Would you believe that, after life sustaining treatments and comfort considerations, swallowing is priority #1 among patients who are critically ill? You’d better! Patients surviving critical care with dysphagia may be a challenge for even the most experienced clinicians, especially when considering the presence and dynamics of various medical therapies and medication effects, intubation with mechanical ventilation, and cognitive, mental, and other physical impairments. Timely and meaningful assessments lead to the creation of a comprehensive care plan. Evidence-based treatments for dysphagia that are provided by a well-integrated, multi-disciplinary, goal-directed, and efficient team will provide the most favorable of patient outcomes.
Martin B. Brodsky is an assistant professor in the Department of Physical Medicine and Rehabilitation and a member of the Outcomes After Critical Illness and Surgery (OACIS) Group, a multidisciplinary clinical and research group dedicated to understanding and improving patient outcomes after critical illness and surgery, at Johns Hopkins University. He earned his PhD at the University of Pittsburgh and his Master’s degree (ScM) in Clinical Investigation at the Johns Hopkins Bloomberg School of Public Health with a Johns Hopkins Clinical Research Scholars Award (KL2 Mentored Careeer Development Award). Dr. Brodsky is a researcher, international lecturer, and clinician with more than 20 years of continuous medical speech-language pathology experience. His peer-reviewed research publications and book chapters focus on swallowing and swallowing disorders. Dr. Brodsky’s research is funded by the National Institutes of Health, studying the effects of critical illness and critical care medicine on swallowing and its long-term outcomes. He is a former member of the Society of Critical Care Medicine’s 3-year Task Force on Post Intensive Care Syndrome, a frequent reviewer for the American Speech-Language-Hearing Association and scientific journals, and a member of the American Speech-Language Hearing Association, Dysphagia Research Society, and the American Psychological Association.
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.
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.
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.
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.
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.
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.