RLA) levels. The medication takes was also investigated. Results: Ten (37%) of 27 subjects swallowed successfully and were able to take an oral diet: 7 subjects a soft diet, and 3 a regular diet. Seventeen of 27 (63%) subjects exhibited pharyngeal stage dysphagia with aspiration and were not permitted an oral based diet. Swallow rehabilitation treatment was given to patients recruited with dysphagia. At discharge to acute care 7 of 17 patients with dyspagia required nutritional supplement. There was significative correlation between the onset of oral feeling and cognitive state recovery time: RLA scores for patients with swallowed successfully was 3.3 (mean) (SD 0.9), while for patients with abnormal swallowing was 2.3 (mean) (DS 0.4). All patients regardless of the presence or absence of abnormal swallowing needed an RLA level IV at the initiation of oral feeding while an RLA level VI was needed for total oral feeding. Finally, the medication at normally therapeutic doses did not significantly affect the swallowing. Conclusions: Swallowing disorders and behavioral/cognitive skills are frequently present in patients with severe TBI and significantly affect oral intake of food. The impact of cognition is often non-appreciated within the medical community as significantly interfering with preventing oral intake. Instead our study confirms that when the cognitive status improves the patient frequently to starts eating earlier.
2003
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11577/2470993
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