Original Article 193 https://doi.org/10.22491/2357-9730.

103060

Clinical findings of speech therapy swallowing

assessments in patients with oropharyngeal
dysphagia following orotracheal intubation

Paula Tasca Vizioli1, Fernanda Machado Balzan2, Sílvia Dornelles3,

Simone Augusta Finard4

ABSTRACT

Clin Biomed Res. 2020;40(4):196-205 Introduction: Endotracheal intubation has been associated with oropharyngeal
1 Hospital de Clínicas de Porto Alegre, dysphagia. The aim of this study was to identify the prevalence of oropharyngeal
Universidade Federal do Rio Grande dysphagia among patients in an intensive care unit (ICU) by comparing patients
do Sul. Porto Alegre, Rio Grande do requiring orotracheal intubation with those who did not undergo this procedure.
Sul, Brasil.

Methods: This is a cross-sectional study that analyzed the medical records of

2 Hospital de Clínicas de Porto Alegre, 681 patients admitted to the ICU of Hospital de Clínicas de Porto Alegre between
Universidade Federal do Rio Grande 2014 and 2017; inclusion criteria were patients aged 18 years and older who had been
do Sul. Porto Alegre, Rio Grande do assessed by the hospital’s Speech Therapy Service. Patients who had undergone
Sul, Brasil. tracheostomy, who had incomplete medical records or multiple speech-language
assessments were excluded.
3 Critical Adult Program at Hospital
de Clínicas de Porto Alegre, Results: A total of 380 patients were included in the statistical analysis: 97 (25.5%)
Universidade Federal do Rio Grande
had not undergone orotracheal intubation (Group 1), 229 (60.3%) had undergone
do Sul. Porto Alegre, Rio Grande do
orotracheal intubation once (Group 2), and 54 (14.2%) had undergone orotracheal
Sul, Brasil.
intubation on 2 or more occasions (Group 3). Regarding the Functional Oral
Intake Scale (FOIS), 61.1% of patients in Group 3 received a FOIS I classification
4 Critical Adult Program at Hospital (p = 0.020), whereas 16.5% of patients from Group 1 received a FOIS V. Concerning
de Clínicas de Porto Alegre,
their outcomes, 40.7% of patients in Group 3 died (p = 0.006), and 82.5% of patients
Universidade Federal do Rio Grande
in Group 1 were discharged from the ICU. Considering the severity of oropharyngeal
do Sul. Porto Alegre, Rio Grande do
Sul, Brasil.
dysphagia according to the Dysphagia Risk Evaluation Protocol (PARD), no
statistically significant association was observed between groups (p = 0.261).

Corresponding author:
Paula Tasca Vizioli
Conclusions: In this study, the prevalence of oropharyngeal dysphagia was higher
paulatvizioli@gmail.com in patients who had undergone orotracheal intubation in the ICU.
Hospital de Clínicas de Porto
Keywords: Dysphagia; Critical care; Artificial breathing; Intensive care unit; Intubation
Alegre, Universidade Federal do Rio
Grande do Sul
Rua Cesar Lombroso, 29,
apartamento 301
90430-120, Porto Alegre, RS, Brasil.

INTRODUCTION

Critically ill intensive care unit (ICU) patients present a variety of

factors that increase the risk of aspiration, such as a decreased level
of consciousness, excessive sedation and analgesia, a supine resting
position, and the insertion of trach, nasointestinal, or endotracheal tubes 1.
In the presence of one or more of these factors, oropharyngeal dysphagia
is a common complication that can occur due to neurological, psychogenic,
or mechanical impairment, with characteristics that vary from silent
to symptomatic. In symptomatic oropharyngeal dysphagia, patients may
complain of coughing, choking, or a wet-sounding voice; these signs and
symptoms are also frequently perceived by assisting staff or caregivers.
Silent aspiration may occur due to a lack of sensation and, thus, an absence
of complaints or protective reflexes, hampering the early detection of
this disorder2. Studies show that, in 44%–87% of cases, patients requiring
endotracheal tubes present varying degrees of dysphagia1,3.

