Nursing Interventions in Adult Patients With Oropharyngeal Dysphagia a Systematic Review

• Protocol
• Open Access
• Published: 20 November 2019

Interventions for oropharyngeal dysphagia in acute and disquisitional intendance: a protocol for a systematic review and meta-analysis

• Jennifer Mc Gaugheyⁱⁱ,
• Richard Fallis³,
• Daniel F. McAuley^one,
• Margaret Walshe⁴ &
• Bronagh Blackwood^one

Systematic Reviews book 8, Article number:283 (2019) Cite this article

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Abstract

Background

Oropharyngeal dysphagia or swallowing difficulties are common in acute care and critical care, affecting 47% of hospitalised delicate elderly, 50% of astute stroke patients and approximately 62% of critically ill patients who have been intubated and mechanically ventilated for prolonged periods. Complications of dysphagia include aspiration leading to chest infection and pneumonia, malnutrition, increased length of hospital stay and re-access to infirmary. To date, most dysphagia interventions in acute care have been tested with acute stroke populations. While intervention studies in disquisitional care have been emerging since 2015, they are limited and and then in that location is much to learn well-nigh the type, the delivery and the intensity of treatments in this setting to inform future clinical trials. The aim of this systematic review is to summarise the evidence regarding the human relationship between dysphagia interventions and clinically important patient outcomes in astute and disquisitional care settings.

Methods

Nosotros will search MEDLINE, EMBASE, Central, Spider web of Science, CINAHL and clinical trial registries from inception to the present. Nosotros will include studies conducted with adults in acute care settings such as astute infirmary wards or units or intensive intendance units and critical intendance settings. Studies will be restricted to randomised controlled trials and quasi-randomised controlled trials comparison a new dysphagia intervention with usual intendance or another intervention. The main outcomes that will be collected include length of time taken to return to oral intake, change in incidence of aspiration and pneumonia, nutritional status, length of hospital stay and quality of life. Key intervention components such as delivery, intensity, acceptability, fidelity and agin events associated with such interventions will be collected to inform future clinical trials. Ii independent reviewers will assess articles for eligibility, data extraction and quality appraisal. A meta-analysis will be conducted as appropriate.

Discussion

No systematic review has attempted to summarise the testify for oropharyngeal dysphagia interventions in astute and critical care. Results of the proposed systematic review will inform practice and the design of future clinical trials.

Systematic review registration

PROSPERO CRD 42018116849 (http://www.crd.york.air conditioning.great britain/PROSPERO/)

Peer Review reports

Background

Clarification of the condition

In astute and critical care settings, a patient's medical, neurological, respiratory and cerebral status can modify from day to day thus impacting on swallow function. This provides a challenge for professionals seeking to intensively remediate swallowing difficulties. Post-obit acute stroke, dysphagia is in part caused past a loss of functional connectivity within the neural swallowing network. Yet, neuroplasticity results in the undamaged hemisphere compensating for lost functions from lesions in the affected hemisphere, with more than half of these patients recovering eat office in the first 3 weeks post-stroke [ane]. Other individuals with dysphagia who may present in these settings include patients with traumatic injuries to brain or cervical spine, patients with progressive symptoms in line with their neurodegenerative or neuromuscular status necessitating an intensive care or acute care stay and frail elderly patients hospitalised for acute illness and presenting with sarcopenia, a loss of skeletal muscle mass and role due to crumbling [2,3,4]. Dysphagia is the consequence of such loss of function in the skeletal muscles of swallowing.

Inside critical care settings, skeletal muscle dysfunction is mutual particularly with patients who have been intubated and mechanically ventilated for prolonged periods, accept a tracheostomy or have intensive intendance acquired weakness. During intubation, the oral, pharyngeal and laryngeal muscles of swallowing are immobilised. This has been shown to alter the mechanoreceptors and chemoreceptors of pharyngeal and laryngeal mucosae, while also causing musculus atrophy and loss of proprioception [v, 6]. Reduced pharyngeal and laryngeal sensation places patients at higher risk of silently aspirating food and fluids into the upper airway (i.e. no cough response when aspiration occurs). These patients nowadays with tongue weakness and take longer to swallow when compared with historic period matched controls, suggesting swallow-related muscle weakness [7, 8]. Recent studies have found skeletal musculus wasting and weakness occur early on and frequently during mechanical ventilation and after the onset of critical illness [9,10,11].

