The efficacy and effectiveness of early interventions for swallowing to improve swallowing outcomes in patients in the ICU with dysphagia: A Systematic Review

Abstract

Background Oropharyngeal dysphagia is observed frequently in patients in intensive care units (ICUs). Τhere are a number of risk factors that might lead to the development of dysphagia and the consequences can affect the physiology, functional and psychological aspects of the patient’s life. While early intervention has proven to improve the overall medical status of the patients, few studies have examined the impact of early dysphagia intervention in patients in critical care.

Aims The primary aim of this review is to determine the efficacy and effectiveness of early intervention compared to late intervention for improving the swallowing outcomes of patients in critical care. As swallowing outcomes, we refer to the time for oral intake resumption, the improvement of oral intake, the change in respiratory status, the length of ICU stay, the change in the levels of secretions, and the appearance of any adverse events.

Methods We searched in 10 electronic databases for published and unpublished randomised control trials (RCTs), quasi-experimental trials, observational studies and systematic reviews and bibliography lists of included studies to March 2022. Two independent viewers evaluated articles for eligibility, and conflicts were resolved by consensus. The primary reviewer conducted data extraction, quality assessment, and bias risk. The risk of bias was assessed with the Cochrane Collaboration's Risk of Bias (RoB) 2 tool for RCTs and the checklist by Joanna Briggs Institute Critical Appraisal tools for cohort studies. Meta-analysis was not performed due to incomparable results; therefore, the findings were described narratively. Preferred Reporting Items for Systematic Research and MetaAnalyses (PRISMA) criteria were used to perform this review. Results The search identified n=6 studies eligible for the inclusion criteria of this review. Of these four studies were RCTs and two studies were observational. The studies were divided into two groups based on the intervention they applied, three studiesapplied only rehabilitation techniques and three included apart from rehabilitation exercises, compensatory strategies, and/or diet modification and/or usual care. The appropriate timing of the intervention was unable to be defined due to insufficient data. Dysphagia intervention presented small improvement in functional oral intake, in respiratory conditions, but no significant difference in the time to return to oral intake, and in the length of ICU stay in days. The risk of bias in the included studies was found to significantly impacts the quality of the findings.

Conclusion A firm conclusion was unable to be made due to the high heterogeneity of the included studies and lack of quality evidence. There is a necessity for further research regarding early interventions and their timing for improving swallowing outcomes in ICU patients.