196 ISSN 2357-9730 http://seer.ufrgs.br/hcpa

 Speech therapy in dysphagia following orotracheal intubation

Since it is an invasive procedure, orotracheal records were made available by the coordination of
intubation damages the mucosa of the oral cavity, the hospital’s Technology and Information Group.
pharynx, larynx, and trachea4. It is known that This study did not require an informed consent form,
endotracheal tubes, due to their abrasion effect on as no direct interventions were performed. Institutional
the mucosa, cause dysphagia and supraglottic edema terms for the use of data were signed and approved.
and decrease laryngeal sensitivity5. The swallowing We included information on patients of both
reflex is also compromised when there is damage sexes, aged over 18 years old, who were admitted
to the peripheral and bulbar innervation. Aspiration to the ICU between 2014 and 2017; these patients
resulting from dysphagia occurs in 14–56% of patients should have also undergone a clinical swallowing
who received mechanical ventilation for 48 hours assessment by the Speech Therapy Service.
or more6. Traumatic emergency intubations can Owing to the convenient sampling technique, no sample
cause abrasions and/or lacerations during placement size calculations were performed. Medical records
of the tube. The tube caliber and high cuff pressures containing information on tracheostomy placement,
can also result in higher impact injuries such as duplicate assessment requests, and evaluations at
paralyses and paralyses, which can alter the motor other hospital units, as well as those lacking necessary
patterns and sensitivity of affected structures7. data, were excluded from our analysis.
These injuries can happen during the orotracheal Data were collected considering the following
intubation period or permanently persist after intubation8. variables: sex, age, weight, height, body mass
Padovani and colleagues1 report that injuries can index (BMI), underlying disease, ICU diagnosis,
occur due to trauma during tube placement and also duration of endotracheal intubation, reintubation,
by agitation of the patient while intubated. Recovery number of extubations, ratio of reintubation,
from these injuries begins shortly after extubation, duration of second endotracheal intubation, tube
that is, with the removal of the tube9. size, and feeding pathway before speech therapy
Patients with dysphagia may present complications assessment. In addition, we collected data on the
such as impaired nutritional status, dehydration, first clinical speech therapy assessment regarding the
and pulmonary infections6. The rate of aspiration Functional Oral Intake Scale (FOIS)13, the degree of
pneumonia in these patients is high and the chance dysphagia according to the Dysphagia Risk Evaluation
of death is 3 times higher than that in patients Protocol (PARD)14, and vocal performance according
without dysphagia10. to the RASAT scale15. Information concerning oral
The need for intensive care of critically ill patients preparation, elevation of the larynx, wet-sounding
in the ICU requires joint and interprofessional work. voice, multiple swallows, cervical auscultation, throat
In these cases, the speech therapist acts in the early clearing, coughing, gagging, or changes in vital
detection of swallowing disorders in order to prevent signs was also collected. Finally, we extracted data
the occurrence of aspiration. Aspiration of food or regarding the gross outcome of the patient (hospital
secretions into the lower airways causes breathing discharge or death).
difficulties and increases patients’ length of stay. Quantitative variables were described by
When aspiration occurs, the patients’ general means and standard deviations (SDs), and
conditions may deteriorate, rendering them unstable categorical variables were reported by absolute and
and increasing the probability of death11,12. relative frequencies. We used a one-way analysis
The present study aims to identify the prevalence of variance (ANOVA) to compare means and a chi-
of oropharyngeal dysphagia in ICU patients by squared test with analysis of adjusted residuals when
comparing those without endotracheal tubes to those comparing proportions. A non-parametric test was
who received treatment with endotracheal tubes and used due to a non-normal sample distribution (Shapiro-
mechanical ventilation. Wilk statistical significance). Depending on the type
of variable, the one-way ANOVA test was performed.
The significance level was established at 5% (p < 0.05).
METHODS Statistical analyses were performed using the SPSS
software, version 20.0.
This was a cross-sectional study based on
the analysis of medical records of patients admitted
to the ICU at Hospital de Clínicas de Porto Alegre — RESULTS
an excellence center for the care of critically ill
adult patients — between 2014 and 2017; during their We analyzed a total of 681 medical records of adult
stay, patients were treated by the hospital’s Speech patients who were admitted to the ICU at Hospital
Therapy Service. Data collection only began after de Clínicas de Porto Alegre from 2014 to 2017.
approval by the Scientific Research Ethics Committee According to the inclusion criteria, 380 patients
of Hospital de Clínicas de Porto Alegre under CAAE were selected. These were separated into 3 groups:
No. 80602917.3.0000.5327. The patients’ medical Group 1 comprised 97 (25.5%) patients who did not