Description of the intervention

Dysphagia interventions involve approaches that may be compensatory or rehabilitative in nature. Compensatory approaches aim to alter the flow of a food or liquid bolus past modifying their consistency or past repositioning the head, neck or torso before the onset of swallowing, a temporary measure to facilitate safer eating and drinking. Directly swallowing rehabilitation involves swallowing exercises that focus on muscle strength, resistance preparation or skill training such equally tongue or respiratory musculus strength training and swallowing manouevres. Other direct rehabilitative methods include peripheral sensory stimulation such as thermal tactile stimulation, electrotherapies and non-invasive brain stimulation.

To appointment, the prove base of operations for such dysphagia interventions in acute care settings has tended to focus predominantly on astute stroke patients merely some studies besides target brain injury, head and neck cancer and frail elderly populations [12,13,14,15]. Astute stroke populations likewise dominate the evidence base for dysphagia handling in intensive care. Pharyngeal electrical stimulation has been tested in this population while tracheostomised, past placing a small catheter that contains electrodes in the pharynx to allow stimulation of nearby structures. Positive outcomes for length of time to decannulation were reported but no differences noted in outcomes addressing length of stay or render to oral intake [xvi]. These patients nowadays with complex swallowing difficulties; the key swallowing network is disrupted due to the brain lesion, but as a event of intensive intendance treatment and its complications, harm to different peripheral structures is also possible.

Moreover, any evidence for the efficacy and effectiveness of dysphagia interventions in non-stroke intensive care populations is limited at present. Electrotherapies are the mainstay treatment being used in research. However, the high cost associated with some of these therapies preclude them from utilise in routine clinical do. An unpublished 2018 clinical trial in an acute respiratory distress syndrome population enrolled patients that were predicted to require more than than 4 days intubation [17]. They commenced neuromuscular electrical stimulation shortly after existence intubated, and treatment continued until patients were extubated. The findings from this trial are forthcoming. Given that critically ill patients are weak with vulnerable respiratory systems, a passive treatment similar electrotherapy has been constitute to be both deliverable and condom in this setting. However, in that location are other interventions that could plausibly be tested in intensive care.

One such intervention is respiratory musculus strength grooming. Mechanical ventilation rapidly causes atrophy of the diaphragm muscles, increasing the chance of weaning failure. Force training the inspiratory muscles has emerged as a possible handling for these patients, with studies reporting improved maximal inspiratory pressure and improved weaning outcomes post-treatment [xviii, 19]. The expiratory muscles, including the submental muscles used during swallowing, also cloudburst during intubation and mechanical ventilation. Force training these muscles was primarily done by physiotherapy to ameliorate cough forcefulness in respiratory patients. However, the last decade has seen this grooming technique existence used as a dysphagia intervention for patients with Parkinson'southward affliction or stroke [20, 21]. Increased musculature force activation in the expiratory muscles results in improvements in eat biomechanics, coughing strength and aspiration rates.

How the intervention might work

Swallowing difficulties can arise from both disruptions to the central neural swallowing network, every bit seen in astute stroke patients, or due to other mechanisms in intensive intendance causing sensory and motor impairments, such every bit critical illness polyneuropathy. The principle of neuroplasticity indicates that if a neural substrate is not biologically agile, its function can degrade. In swallowing, disuse of this mechanism may diminish its cortical representation and pose a threat to functional recovery in the long term [22]. The aim of straight swallowing rehabilitation is to accelerate this process of plasticity. Studies accept shown that pushing whatsoever muscular system in an intense and persistent way will bring about changes in neural innervation and patterns of motion [23]. Information technology is also thought that some dysphagia interventions may improve swallowing past enhancing the sensory bulldoze to the encephalon and causing increased activeness in motor swallowing areas [24].

Why it is of import to do this review?

The management options for patients with dysphagia in acute care and critical intendance are limited. This is due historically to an under recognition of dysphagia and its clan with increased morbidity and mortality in these settings. Studies are now emerging in these settings but are limited, with small sample sizes used and variable results when similar outcomes are addressed [13,14,15,16,17,18, 25]. There is still a lot to learn about intervention type, mode of delivery and optimal handling intensity and timing to ensure effectiveness in intensive intendance settings. Oftentimes, limited information is provided in studies on protocol adherence and how acceptable an intervention is for participants and trainers, so, it is difficult to know if interventions are genuinely ineffective or have failed to exist fully implemented. To engagement, no systematic review has looked at both the effectiveness of dysphagia interventions in astute and disquisitional care or described in detail the primal components of interventions tested in these settings to inform time to come clinical trials in intensive intendance.

Objectives

1. one.

   To make up one's mind the effectiveness of dysphagia interventions in improving oral intake and reducing aspiration for adults in acute and critical care.

2. 2.

   To identify key intervention components such as delivery, dose, intensity, timing and fidelity to inform future clinical trials of dysphagia interventions in intensive intendance.

