Profile of users receiving Speech-Language Therapy service at a Critical Patient Unit
Perfil de usuarios que reciben atención fonoaudiológica en una unidad de paciente crítico
Manuel del Campo Rivas; Pamela Estay Jorquera; Gabriela Valencia Rojas; Paula Muñoz Ramos; Karen Arce Rossel; Angélica Silva-Ríos
Abstract
Objective: to describe the profile of patients treated by Speech-Language therapists in a Critical Patient Unit.
Methods: an ex post facto, observational and descriptive study was carried out. Monthly statistical data of patients hospitalized in the period January-December 2018 were analyzed, in the Intensive Care Unit at a public hospital. Data were described from the analysis of frequency and measures of central tendency. The distribution of the variables was determined through the skewness-kurtosis test, considering a significance level of p<0.05.
Results: 217 individuals got 868 speech-language therapy services. Men (57.26%), older than 65 years old, required a more frequent intervention. The main medical diagnosis of admission to the unit corresponded to non-specific pathologies (57.14%), respiratory disease (15.21%) and cerebrovascular disease (12.79%). The speech-language therapy functions were related to the evaluation of swallowing (54.31%) and voice (32.4%). In relation to the intervention, the treatment of dysphagia (25.82%) and oral motor functions (25.04%) was predominant in the duties. Functions associated with language, speech and cognition were secondary.
Conclusion: the profile of the critical patient and the speech-language therapy work in this field represent a first step to characterize the role of the speech-language therapist in Intensive Medicine teams.
Keywords
Resumen
Objetivo: describir el perfil de usuarios atendidos por fonoaudiólogos en una unidad de paciente crítico.
Métodos: se realizó un estudio observacional descriptivo con temporalidad ex post facto. Se analizaron los resúmenes estadísticos mensuales de usuarios internados durante los meses de enero a diciembre de 2018, en la unidad de cuidados intensivos de un hospital público. Se describieron los datos a partir de análisis de frecuencia y medidas de tendencia central. La distribución de las variables se determinó mediante skewness-kurtosis test, considerando un nivel de significancia p<0,05.
Resultados: 217 sujetos recibieron 868 atenciones fonoaudiológicas. Los hombres (57,26%) mayores de 65 años requirieron una intervención más frecuente. Los principales diagnósticos médicos de ingreso a la unidad correspondieron a patologías inespecíficas (57,14%), enfermedades respiratorias (15,21%) y cerebrovasculares (12,79%). Las funciones de fonoaudiología se relacionaron con la evaluación de la deglución (54,31%) y de la voz (32,4%). En cuanto a la intervención, el tratamiento de la disfagia (25,82%) y las funciones motoras orales (25,04%) dominaron la carga laboral. Las funciones asociadas con el lenguaje, el habla y la cognición fueron secundarias.
Conclusión: el perfil del paciente crítico y las labores fonoaudiológicas en este ámbito representan un primer paso para caracterizar el rol profesional del fonoaudiólogo en el contexto de los equipos de medicina intensiva.
Palabras clave
References
1. Vega YE, Rodríguez MA, del Campo MN. Análisis del rol del fonoaudiólogo(a) en el sector saúde en Chile. Cienc Amp Trab. 2017;19(59):76-80.
2. SOCHIMI: Sociedad Chilena de Medicina Intensiva. La Sociedad Chilena de Medicina Intensiva incorpora nuevas disciplinas a su organización: fonoaudiología y terapia ocupacional [Internet]. 2018 [cited 2019 Jan 17]. Available at: https://www.medicina-intensiva.cl/
3. Huerta P, Igor J, Uribe S, Grandjean J, Burgos M. Movilización precoz en pacientes conscientes de la Unidad de Paciente Crítico Adultos del Hospital Regional de Valdivia. Valoración de la función cardiovascular, balance dinámico, calidad de vida y el grado de independencia funcional al mes posalta. Rev Chil Med Intensiva. 2017;32(2):93-9.
4. Donovan AL, Aldrich JM, Gross AK, Barchas DM, Thornton KC, Schell-Chaple HM et al. Interprofessional care and teamwork in the ICU. Crit Care Med. 2018;46(6):980-90.
5. Kendall-Gallagher D, Reeves S, Alexanian JA, Kitto S. A nursing perspective of interprofessional work in critical care: findings from a secondary analysis. J Crit Care. 2017;38(1):20-6.
6. Baumgartner CA, Bewyer E, Bruner D. Management of communication and swallowing in Intensive Care: the role of the speech pathologist. AACN Adv Crit Care. 2008;19(4):433-43.
