The Consequences of Critical Care on Swallowing
Presented by Martin B. Brodsky
Non-Financial: Martin Brodsky has no competing non-financial interests or relationships with regard to the content presented in this course.
Meet your instructor
Martin B. Brodsky
Dr. Martin Brodsky is the section head for speech-language pathology in the Department of Otolaryngology Head and Neck Surgery within the Integrated Surgical Institute at Cleveland Clinic and is an adjunct associate professor of physical medicine and rehabilitation and pulmonary and critical care medicine at Johns Hopkins…
Chapters & learning objectives
1. Aging and Health Care
You need to know where you’ve been (and where you are) to know where you’re going. Understanding that the impact of health care changes across the world, let alone your own backyard, will prepare you for the future. This brief introduction sheds new light on the ever-growing population of older adults and the demands they will place on younger generations. Specifically, this introduction describes the distribution of dysphagia research across the age spectrum.
2. Epidemiology of Intubation and Dysphagia in Critical Care
Fact: intubation with mechanical ventilation saves lives. But at what cost to the patient and the health care system? This chapter delves into the very real costs of critical care, whether the risk of adverse events, financial, mental/emotional, cognitive, and/or physical.
3. Swallowing and Endotracheal Intubation
Only a subset of patients who are critically ill will be intubated with mechanical ventilation. Although this routine procedure saves lives, it concurrently reduces quality of life, often long after the tube has been removed. This chapter introduces you to the aftermath that is post-extubation dysphagia.
4. Research Quality and Perspectives of Practice
Research is not perfect. In fact, every research article printed in a peer-reviewed publication has its shortcomings. Critical review is necessary to distinguish the merits of a body of evidence to determine the clinical application. This chapter critically reviews historical research on post-extubation dysphagia, but balances this much-biased literature with several contemporary studies that provide more well-controlled evidence while emphasizing clinical application.
5. Outcomes and Challenges
This chapter bases its discussion on 5-year longitudinal data on survivors’ symptoms of dysphagia after critical care and two illustrative cases studies and their videofluoroscopic swallow studies that took place while admitted to the intensive care unit. With real cases as a backdrop, clinicians are then provided tips and hints for successful intensive care unit (ICU) interactions, specifically with dysphagia in mind. Finally, patient, clinician, and medical care/system challenges are presented with practical hints to overcome some of the adversity clinicians face.
6. Final Thoughts and Discussion
Short and to-the-point, this chapter summarizes the barriers to the integration of post-ICU care, reminding clinicians that while we may think we know a lot about swallowing with respect to the populations of patients in critical care, in fact, we are only just beginning. Much more information is needed, especially in an aging world with reduced awareness of dysphagia in ICUs, virtually no rehabilitative treatments and few well-controlled studies. The course concludes with a discussion with Dr. Robert Miller from the University of Washington.
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