Methods

Types of studies

We will consider intervention studies using randomised and quasi-randomised clinical trial methodology only. All clinical trials published from inception in whatever linguistic communication will be included in this review. Relevant randomised controlled trials are classified as all trials that involve at least one group receiving a specific dysphagia intervention aimed at improving or eliminating dysphagia and 1 grouping receiving a traditional dysphagia intervention, a placebo or usual care. Treatments administered had to be allocated by a random process. We volition classify as quasi-randomised clinical trials all trials of like design where the method of allocation to the treatment grouping is known simply is not considered strictly random (i.eastward. alternate allocation by day or appointment of birth or medical record number). Nosotros will but include cross-over trials in the review if the data from the first intervention period were reported and nosotros will only use this data.

Types of participants

We volition include only studies conducted in acute care settings (i.e. studies carried out in whatsoever acute hospital ward or unit including acute medical, respiratory, surgical, neurological or critical intendance/intensive care units within an astute infirmary or third hospital setting). Adult participants, 18 years or older of any sexual practice, ethnicity, phase of illness and degree of medical, respiratory, neurological or surgical severity will be included. We will impose no limitations regarding the length of intubation and ventilation fourth dimension or the presence of a tracheostomy tube in disquisitional intendance study participants.

Exclusion criteria

Nosotros will exclude cluster-randomised controlled trials as we are not considering the group effect of a dysphagia intervention. We will exclude treatment studies carried out in outpatient settings, rehabilitation units, residential care homes (i.east. nursing homes) or long-term care facilities.

Types of interventions

Interventions

Nosotros volition consider any dysphagia intervention delivered alone or in combination with a traditional swallowing rehabilitation programme (usual care) in included studies. Such interventions may include:

• Electrotherapeutic interventions

• Respiratory muscle training

• Sensory-motor interventions such as thermal-tactile stimulation

• Lingual strength training

• Consume skill training using biofeedback

• Non-invasive encephalon stimulation

• An isolated swallowing manouevre or swallowing practise

Comparisons

The comparison group in these studies volition receive a traditional swallowing rehabilitation plan (sometimes termed 'usual care' in studies) or placebo intervention. Traditional rehabilitation or usual care in dysphagia management can vary widely across studies, ranging from diet/fluid modification alone to a combination of this approach with swallowing manouevres, swallowing exercises, head and cervix postures or environmental modifications. A placebo in dysphagia studies by and large refers to sham stimulation in neurostimulation studies or use of a sham training device in respiratory musculus force preparation studies.

Types of outcome measures

Primary outcomes

1. i.

   Time taken in days from onset of dysphagia intervention for participants to return to a functional oral nutrition equally determined past an advisable decision tool such as the Functional Oral Intake Scale [26] or similar rating scale.

2. 2.

   Change in incidence of aspiration as rated past videofluoroscopy or endoscopic evaluation of swallowing using Penetration Aspiration Calibration [27] at relevant short- and long-term time points, as reported by the authors.

Secondary outcomes

1. 1.

   Change in secretion severity as rated by endoscopic evaluation using a validated scale such as the New Zealand Secretion Scale [28] at relevant brusque- and long-term time points, as reported by the authors.

2. 2.

   Modify in residue severity equally rated by videofluoroscopy or endoscopy using a validated scale such as the Yale Residue Scale [29] at relevant short- and long-term time points, every bit reported past the authors.

3. 3.

   Nutritional status as measured by a validated nutritional screening tool such as the Malnutrition Universal Screening Tool [30] or similar every bit described by authors, to assess potential negative consequences of dysphagia (i.e. malnutrition, dehydration, weight loss).

4. 4.

   Agin events associated with intervention such as patient discomfort, deterioration in swallow function or physiological parameter as per instrumental assessment.

5. 5.

   Incidence of pneumonia as measured by the presence of a new or worsening chest X-ray or computed tomography (CT) change consequent with pneumonia in the context of at to the lowest degree two of the post-obit: temperature < 35 °C or > 38 °C; a white cell count of < iv × 10⁹/Fifty or > eleven × 10⁹/Fifty; or purulent tracheal secretions.

6. half dozen.

   Economic and resources costs equally measured past duration of hospital stay, number of staff and staff training cost required to deliver the intervention.

7. 7.

   Quality of life as measured by validated dysphagia scales (e.g. Swallowing Quality of Life Scale [31] or Dysphagia Handicap Index [32]) at relevant curt- and long-term time points as reported by the authors.