7. Macht M, Wimbish T, Clark BJ, Benson AB, Burnham EL, Williams A et al. Diagnosis and treatment of post-extubation dysphagia: results from a national survey. J Crit Care. 2012;27(6):578-86.
8. Schefold JC, Berger D, Zürcher P, Lensch M. Perren A, Jakob SM et al. Dysphagia in mechanically ventilated ICU patients (DYNAMICS): a prospective observational trial. Crit Care Med. 2017;45(12):2061-9.
9. Happ MB, Baumann BM, Sawicki J, Tate JA, George EL, Barnato AE. SPEACS-2: Intensive Care Unit "communication rounds" with speech language pathology. Geriatr Nur. 2010;31(3):170-7.
10. Silva DLR e, Lira FOQ, Oliveira JCC de, Canuto MSB, Silva DLR, Lira FOQ et al. Speech therapy practice in the intensive care unit of a hospital of infectious diseases of Alagoas. Rev. CEFAC. 2016;18(1):174-83.
11. Brummel NE. Jackson JC, Girard TD, Pandharipande PP, Schiro E, Work B et al. A Combined Early Cognitive and Physical Rehabilitation Program for people who are critically III: the activity and cognitive therapy in the Intensive Care Unit (ACT-ICU) trial. Phys Ther. 2012 92(12):1580-92.
12. Jackson J, Ely E. Morey M, Anderson V, Siebert C, Denne L et al. Cognitive and physical rehabilitation of ICU survivors: results of the RETURN randomized, controlled pilot investigation. Crit Care Med. 2012;40(4):1088-97.
13. McRae J, Montgomery E, Garstang Z, Cleary E. The role of speech and language therapists in the intensive care unit. J Intensive Care Soc. 2019;0(0):1-5.
14. Lara BA, Cataldo A, Castro R, Aguilera PR, Ruiz C, Andresen M. Medicina de urgencia y unidades de cuidados intensivos: una alianza necesaria en busca de la mejoría de la atención de pacientes críticos. Rev Médica Chile. 2016;144(7):911-7.
15. Herrera E, Infante A. Guías 2004 de organização y funcionamiento de unidades de pacientes críticos. Rev Chil Med Intensiva. 2004;19(4):209-23.
16. ASHA: American Speech and Hearing Association. Roles and Responsibilities of Speech-Language Pathologists in the Neonatal Intensive Care Unit: Guidelines [Internet]. Rockville, MD: American Speech-Language-Hearing Association; 2005 [cited 2020 Jan 30]. Report No.: GL2005-00060. Available at: http://www.asha.org/policy/GL2005-00060/
17. de Medeiros GC, Sassi FC, Mangilli LD, Zilberstein B, de Andrade CRF. Clinical dysphagia risk predictors after prolonged orotracheal intubation. Clinics. 2014;69(1):8-14.
18. Rodrigues KA, Machado FR, Chiari BM, Rosseti HB, Lorenzon P, Gonçalves MIR. Swallowing rehabilitation of dysphagic tracheostomized patients under mechanical ventilation in intensive care units: a feasibility study. Rev Bras Ter Intensiva. 2015;27(1):64-71.
19. Wilches E, López M, Arango G. Rehabilitación funcional del paciente neurológico en la UCI. Guía Neurológica 6 La unidad de cuidado intensivo; 2004.
20. Sosnowski K, Lin F, Mitchell ML, White H. Early rehabilitation in the intensive care unit: an integrative literature review. Aust Crit Care Off J Confed Aust Crit Care Nurses. 2015;28(4):216-25.
21. Reid JC, Unger J, McCaskell D, Childerhose L, Zorko DJ, Kho ME. Physical rehabilitation interventions in the intensive care unit: a scoping review of 117 studies. J Intensive Care [Internet]. 2018 [cited 2020 Jan 27];6(80):1-12. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6286501/
22. Marin YG, Nieto AP. Realidad laboral del fonoaudiólogo en la Unidad de Cuidados Intensivos. Rev signos fónicos. 2015;1(1):44-56.
23. Rodriguez Riaño J, Ballesteros Peréz DV, Franco Hernández SG, Burgos García M, Hernández Blanco ML, Ramírez Lozano MT. Práctica fonoaudiológica en unidades de cuidado crítico en Colombia [proyecto]. Corporación Universitaria Iberoamericana. [Internet]. 2018 [cited 2020 Feb 3]; Available from: http://repositorio.iberoamericana.edu.co/handle/001/842
24. Costa CC, Favero TC, Rosa FB da, Steidl EM dos S, Mancopes R. Decannulation: speech therapy and physiotherapy approach. Distúrb. Comun. 2016 28(1):93-101.