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 Vizioli et al.

require orotracheal intubation during their ICU stay; on whom reintubation had to be performed at any
Group 2 comprised 229 (60.3%) patients who had period of the ICU stay and not only patients on whom
an orotracheal tube insertion and were intubated attempts at extubation had failed.
for at least 48 hours; and Group 3 comprised The study flowchart is shown in Figure 1, with the
54 (14.2%) participants with 2 or more orotracheal sample description in Table 1. The average age of
tube insertions. the patients was 62.1 (SD = ± 15.4) in Group 1, 61.9
It is important to highlight that Group 3 (SD = ± 15.1) in Group 2, and 60.7 (SD = ± 14.9)
(≥ 2 orotracheal tube insertions) included patients in Group 3.

Population
n=681 pacients

Excluded:
- Pacients with tracheostomy n=111
- No assessment or incomplete data n=190

Included and Analyzed sample:

Pacients n=380

Group 2: Group 3:
Group 1:
One orotracheal Two or more
No mechanical
intubation orotracheal intubation
ventilation=97
n=229 n=54

Figure 1: Study follow-up flowchart.

198 Clin Biomed Res 2020;40(4) http://seer.ufrgs.br/hcpa

 Speech therapy in dysphagia following orotracheal intubation

Table 1: Sample.
Group 1 Group 2 Group 2
No mechanical 1 intubation ≥ 2 intubations p
ventilation n = 97 n = 229 n = 54
Sex, male – n (%) 55 (56.7) 133 (58.1) 26 (48.1) 0.415
Age – mean ± SD 62.6 ± 15.4 61.9 ± 15.1 60.7 ± 14.9 0.762
BMI – mean ± SD 26.5 ± 7.0 27.4 ± 8.6 25.3 ± 7.0 0.180
Duration of mechanical ventilation – md (25–75) - 5 (2–8) 4 (3–6)
ETT number – n (%) n=74 (100) n=26 (100) 0.669
≤7 5 (6.9) 1 (3.8)
7.5 8 (11) 1 (3.8)
≥8 60 (82.1) 21 (84.6)
Underlying disease – n (%) 0.105
Stroke 41 (42.3) 41 (17.9) 6 (11.1)
Heart failure 13 (13.4) 32 (14.0) 17 (31.5)
Neoplasms 7 (7.2) 35 (15.3) 6 (11.1)
Chronic obstructive pulmonary disease 4 (4.1) 19 (8.3) 5 (9.3)
HIV 2 (2.1) 9 (3.9) 6 (11.1)
Sepsis 1 (1.0) 11 (4.8) 3 (5.6)
Chronic kidney disease 2 (2.1) 4 (1.7) 4 (7.4)
Other 27 (27.8) 78 (34.1) 17 (31.5)
ICU diagnosis – n (%) 0.000
Stroke 43 (44.3)* 39 (17.0) 6 (11.1)
Neoplasms 4 (4.1) 30 (13.1)* 6 (11.1)
Heart failure 13 (13.4) 21 (9.2) 3 (5.6)
Acute respiratory failure 3 (3.1) 23 (10.0) 9 (16.7)*
Sepsis 4 (4.1) 7 (3.0) 4 (7.4)
Chronic kidney disease 0 (0.0) 3 (1.3) 5 (9.3)*
Guillain-Barré syndrome 4 (4.1)* 2 (0.9) 0 (0.0)
Other 26 (26.8) 104 (45.4)* 21 (38.9)
BMI: Body mass index; md: median; ETT: endotracheal tube; HIV: human immunodeficiency virus; ICU: intensive care unit. The one-way ANOVA
compared means between groups regarding age and BMI. The other variables were analyzed using the chi-squared test with adjusted residuals
at a significance level of 5%. *The statistical significance level was set at 5% after residual adjustments (p < 0.05).