Search strategy

Electronic searches

We will search the following databases for relevant studies from inception onwards with no language restrictions: CENTRAL, MEDLINE, EMBASE, Web of Science and CINAHL. Nosotros will also search the following trial registers: ClinicalTrials.gov (www.clinicaltrials.gov) and the Globe Health Organisation International Clinical Trials Registry Platform (world wide web.who.int/ictrp/en/). If we fail to retrieve any relevant trials from either of these registries, we will search additional registries [i.east. ISRCTN and UKCTG registries]. Nosotros will not impose language or other restrictions. Whatever non-English publications will exist translated by accessing translation services available from Queen'southward University Belfast Medical Library or accessing staff or doctoral/postdoctoral research students who are native speakers in the School of Medicine, Dentistry and Biomedical Sciences at Queen'due south University.

Key search terms (both MESH and keyword terms) will include the following: dysphagia, deglutition disorders, acute care, astute hospital, critical care, critical disease, swallowing rehabilitation, swallowing therapy. Our MEDLINE search strategy (Additional file ane) volition exist adjusted for searches in the other databases to be included in this review.

Data drove and assay

Choice of studies

Citations will be stored using the Covidence software (world wide web.covidence.org) and duplicates removed. Studies volition exist screened initially co-ordinate to the championship and abstract by ii authors independently, and those non meeting the criteria volition exist discarded. Disagreement will exist resolved by give-and-take and referral to a tertiary author if necessary. After this initial phase, the full text of all remaining studies will be reviewed past two authors independently for inclusion or exclusion in the final study. As before, disagreements will be resolved by discussion and referral to a 3rd author if necessary.

Data extraction and management

Nosotros will record general study information along with type of study, the context and organization of the written report setting, recruitment information, sample size and patient characteristics (including sexual activity, historic period, primary diagnosis, co-morbidities and severity of dysphagia at baseline). Primary and secondary outcomes will be recorded including the specific measurement, analysis metric, method of assemblage and time signal for each outcome, every bit per SPIRIT 2013 statement [33]. A full description of the intervention including mode of delivery, dose, intensity, timing and fidelity volition be extracted using the TIDieR checklist [34]. Afterwards piloting, this data will be extracted independently past two authors using a information extraction form (Additional file 2). Any discrepancies will exist resolved by involving a 3rd review author.

Assessment of run a risk of bias

A bias in the carry of a trial may misconstrue the design, execution, analysis or interpretation of the research [35]. In this review, the risk of bias in included studies will be independently assessed by two review authors using the domain-based evaluation recommended by the Cochrane Collaboration [36]. For each domain, we will assign a judgement regarding the risk of bias as 'loftier', 'low' or 'unclear'. The domains include:

1. one.

   Random sequence generation (low risk includes random methods such equally random number table, computer random number generator or coin toss)

2. two.

   Allotment darkening (low gamble includes central resource allotment or serially numbered, or sealed, opaque envelopes)

3. 3.

   Blinding of participants and personnel (considered depression risk if authors mentioned that participants and personnel were blinded to the intervention)

4. 4.

   Blinding of effect assessment (considered low risk if trial authors mentioned that outcome assessors were blinded to group allocation)

5. 5.

   Incomplete outcome information (considered depression risk if outcome information were completely addressed)

6. 6.

   Selective upshot reporting (considered depression risk if a protocol was available and pre-specified outcomes were reported accordingly, or in the absence of a protocol, if all expected outcomes were reported)

7. 7.

   Other biases such as trial non being registered, interventions beingness insufficiently well delivered or conflicts of interest such equally inappropriate funder influence

Any disagreements will be resolved by involving a third reviewer. We will construct a 'risk of bias' table to present the results within and across studies. We will employ the cess of risk of bias to perform sensitivity analyses based on methodological quality as necessary.

Data synthesis and assay

If sufficient trials are available and their populations and event measures are clinically like, we will carry out meta-analyses of primary and secondary outcomes. The following measures of handling outcome volition be used: risk ratio (RR) and 95% conviction interval (CI) for the assay of dichotomous outcomes, mean deviation (MD) or standardised mean differences (SMD) and 95% CI for continuous outcomes. Individual participants in each trial arm will comprise the unit of assay. We will just utilize data reported from the beginning intervention fourth dimension period in any cross-over trials included in this review. The comparison group volition receive either a placebo such every bit sham stimulation or standard care such as traditional swallowing exercises and/or diet modification.

If two or more than randomised controlled trials contribute data for an outcome, the data will be combined in a meta-analysis using Review Manager v.3 on an intention to treat basis if appropriate to practice and so [37]. We programme to pool results using RevMan software with a fixed-effect model and assess the results for heterogeneity. If there is substantial heterogeneity, we volition repeat the meta-analysis using a random-effects model. Where there are data from merely i study for an outcome, the results volition be reported narratively.