25. Padovani AR, Moraes DP, Sassi FC, Andrade CRF de. Clinical swallowing assessment in intensive care unit. CoDAS [Internet]. 2013 [cited 2020 Feb 3]; 25(1):1-7. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S2317-17822013000100002&lng=en.
26. Cartagena Goldschmidt T, Lillo Montecinos JA, Muñoz Diaz FJ. Rol del fonoaudiológico en unidad de paciente crítico, percepción del equipo multidiciplinario [Internet] [Thesis). Universidad Andrés Bello; 2018 [cited 2020 Feb 3]. Available from: http://repositorio.unab.cl/xmlui/handle/ria/10213
27. ASHA: American Speech and Hearing Association. Scope of Practice in Speech-Language Pathology [Internet]. American Speech-Language-Hearing Association. 2016 [cited Jun 2017 22]. Available from: http://www.asha.org/policy/SP2016-00343/#Framework
28. Neumeier A, Moss M. We need an additional seat at the critical care multidisciplinary team table for our speech-language pathologists. Ann Am Thorac Soc. 2014;11(10):1610-1.
29. Cardinal L, Freeman-Sanderson A, Togher L. The speech pathology workforce in intensive care units: Results from a national survey. Aust Crit Care. 2020;33(3):250-8.
30. Ganga Contreras F, Santana P, Angélica M, González Vásquez D, Rebagliati Badal F, Ganga Contreras F et al. Rol del Estado frente al envejecimiento de la población: el caso de Chile. Convergencia. 2016;23(71):175-200.
31. Villalobos Dintrans P. Panorama de la dependencia en Chile: avances y desafíos. Rev. méd. Chile [Internet]. 2019 [cited 2020 Sep 2]; 147(1):83-90. Available from: https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872019000100083&lng=es.
32. Ogura T, Nakamura Y, Takahashi K, Nishida K, Kobashi D, Matsui S. Treatment of patients with sepsis in a closed intensive care unit is associated with improved survival: a nationwide observational study in Japan. J Intensive Care [Internet]. 2018 [cited 2020 Feb 3]; 6(57)1-10. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6122219/
33. Ochoa Parra M, Flores Enderica CG, Meneses Meneses MJ, Beltrán Zhindón MG, Arcentales Peralta MS, Bravo Genovéz AP et al. Prevalencia de infecciones en la Unidad de Cuidados Intensivos del Hospital José Carrasco Arteaga. Rev Médica Hosp José Carrasco Arteaga. 2016;8(2):137-41.
34. Skoretz SA, Riopelle SJ, Wellman L, Dawson C. Investigating swallowing and tracheostomy following critical illness: a scoping review. Crit Care Med. 2020;48(2):e141-51.
35. Brodsky MB, Levy MJ, Jedlanek E, Pandian V, Blackford B, Price C et al. Laryngeal injury and upper airway symptoms after oral endotracheal intubation with mechanical ventilation during critical care: a systematic review. Crit Care Med. 2018;46(12):2010-7.
36. Jain U, McCunn M, Smith CE, Pittet J-F. Management of the traumatized airway. Anesthesiology. 2016;124(1):199-206.
37. Heidler M-D, Salzwedel A, Jöbges M, Lück O, Dohle C, Seifert M et al. Decannulation of tracheotomized patients after long-term mechanical ventilation results of a prospective multicentric study in German neurological early rehabilitation hospitals. BMC Anesthesiol. 2018;18(1):65.
38. Freeman-Sanderson A, Togher L, Phipps P, Elkins M. A clinical audit of the management of patients with a tracheostomy in an Australian tertiary hospital intensive care unit: Focus on speech-language pathology. Int J Speech Lang Pathol. 2011;13(6):518-25.
39. Kılıç M, Yüzkat N, Soyalp C, Gülhaş N. Cost analysis on Intensive Care Unit costs based on the length of stay. Turk J Anaesthesiol Reanim. 2019;47(2):142-5.
40. Reardon PM, Fernando SM, Van Katwyk S, Thavorn K, Kobewka D, Tanuseputro P et al. Characteristics, outcomes, and cost patterns of high-cost patients in the Intensive Care Unit. Crit Care Res Pract [Internet]. 2018 [cited 2020 Jan 27]; 2018(0):1-7. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6139208/
Submitted date:
02/17/2020
Accepted date:
09/24/2020
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