We analyzed patient diet before the speech and a non per os (NPO) regimen before the swallowing
swallowing assessment (p = 0.001) and verified evaluation. On the other hand, patients with
that patients who did not undergo orotracheal a history of 2 or more orotracheal tube insertions
intubation and mechanical ventilation had already had been feeding exclusively via an alternative
been feeding orally or had not been following feeding route (Table 2).

Table 2: Feeding profile prior to speech-language pathologist evaluation.

No mechanical One orotracheal Two or more
Feeding route
ventilation intubation orotracheal intubations p
n (%)
n = 97 n = 229 n = 54
Oral 29 (29.9)* 31 (13.5) 3 (5.6) 0.001
Oral + nasogastric tube 14 (14.4) 31 (13.5) 7 (13.0)
Nasogastric tube 49 (50.5) 161 (63.6) 43 (79.6)*
Gastrostomy 0 (0.0) 1 (0.4) 0 (0.0)
NPO 5 (5.4)* 4 (1.7) 0 (0.0)
Jejunostomy 0 (0.0) 1 (0.4) 1 (1.9)
NPO: non per os. Statistical analysis was performed with a non-parametric test. The chi-squared test was used to compare groups with
a precise p value.
* The statistical significance level was set at 5% after residual adjustments (p < 0.05).

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 Vizioli et al.

Regarding vocal impairment, 75 (69%) patients required stimulation by the staff in order to maintain
in Group 1 did not present vocal symptoms, while patient awareness.
18 (41.9%) patients in Group 2 presented some degree Clinical evaluations by the speech-language
of vocal impairment (p = 0.004). Changes such as pathologist are detailed in Table 3. Statistical significance
vocal intensity and quality, as well as any degree of and association were established for the wet-sounding
hoarseness, breathiness, asthenia, roughness, tension, voice variable (p = 0.012). This symptom was more rarely
or instability were considered. present in patients of Group 1 and was more frequent
Patient awareness at the moment of assessment in Group 3. An association was also established for
was also analyzed (p = 0.011), and we observed the presence of the cough reflex after swallowing in
that 194 (87%) patients in Group 2 were alert Group 3, as well as for changes in vital signs (such as
while 12 (22.2%) patients in Group 3 presented decreased SpO2) and in respiratory and/or heart rates.
decreased alertness and a degree of drowsiness that An absence of the cough reflex was identified in Group 2.

Table 3: Clinical findings of SLP evaluations.