Assessment of heterogeneity

If the presence of statistical heterogeneity is indicated by poor overlap between confidence intervals across studies, the χ ² (chi-squared) test will exist used to measure out this statistic. The impact of such heterogeneity on the meta-analysis will be evaluated using the I ² statistic. This volition depict the percentage of the variability in outcome estimates that is due to differences between trials rather than sampling mistake (chance). A value of > fifty% implies substantial heterogeneity [38]. We will qualitatively appraise clinical heterogeneity by examining potential sources, such as the blazon of intervention in each trial and the type of participants enrolled. Quantitative exploration of any substantial heterogeneity will also be done via subgroup analysis.

Dealing with missing information

In the event that data are missing from reported trials, we will, where possible, contact trial authors to request access to this data for trials published in the last v years.

Assessment of reporting biases

We will place reporting biases (publication bias, time lag bias, duplicate publication bias, citation bias, language bias or outcome-reporting bias) and minimise reporting biases through a comprehensive search for studies, inclusion of unpublished studies and use of trial registries. If a sufficient number of studies is identified (n > 10), we will evaluate biases using funnel plot asymmetry testing. For continuous outcomes with intervention furnishings measured as mean differences, a test proposed by Egger et al. [39] may be used to test for funnel plot asymmetry: linear regression of intervention effect approximate against its standard fault, weighted past the inverse of the variance of the intervention issue estimate.

'Summary of findings' tabular array

A summary of findings tabular array will be included in the review as per the Cochrane Handbook guidelines [36]. This will include results for one population group; descriptions of the intervention and comparison intervention; clarification of all patient important outcomes, both desirable and undesirable; the number of participants and studies for each outcome; a measure out of the typical burden of these outcomes; summary of the intervention effect; and a measure of the quality of evidence, using the GRADE organization [xl].

The five Course considerations that volition exist used are written report limitations, consistency of event, imprecision, indirectness and publication bias. This approach will assign one of four grades to the quality of the prove: high, moderate, depression or very low.

Sensitivity analysis

If advisable, we will investigate the influence of bias on results past undertaking a sensitivity analysis of the chief outcomes excluding studies with a high hazard of bias.

Subgroup analysis

If sufficient studies are available, nosotros will undertake subgroup analysis to explore reasons behind heterogeneity that may be related to the following groups: astute intendance versus critical intendance populations, younger age groups (i.east. < 65 years) versus older age groups (>65 years) and types of dysphagia interventions.

Standards

Reporting will conform to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards [41] (Additional file three). This systematic review has been registered with PROSPERO, an international prospective annals of systematic reviews (http://www.crd.york.ac.uk/PROSPERO/).

Discussion

Oropharyngeal dysphagia is common in acute and critical care, affecting 47% of delicate elderly, l% of astute stroke and 62% of critically ill patients. Most clinical trials testing dysphagia interventions in these settings accept been with stroke populations, including a minor number completed in neurological intensive care with tracheostomised stroke patients. There even so remains much to learn about the blazon and appropriate intensity of treatments for other intensive intendance populations (east.yard. respiratory, cardiac, spinal and trauma).

Swallowing difficulties in intensive care can ascend from both central neural impairments, such as stroke and peripheral neural impairments such as critical illness polyneuropathy. During periods of intubation and mechanical ventilation, the muscles involved in swallowing are largely immobilised. Such disuse of the swallowing mechanism may diminish its cortical representation and delay functional recovery in the long term [22]. Straight swallowing rehabilitation aims to advance the process of neural plasticity, with studies showing that intense and persistent muscle training will bring almost changes in neural innervation and patterns of move [23].

This review will provide an overview of such dysphagia interventions in acute and critical intendance, informing clinical practitioners of current bear witness base and providing important information for hereafter trial design in intensive care. Novel to this review is the detailed analysis of key intervention components using the TIDieR checklist. This will yield valuable information most intervention delivery, intensity, timing and fidelity in studies, assuasive researchers to replicate and build on research findings. Such information may likewise accept implications for clinical guidelines and service delivery in these settings. This review will also comprehensively analyse and summarise outcomes. The use and variability of outcomes across studies will provide of import data for future trial design and the potential development of a core outcome ready for dysphagia intervention studies in intensive intendance.

Availability of information and materials

Non applicable.

