Objective
Delirium is associated with prolonged intensive care unit (ICU) stay and higher mortality. Therefore, the recognition of delirium is important. We investigated whether intensivists and ICU ...nurses could clinically identify the presence of delirium in ICU patients during daily care.
Methods
All ICU patients in a 3-month period who stayed for more than 48 h were screened daily for delirium by attending intensivists and ICU nurses. Patients were screened independently for delirium by a trained group of ICU nurses who were not involved in the daily care of the patients under study. The Confusion Assessment Method for the ICU (CAM-ICU) was used as a validated screening instrument for delirium. Values are expressed as median and interquartile range (IQR; P25–P75).
Results
During the study period, 46 patients (30 male, 16 female), median age 73 years (IQR = 64–80), with an ICU stay of 6 days (range 4–11) were evaluated. CAM-ICU scores were obtained during 425 patient days. Considering the CAM-ICU as the reference standard, delirium occurred in 50% of the patients with a duration of 3 days (range 1–9). Days with delirium were poorly recognized by doctors (sensitivity 28.0%; specificity 100%) and ICU nurses (sensitivity 34.8%; specificity 98.3%). Recognition did not differ between hypoactive or active status of the patients involved.
Conclusion
Delirium is severely under recognized in the ICU by intensivists and ICU nurses in daily care. More attention should be paid to the implementation of a validated delirium-screening instrument during daily ICU care.
Background
Information on the prevalence of dysphagia in a generalized hospitalized population is lacking. We aimed to gain information on the recognition of dysphagia by nursing staff and the ...swallow characteristics of patients with and without dysphagia.
Methods
The Eating Assessment Tool (EAT‐10) and the volume‐viscosity water swallow test (VVST) were utilized to assess the prevalence of dysphagia in a generalized hospitalized population in 2 centers (N = 205). Presence of dysphagia was defined as having either an EAT‐10 score of 2 or higher or having a positive VVST. Nursing staff recognition of dysphagia was assessed. In addition, the swallow characteristics were assessed both clinically and using submandibular surface electromyographic (SEMG) values of the participants.
Key Results
The prevalence of dysphagia in the hospitalized patients was 30.7%. Nursing staff did hardly ever recognize the presence of dysphagia. Concerning the swallow characteristics, patients with dysphagia demonstrated an increase in the SEMG peak levels of the swallowing actions over the course of an exercise from 103 to 110 μV (P = .05), whereas patients without dysphagia did not demonstrate this effect.
Conclusions & Inferences
Training should be conducted for nursing staff to improve awareness and recognition of dysphagia and thus prevent dysphagia complications. Dysphagia is a large burden on the hospitalized population, and further research should be conducted into the specifics.
Prevalence of dysphagia in hospitalized patients and awareness by nurses in the general wards.
Dysphagia occurs commonly in the intensive care unit (ICU). Despite the clinical relevance, there is little worldwide research on prevention, assessment, evaluation, and/or treatment of dysphagia for ...ICU patients. We aimed to gain insight into this international knowledge gap. We conducted a multi-center, international online cross-sectional survey of adult ICUs. Local survey distribution champions were recruited through professional and personal networks. The survey was administered from November 2017 to June 2019 with three emails and a final telephone reminder. Responses were received from 746 ICUs (26 countries). In patients intubated > 48 h, 17% expected a > 50% chance that dysphagia would develop. This proportion increased to 43% in patients intubated > 7 days, and to 52% in tracheotomized patients. Speech-language pathologist (SLP) consultation was available in 66% of ICUs, only 4% reported a dedicated SLP. Although 66% considered a routine post-extubation dysphagia protocol important, most (67%) did not have a protocol. Few ICUs routinely assessed for dysphagia after 48 h of intubation (30%) or tracheostomy (41%). A large proportion (46%) used water swallow screening tests to determine aspiration, few (8%) used instrumental assessments (i.e., flexible endoscopic evaluation of swallowing). Swallowing exercises were used for dysphagia management by 30% of ICUs. There seems to be limited awareness among ICU practitioners that patients are at risk of dysphagia, particularly as ventilation persists, protocols, routine assessment, and instrumental assessments are generally not used. We recommend the development of a research agenda to increase the quality of evidence and ameliorate the implementation of evidence-based dysphagia protocols by dedicated SLPs.
Postextubation dysphagia may impose a substantial burden on intensive care unit patients and healthcare systems. Approximately 517,000 patients survive mechanical ventilation during critical care ...annually. Reports of postextubation dysphagia prevalence are highly variable ranging between 3% and 93%. Of great concern is aspiration leading to the development of aspiration pneumonia when patients resume oral feeding. Screening for aspiration with a water swallow test has been reported to be positive for 12% of patients in the intensive care unit after extubation. This review aims to increase awareness of postextubation dysphagia and provide an updated overview of the current knowledge regarding prevalence, pathophysiology, diagnostic modalities, and treatment options.
PDF