No mechanical One orotracheal Two or more orotracheal
Variable – n(%) p
ventilation intubation intubations
Gag reflex n = 89 n = 205 n = 43 0.408
Absent 76 (85.4) 185 (90.2) 38 (88.4)
Present 13 (14.6) 20 (9.8) 6 (11.6)
Preparatory oral phase n = 89 n = 206 n = 43 0.790
Impaired 45 (50.6) 111 (53.8) 19 (44.2)
Normal 44 (49.4) 95 (46.1) 24 (55.8)
Larynx elevation n = 89 n = 203 n = 43 0.551
Impaired 58 (65.2) 71 (35) 18 (41.9)
Normal 31 (34.8) 132 (65) 25 (58.1)
Wet voice n = 89 n = 204 n = 43 0.012
Absent 73 (82.0)* 139 (68.1) 25 (58.1)
Present 16 (18.0) 65 (31.9) 18 (41.9)*
Multiple swallows n = 89 n = 203 n = 43 0.363
Absent 59 (66.3) 120 (59.1) 23 (53.5)
Present 30 (33.7) 83 (40.9) 20 (46.5)
Cervical auscultation n = 89 n = 186 n = 40 0.063
Normal 67 (75.3) 125 (67.2) 21 (52.5)
Impaired 22 (24.7) 61 (32.8) 19 (47.5)
Throat clearing n = 89 n = 186 n = 40 0.742
Absent 77 (86.5) 157 (84.4) 36 (90)
Present 12 (13.5) 29 (15.6) 4 (10)
Cough n = 89 n = 215 n = 43 0.013
Absent 55 (61.8) 130 (60.5)* 16 (37.2)
Present 34 (38.2) 85 (39.5) 27 (62.8)*
Changes in vital signs n = 89 n = 203 n = 43 0.047
Absent 78 (87.6) 182 (89.7) 33 (76.6)
Present 11 (12.4) 21 (10.3) 10 (23.3)*
Choking n = 89 n = 203 n = 43 0.424
Absent 71 (79.8) 172 (84.7) 35 (81.4)
Present 18 (20.2) 31 (15.3) 8 (18.6)
SLP: speech-language pathologist. The chi-squared test was used to compare groups, with analysis of adjusted residuals. An asymptotic
p value was adopted for all variables.
*Statistical significance level set at 5% (p < 0.05).

200 Clin Biomed Res 2020;40(4) http://seer.ufrgs.br/hcpa

 Speech therapy in dysphagia following orotracheal intubation

Regarding the FOIS, after the evaluation, reference, no statistical difference (p = 0.098) was found.
we observed a statistical significance (p = 0.020) in The corresponding data are presented in Figure 2.
Group 3 since 33 (61.1%) patients received a FOIS Regarding the severity of oropharyngeal
I score, that is, they should not receive oral feeding. dysphagia according to the PARD classification
Sixteen (16.5%) patients in Group 1 were assessed as (Figure 3), no statistically significant association
being apt for oral feeding with a multiple-consistency (p = 0.261) was observed between groups.
diet, albeit with special preparation or compensations Nonetheless, higher frequencies of severe
(FOIS V). However, when comparing only the groups oropharyngeal dysphagia were observed in Groups 3
with orotracheal intubation (Groups 2 and 3) and and 2, with a total of 24 (44.4%) and 74 (32.3%)
considering Group 1 (no orotracheal intubation) as patients, respectively.

70
No mechanical ventilation
60
One orotracheal intubation
50 Two or more orotracheal intubations
p = 0.020
40
Hours

30

20

10

0
I II III IV V VI VII
Level
*Statistically significant association according to a chi-squared test with residuals adjusted to
5% significance (p<0.05).
FOIS I: No oral intake.
FOIS II: Tube dependent with minimal/inconsistent oral intake.
FOIS III: Tube supplements with consisten oral intake.
FOIS IV: Total oral intake of a single consistency.
FOIS V: Total oral intake of multiple consistencies requiring special preparation.
FOIS VI: Total oral intake with no special preparation, but must avoid specific foods or liquids.
FOIS VII: Total oral intake with no restrictions.

Figure 2: Functional Oral Intake Scale (Fois).

24

Severe oropharyngeal dysphagia 74

22
7
Moderate to severe oropharyngeal dysphagia 33
12
9

Moderate oropharyngeal dysphagia 29

10
Nível

Mild to moderate oropharyngeal dysphagia 40

24
3 p=0.261
Mild oropharyngeal dysphagia 21
No mechanical ventilation
12
4
One orotracheal intubation
Functional swallowing 25
13
Two or more
Normal swallowing 7 orotracheal intubations
4

0 20 40 60 80
n

Figure 3: Dysphagia Risk Evaluation Protocol (Pard): oropharyngeal dysphagia degree classification.
The chi-squared test was used to compare groups, with analysis of adjusted residuals at a 5% statistical significance.

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 Vizioli et al.