Abbreviations

Central:

Cochrane Central Register of Controlled Trials

CINAHL:

Cumulative Alphabetize of Nursing and Allied Health Literature

EMBASE:

Excerpta medica database

GRADE:

Grading of Recommendations, Assessment, Evolution and Evaluation

ISRCTN:

International Standard Randomized Controlled Trials Number

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-analysis Standards SPIRIT

Standard Protocol Items: Recommendations for Interventional Trials

TIDieR:

Template for Intervention Clarification and Replication

UKCTG:

Uk Clinical Trials Gateway

References

1. Hamdy Due south, Aziz Q, Rothwell JC, Ability K, Singh KD, Nicolson DA. Recovery of swallowing afterward dysphagic stroke relates to functional reorganization in the intact motor cortex. Gastroenterology. 1998;115(v):1104–12.

   CAS  Article  Google Scholar

2. Wirth R, Dziewas R, Beck AM, Clavé P, Hamdy S, Heppner HJ, Langmore S, Leischker AH, Martino R, Pluschinski P, Rosler A, Shaker R, Warnecke T, Sieber C.C, Volkert D. Oropharyngeal dysphagia in older persons – from pathophysiology to acceptable intervention: a review and summary of an international skilful meeting. Clin Interven Aging, 2016; eleven: 180-208.

3. Maeda K, Akagi J. Sarcopenia is an independent risk factor of dysphagia in hospitalised older people. Geriatr Gerontolo Int. 2015;xvi:515–21.

   Article  Google Scholar

4. Muhle P, Wirth R, Glahn J, Dziewas R. Historic period related changes in swallowing physiology and pathophysiology. Nervenarzt. 2015;86(iv):440–51.

   CAS  Commodity  Google Scholar

5. de Larminat Five, Montravers P, Dureuil B, Desmont JM. Amending in swallowing reflex after extubation in intensive care unit patients. Crit Intendance Med. 1995;23(3):486–90.

   Article  Google Scholar

6. Barquist E, Brown M, Cohn Southward, Lundy D, Jackowski J. Postextubation fiberoptic endoscopic evaluation of swallowing afterward prolonged endotracheal intubation: a randomized, prospective trial. Crit Care Med. 2001;29:1710–three.

   CAS  Article  Google Scholar

7. Su H, Hsiaomm T, Ku S, Wang T, Lee J, Tzeng W, Huang G, Chen C. Natural language weakness and somatosensory disturbance post-obit oral endotracheal extubation. Dysphagia. 2015;30:188–95.

   Article  Google Scholar

8. Brodsky M, De I, Chilukuri One thousand, Huang M, Palmer J, Needham D. Coordination of pharyngeal and laryngeal swallowing events during single liquid swallows after oral endotracheal intubation for patients with astute respiratory distress syndrome. Dysphagia. 2018;33(6):768–77.

   Article  Google Scholar

9. Puthucheary Z, Rawal J, McPhail Thou. Acute skeletal muscle wasting in disquisitional affliction. J Am Med Assoc. 2013;310(15):1591–600.

   CAS  Article  Google Scholar

10. Demoule A, Jung B, Prodanovic H. Diaphragm dysfunction on admission to the intensive intendance unit. Prevalence, hazard factors and prognostic bear upon – a prospective study. Am J Resp Crit Care Med. 2013;188(2):213–ix.

    Article  Google Scholar

11. Dres M, Dube B, Mayaux J. Coexistence and impact of limb muscle and diaphragm weakness at time of liberation from mechanical ventilation in medical intensive care unit of measurement patients. Am J Resp Crit Care Med. 2017;195(1):57–66.

    Article  Google Scholar

12. Speyer R, Baijens Fifty, Heijnen K, Zwijnenberg I. Effects of therapy in oropharyngeal dysphagia past speech and linguistic communication therapists: a systematic review. Dysphagia. 2010;25(1):40–65.

    Article  Google Scholar

13. Beom J, Oh B, Choi Chiliad, Kim Due west, Song YJ, You DS, Kim SJ, Han TR. Effect of electrical stimulation of the suprahyoid muscles in brain-injured patients with dysphagia. Dysphagia. 2015;thirty:423–9.

    Article  Google Scholar

14. Kraaijenga S, van der Molen L, Jacobi I, Hamming-Vrieze O, Hilgers FJM, van den Breke MWM. Prospective clinical study on long-term swallowing function and phonation quality in advanced head and neck cancer patients treated with concurrent chemoradiotherapy and preventive swallowing exercises. Eur Curvation Oto Rhino Laryngol. 2015;272(11):3521–31.

    Article  Google Scholar

15. Ortega O, Rofes Fifty, Martin A, Arreola V, Lopez I, Clave P. A comparative study between two sensory stimulation strategies after two weeks treatment on older patients with oropharyngeal dysphagia. Dysphagia. 2016;31(5):706–16.

    Commodity  Google Scholar

16. Suntrup S, Marian J. Schroder. Electric pharyngeal stimulation for dysphagia in tracheostomised stroke patients: a randomised controlled trial. Inten Care Med. 2015;41(9):1629–37.

