Swallowing Rehabilitation of Dysphagic Tracheostomized Patients Under Mechanical Ventilation at ICU

NCT ID: NCT01496924

Last Updated: 2011-12-21

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

PHASE2

Total Enrollment

30 participants

Study Classification

INTERVENTIONAL

Study Start Date

2008-01-31

Study Completion Date

2012-06-30

Brief Summary

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There is an association between increased risk of oropharyngeal dysphagia and artificial ventilation through endotracheal tube, followed by tracheostomy. The aim of the present study is to analyze the outcomes of an early swallowing rehabilitation program of dysphagic tracheostomized patients under mechanical ventilation at the intensive care unit.

Detailed Description

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This prospective study will be conduct in seven intensive care units of the university public hospital Inclusion criteria are: patients under mechanical ventilation and tracheostomy for at least 48 hours, appropriate level of consciousness (Glasgow coma scale ≥ 11), hemodynamic stability without need for vasoactive drugs; minimum mechanical ventilation parameters characterized by: pressure support ventilation (PSV) ≤ 20 cm H2O, positive end-expiratory pressure (PEEP) ≤ 8 cm H2O, fraction of inspired oxygen (FiO2) ≤ 50 and respiratory rate ≤ 30 inspirations per minute. Primary exclusion criteria are: patients who underwent surgery with resection of structures of oral cavity, pharynx, larynx and/or esophagus; nasal fracture or skull base fracture preventing otorhinolaryngological exam; possible surgical treatment after ICU admission with no reasonable time for carrying out the planned intervention; degenerative diseases characterized by outbreaks and remissions; past history of oropharyngeal dysphagia, previous speech therapy, excessive amount of thick tracheal secretion requiring frequent tracheal suctioning, end-stage of chronic obstructive pulmonary disease, tracheoesophageal fistula, allergy to dyes, and low survival expectancy.

The study consist of three stages: (1) sample selection with a test of the speaking valve and initial assessments, (2) swallowing rehabilitation and (3) post-treatment reassessments. Clinical assessments will be performed by speech-pathologists and otorhinolaryngologists with patients under mechanical ventilation. Subsequently, patients with dysphagia will be submitted to a rehabilitation program with standardized intervention, followed by a new assessment of abnormalities. The efficacy of swallowing treatment will be assessed by comparing the scores before and after treatment. Paired Student's test or Wilcoxon-test will be applied, according to data distribution. Categorical variables will be expressed as number and percentage and analyzed through McNemar test. All p-values will be two-sided and a p-value \< 0.05 considered statistically significant.

Conditions

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Dysphagia

Keywords

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Dysphagia Intensive care units Deglutition disorders Rehabilitation

Study Design

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Allocation Method

NA

Intervention Model

SINGLE_GROUP

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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speech therapy group

All dysphagic patients will be submitted to speech therapy

Group Type OTHER

speech therapy

Intervention Type OTHER

A single oral-motor technique will be used in a 10-times series intercalated with rest. Swallowing training techniques comprised indirect therapy (swallowing of saliva) and direct therapy (swallowing of food).

Interventions

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speech therapy

A single oral-motor technique will be used in a 10-times series intercalated with rest. Swallowing training techniques comprised indirect therapy (swallowing of saliva) and direct therapy (swallowing of food).

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* admission in an ICU
* mechanical ventilation and tracheostomy for at least 48 hours
* appropriate level of consciousness (Glasgow coma scale ≥ 11)
* hemodynamic stability without need for vasoactive drugs
* minimum mechanical ventilation parameters characterized by pressure support ventilation (PSV) ≤ 20 cm H2O, positive end-expiratory pressure (PEEP) ≤ 8 cm H2O, fraction of inspired oxygen (FiO2) ≤ 50 and respiratory rate ≤ 30 inspirations per minute.

Exclusion Criteria

* surgery with resection of structures of oral cavity, pharynx, larynx and/or esophagus
* nasal fracture or skull base fracture preventing otorhinolaryngological exam
* possible surgical treatment after ICU admission with no reasonable time for carrying out the planned intervention
* degenerative diseases characterized by outbreaks and remissions
* past history of oropharyngeal dysphagia
* previous speech therapy
* excessive amount of thick tracheal secretion requiring frequent tracheal suctioning
* end-stage of chronic obstructive pulmonary disease
* tracheoesophageal fistula
* allergy to dyes
* low survival expectancy.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Federal University of São Paulo

OTHER

Sponsor Role lead

Responsible Party

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Katia Alonso Rodrigues

principal investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Katia Alonso, PHD

Role: PRINCIPAL_INVESTIGATOR

Federal University of São Paulo

Locations

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Intensive Care Unit - Hospital Sao Paulo

São Paulo, São Paulo, Brazil

Site Status RECRUITING

Countries

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Brazil

Central Contacts

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Katia Alonso, PHD

Role: CONTACT

Phone: 55 11 92119858

Email: [email protected]

Maria Inez Goncalves, PHD

Role: CONTACT

Phone: 55 11 55497500

Facility Contacts

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Katia Alonso, PHD

Role: primary

Other Identifiers

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CEP1802/06

Identifier Type: -

Identifier Source: org_study_id