We observed a statistically significant difference orotracheal intubation were discharged from the ICU.
regarding patient outcomes (p = 0.006) (Figure 4). These data were not related with the independent
Results showed that 22 (40.7%) patients with a history variables present in this study and no severity scores
of 2 or more orotracheal tube insertions had died, at ICU admission were obtained due to difficulties in
while 80 (82.5%) patients who did not undergo accessing this information.

180
p = 0.006
150
No mechanical ventilation
120 One orotracheal intubation
n

Two or more orotracheal intubation

90

60

30

0
Discharge Death

*Statistical significance level set at 5% after a chi-squared test with residual

adjustment (p < 0.05).

Figure 4: Outcomes.

After statistical analysis of the 3 groups, a new subjected to orotracheal intubation and highlighted
proportion comparison was performed — this time the relationship between a higher degree of severity
disregarding data from Group 1 (no orotracheal and cases of prolonged tracheal intubation. However,
intubation). When comparing Groups 2 and 3, these data are variable and consist of low-quality
which comprised patients subjected to orotracheal evidence7. The severity of post-extubation oropharyngeal
intubation, no statistical differences were dysphagia has been associated with the duration of
observed; thus, between these groups, the FOIS orotracheal intubation and orofacial myofunctional
classification and dysphagia severity (PARD) scores deficits, which in turn cause dysfunctions in the oral
were indistinguishable. preparatory phase such as longer oral transit times
and decreased tongue and lip strength17.
Dysphonia has been a common finding in patients
DISCUSSION after extubation. The impact of the endotracheal
The epidemiological profile of ICU patients may tube has been studied for many years and has
vary according to their clinical state and the type been related to laryngeal lesions, mainly arytenoid
of care provided. The ICU where this study was edema, granulomas, ulcerations, and subglottic
performed does not provide care to trauma patients, stenosis18. Laryngeal changes may be associated
hence the most prevalent underlying diseases are with penetration and aspiration due to deficiencies
neurological diseases and those of the circulatory in glottic closure, one of the lower airway protective
and respiratory systems. mechanisms19. Notably, laryngeal lesions due to
No statistical significance was found between orotracheal intubation are related to its duration,
groups regarding the severity of oropharyngeal emergency status, and tube size. These criteria
dysphagia. However, it is important to emphasize should be considered upon individual assessment
that severe swallowing problems were more frequent and rely on recommendations for sizes above 8 mm
in patients in the orotracheal intubation groups in men and above 7 mm in women20,21.
(Groups 2 and 3). This corroborates several studies16-18, Clinical signs and symptoms of oropharyngeal
since a long duration of mechanical ventilation and dysphagia (eg, coughing, choking, or a wet-
history of previous reintubation are associated with sounding voice) are not always present. Here, we
the development of post-extubation dysphagia5. must note that the standard recommendation for
Previous research has similarly demonstrated a high the safe initiation of oral feeding in patients who have
incidence of oropharyngeal dysphagia in patients been intubated is 24 hours after extubation, given

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 Speech therapy in dysphagia following orotracheal intubation