    CAS  Article  Google Scholar

17. Brodsky Thousand, Needham D. PReventing the EffectS of Intubation on DEglutition (PRESIDE). www.clinicaltrials.gov NCT02442102.

18. Martin Ad, Davenport PD, Franceschi Ac, Harman E. Apply of inspiratory muscle strength training to facilitate ventilator weaning: a serial of 10 consecutive patients. Chest. 2002;122:192–half dozen.

    Article  Google Scholar

19. Martin D, Smith BK, Davenport P, Harman Eastward, Gonzalez-Rothi RJ, Baz M, Layon J, Banner M, Caruso LJ, Deoghare H, Huang T, Gabrielli A. Inspiratory muscle strength preparation improves weaning outcome in failure to wean patients: a randomised trial. Crit Care. 2011;15:R84 http://ccforum.com/content/15/2/R84.

    Article  Google Scholar

20. Troche Chiliad, Okun G, Rosenbek J, Musson North, Fernandez H, Rodriguez R. Aspiration and swallowing in Parkinson affliction and rehabilitation with EMST. Neurology. 2010;75:1912–9.

    CAS  Article  Google Scholar

21. Park JS, Oh DH, Chang MY, Kim Troche M, Okun Thou, Rosenbek J, Musson N, Fernandez H, Rodriguez R. Aspiration and swallowing in Parkinson disease and rehabilitation with EMST. Neurology. 2010;75:1912–9.

    Commodity  Google Scholar

22. Robbins JA, Butler S, Daniels S, Gross RD, Langmore S, Lazarus CL, Martin-Harris B, McCabe D, Musson Northward, Rosenbek J. Swallowing and dysphagia rehabilitation: translating principles of neural plasticity into clinically oriented evidence. J Speech Lang Hear Res. 2008;51:276–300.

    Article  Google Scholar

23. Burkhead L, Sapienza C, Rosenbek JC. Force-grooming practice in dysphagia rehabilitation: principles, procedures and directions for future research. Dysphagia. 2007;22:251–65.

    Commodity  Google Scholar

24. Hamdy S, Rothwell J, Azizm Q. Long-term reorganisation of human motor cortex driven by short-term sensory stimulation. Nat Neurosci. 1998;1:64–viii.

    CAS  Article  Google Scholar

25. Hwang C, Choi Yard, Ko Y. Pre-emptive swallowing stimulation in long-term intubated patients. Clin Rehabil. 2007;21(1):41–6.

    Article  Google Scholar

26. Crary M, Carnaby-Isle of mann G, Groher M. Initial psychometric assessment of a functional oral intake scale for dysphagia in stroke patients. Arch Phys Med Rehabil. 2005;86:1516–20.

    Commodity  Google Scholar

27. Rosenbek J, Robbins J, Roecker E, Coyle JL, Wood JL. A penetration-aspiration scale. Dysphagia. 1996;11:93–eight.

    CAS  Commodity  Google Scholar

28. Miles A, Hunting A, McFarlane Chiliad, Caddy D. Predictive value of the New Zealand secretion scale for pneumonia. Dysphagia. 2018;33:115–22.

    Commodity  Google Scholar

29. Neubauer PD, Rademaker AW, Leder SB. The Yale Pharyngeal Residuum Severity Rating Scale: an anatomically defined and image-based tool. Dysphagia. 2015;30:521–8.

    Article  Google Scholar

30. Stratton RJ, Rex CL, Stroud MA, Jackson AA, Elia Thou. 'Malnutrition Universal Screening Tool' predicts mortality and length of hospital stay in acutely ill elderly. Br J Nutr. 2006;95:325–30.

    CAS  Commodity  Google Scholar

31. McHorney CA, Robbins JA, Lomax Grand, Rosenbek JK, Chignell G, Kramer AE, Bricker DE. The SWAL-QOL and SWAL Intendance outcomes tool for oropharyngeal dysphagia in adults: III Documentation of Reliability and Validity. Dysphagia. 2002;17:97–114.

    Article  Google Scholar

32. Silbergleit A, Schultz L, Jacobsen B, Beardsley T, Johnson A. The Dysphagia Handicap Index: Development and Validation. Dysphagia. 2012;27(ane):46–52.

    Article  Google Scholar

33. Chan A-W, Tetzlaff JM, Altman DG, Laupacis A, Gøtzsche PC, Krleža-Jerić K, Hróbjartsson A, Mann H, Dickersin K, Berlin J, Doré C, Parulekar Due west, Summerskill West, Groves T, Schulz K, Sox H, Rockhold FW, Rennie D, Moher D. SPIRIT 2013 Statement: defining standard protocol items for clinical trials. Ann Intern Med. 2013;158:200–7.

    Commodity  Google Scholar

34. Hoffman T, Glasziou P, Boutron I, Milne R, Perera R, Moher D, Altman D, Barbour V, Macdonald H, Johnston M, Lamb Southward, Dixon-Woods M, McCullough P, Wyatt J, Chan A, Michie S. Ameliorate reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. BMJ. 2014;348:g1687.

    Commodity  Google Scholar

35. Sackett DL. Bias in analytic enquiry. J Chronic Dis. 1979;32:51–63.

    CAS  Article  Google Scholar

36. Higgins, J.P.T., Light-green, Southward. (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. Cochrane Collab, 2011. Bachelor from www.cochrane-handbook.org.

37. Revman. The Nordic Cochrane Heart, The Cochrane Collaboration. Review Manager (RevMan) Version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration; 2012.

    Google Scholar

38. Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. Brit Med J. 2003;327(7414):557–60.

    Article  Google Scholar

39. Egger G, Smith GD, Schneider M, Minder C. Bias in meta-analysis detected past a simple, graphical test. BMJ. 1997;315:629–34.

    CAS  Article  Google Scholar

40. Balshem H, Helfand Yard, Schunemann H, Oxman Advert, Kunz R, Brozek J, Vist GE, Falck-Ytter Y, Meerpohl J, Norris S, Guyatt GH. GRADE guidelines: rating the quality of evidence. J Clin Epidemiol. 2011;64(iv):401–six.

    Article  Google Scholar

41. Shamseer L, Moher D, Clarke M, Ghersi D, Liberati A, Petticrew Yard, Shekelle P, Stewart Fifty, PRISMA-P Group. Preferred reporting items for systematic review and meta-assay protocols (PRISMA-P) 2015: elaboration and explanation. BMJ. 2015;349(jan02 1):g764.

    Article  Google Scholar

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Acknowledgements

The author SD would like to thank Mrs. Anamarie Magorrian, Oral communication and Language Therapy Assistant Manager, Adult Acute Services, Belfast Health and Social Care Trust, Northern Ireland, for fully supporting all preliminary work completed in clinical settings during pre-doctoral stage and supporting preparation for doctoral funding awarding.

Funding

This work is beingness conducted as function of a doctoral research fellowship awarded to SD and funded by the Health and Social Care Inquiry and Development Partition of the Public Wellness Agency in Northern Ireland, Great britain.

Author data

Affiliations

1. Wellcome-Wolfson Institute for Experimental Medicine, Schoolhouse of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, 97 Lisburn Route, Belfast, BT9 7BL, United kingdom

   Sallyanne Duncan, Daniel F. McAuley & Bronagh Blackwood

2. School of Nursing and Midwifery, Medical Biology Centre, Queen'due south University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, U.k.

   Jennifer Mc Gaughey

3. Queen's Academy Belfast Medical Library, Mullhouse Building, Mullhouse Road, Belfast, BT12 6DP, U.k.

   Richard Fallis

4. Section of Clinical Oral communication and Language Studies, Trinity College Dublin, Leinster St. Southward, Dublin ii, D02 KF66, Ireland

   Margaret Walshe

Contributions

SD, BB, DM and MW conceived the idea for the review. SD drafted this protocol under the supervision of BB, DM and MW. JMcG commented on drafts of the protocol. RF assisted SD with the development of a search strategy and completion of all electronic database and clinical trial registry searches. All authors read and approved the concluding manuscript.

Authors' information

SD is a PhD educatee at Queen's University, Belfast (QUB). RF is a medical librarian at QUB. JMcG is a lecturer in School of Nursing & Midwifery, QUB. DMcA and BB are Professors of Disquisitional Intendance Medicine, QUB. MW is a Professor of Clinical Speech and Language Studies at Trinity Higher Dublin.

Corresponding author

Correspondence to Sallyanne Duncan.

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The authors declare that they have no competing interests.

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Duncan, S., Gaughey, J.M., Fallis, R. et al. Interventions for oropharyngeal dysphagia in acute and critical intendance: a protocol for a systematic review and meta-analysis. Syst Rev 8, 283 (2019). https://doi.org/10.1186/s13643-019-1196-0

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• Received: 05 Feb 2019

• Accepted: 13 October 2019

• Published: twenty Nov 2019

• DOI : https://doi.org/10.1186/s13643-019-1196-0

Keywords

• Dysphagia
• Deglutition disorders
• Acute care
• Acute infirmary
• Critical intendance
• Intensive care
• Swallow interventions
• Swallow therapy

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