spontaneous improvement in swallowing function5. Studies show that symptoms of dysphagia can last
A study that analyzed patient swallowing performance, between 6 months and 5 years32 and can be predictors
in which the penetration and aspiration scales were of death33. Among other aspects, a 45% increase
used to evaluate patients at 2, 4, and 24 hours after in hospital care costs was found in postoperative
extubation22, concluded that oral feeding after extubation cardiac patients with dysphagia 34. In addition,
could be started sooner. However, greater safety and the patients’ ICU stay could lead to psychological
protection of the airway were observed when oral changes such as post-traumatic stress, anxiety,
feeding was introduced after 24 hours; moreover, and depression35, all of which may be aggravated
this longer minimal waiting period resulted in less by the presence of dysphagia.
restricted diets. Therefore, the reintroduction of oral Studies have suggested that reintubation demands
feeding before 24 hours post-extubation may lead to are linked to an increased likelihood of death and
laryngeal penetration and/or aspiration, essentially a worse outcome due to new complications and
increasing the risk of bronchopneumonia. comorbidities36,37. In our study, we observed a difference
A wet-sounding voice is one of several cardinal among groups regarding the discharge and death
parameters observed during clinical evaluations outcomes (Figure 4). However, information on
and is indicative of the presence of foreign the severity of patients’ illnesses at the time of ICU
content in the glottic region. The absence of vocal admission was not obtained during data collection.
alterations after swallowing is considered to provide Moreover, the death outcome was not statistically
reasonable assurance that laryngeal aspiration and/ analyzed for a correlation with possible confounding
or penetration is absent. Even so, this clinical sign and interaction variables.
is understood to be at best a clue, as evidence from Other studies38,39 have concluded that the presence
acoustic measurement studies has demonstrated of a full-time speech therapist at the ICU is not a reality
a moderate sensitivity and specificity and that the at all hospitals and emphasized the importance
auditory perception of vocal alterations may not of creating sensitive protocols for screening for
necessarily correlate to actual laryngeal penetration post-extubation dysphagia. These protocols should
and/or aspiration23,24. enable any member of an interdisciplinary team
Our study demonstrated vocal changes in patients to assess the risk of aspiration and the need to
who underwent orotracheal intubation. These vocal consult a speech therapist 38,39. In addition to
alterations can last for a few days after extubation identifying a risk of aspiration, the multidisciplinary
or be permanent. Vocal complications are related team must be familiar with the predictive factors
to prolonged intubation (longer than 48 hours), for oropharyngeal dysphagia40.
endotracheal tube size25, patient agitation, poor The present study has several limitations
endotracheal tube positioning, poor humidification and biases. Among them, we note the different
of the inspired air, and local infection26-29. The most types of diseases that can change the biomechanics
prevalent changes are hoarseness and breathiness, of swallowing, thus confounding the real impact
loss of voice, throat clearing, sore throat, and vocal of orotracheal intubation on this function.
fatigue due to the association of injuries such as For this purpose, a homogeneous sample would
changes in the vocal fold mucosa and functional be necessary. However, we chose to maintain
deficiencies (eg, changes in glottic coaptation these participants in our research because we
during phonation)26,27. Vocal changes are common believe this sample composition reflects the reality
in ICUs; however, they are little studied and require of populations in clinical practice. Another aspect
more attention by speech therapists and intensive is that clinical evaluations were not performed
care professionals. by the same speech therapist, and results may
Changes in vital signs were observed in Group 3. present differences due to the subjective nature
During the functional swallowing assessment, of the assessment. It is important to note that, as
pulse oximetry was used as a simple monitoring this was a retrospective study, the collected data
measure 1,30. The SpO 2 analysis is based on refer to clinical examinations, without the benefit
the hypothesis that food aspiration would cause of objective swallowing examination results.
a bronchospasm reflex, thereby reducing ventilatory Furthermore, additional studies with larger patient
perfusion and resulting in oxygen desaturation14,31. samples are needed to highlight the real impact of
However, it should be emphasized that SpO2 levels orotracheal intubation on swallowing, with a view
should not be used individually as predictive signs to implementing safe practices.
of food aspiration, but rather be evaluated together We emphasize that our study was conducted
with other clinical findings. within the practical realm of experience of speech
In addition to the unfavorable outcome, the presence therapy pathologists at a specific Brazilian ICU.
of oropharyngeal dysphagia has been associated It is known that, for consistent scientific evidence
with greater patient comorbidity after discharge. and generalization of results and data, the follow-

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 Vizioli et al.

up of assumptions and bias control criteria must oropharyngeal dysphagia is high in patients who
be satisfied. have undergone orotracheal intubation in the ICU.
Considering the data obtained in this study, it was Proper diagnosis and treatment of dysphagia in
not possible to reject the hypothesis that groups did this population are essential to prevent the occurrence
not differ in the degree of oropharyngeal dysphagia. of aspiration pneumonia, which prolongs length
Even though no statistical significance was found of stay, increases hospital costs, and can lead to
between groups, it is clear that the prevalence of comorbidities and even death.

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Received: May 16, 2020

Accepted: Nov 22, 2020

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