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Intervenções de reabilitação para a pessoa com disfagia pós-extubação: um consenso de peritos
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Resumo(s)
A disfagia, ou deglutição comprometida, é uma condição comum em pessoas submetidas a ventilação mecânica invasiva, com uma incidência estimada de 41%. Esta situação clínica, origina um conjunto de complicações com impacto negativo na qualidade de vida da pessoa, pelo que, a implementação de programas de reabilitação específicos para a disfagia em pessoas pós-extubação, são primordiais para garantir o sucesso da sua recuperação.
Objetivo: Este trabalho teve como objetivo validar, através de um painel de peritos, um conjunto de intervenções para a reabilitação da pessoa com disfagia pós-extubação.
Métodos: A metodologia adotada para o processo de validação foi o método de Delphi modificado, em três rondas, com uma amostra heterogénea e representativa da realidade nacional. Critérios a priori: consenso ≥75% de concordância; análise mista (estatística descritiva e análise de conteúdo); priorização final por aplicabilidade clínica.
Resultados: Foram validadas treze intervenções e a sua respetiva hierarquização para a prática clínica, com priorização máxima para o rastreio sistemático da disfagia a partir de 1 hora pós-extubação, quando clinicamente seguro e a avaliação clínica obrigatória, perante rastreio positivo, complementando-se com avaliação instrumental sempre que a avaliação fosse inconclusiva. Realçou-se a importância da adoção de estratégias compensatórias e programas de reabilitação individualizados que possam incluir exercícios de fortalecimento e/ou reabilitação respiratória, exercícios vocais, estimulação sensorial, terapia orofacial e mobilidade cervical. É recomendado o uso prudente da neuroestimulação e a telerreabilitação foi apontada como instrumento em evolução de garantia da continuidade de cuidados e capacitação da família e/ou cuidadores informais.
Conclusão: Os resultados dão continuidade ao trabalho desenvolvido na identificação das intervenções de reabilitação para a pessoa com disfagia pós-extubação, criando uma base consensual que possa, numa etapa futura, ser testada em contexto clínico quanto à sua eficácia e segurança.
Dysphagia, or compromised swallowing, is a common condition among individuals undergoing invasive mechanical ventilation, with an estimated incidence of 41%. This clinical condition leads to a range of complications that negatively impact quality of life. Therefore, the implementation of targeted rehabilitation programs for dysphagia in post-extubation patients is essential to ensure successful recovery. Objective: This study aimed to validate, through a panel of experts, a set of interventions for the rehabilitation of patients with post-extubation dysphagia. Methods: A modified Delphi method was adopted for the validation process, carried out over three rounds with a heterogeneous sample representative of national clinical practice. A priori criteria included: ≥75% agreement for consensus; mixed-method analysis (descriptive statistics and content analysis); and final prioritization based on clinical applicability. Results: Thirteen interventions were validated and hierarchized for clinical practice. Systematic dysphagia screening starting one hour after extubation, when clinically safe, was given the highest priority. Positive screening required mandatory clinical assessment, complemented by instrumental evaluation when the clinical assessment was inconclusive. Emphasis was placed on the importance of adopting compensatory strategies and individualized rehabilitation programs, which may include strengthening and/or respiratory rehabilitation exercises, vocal exercises, sensory stimulation, orofacial therapy, and cervical mobility training. Cautious use of neurostimulation was recommended, and telerehabilitation was identified as an emerging tool to ensure continuity of care and to support the empowerment of families and informal caregivers. Conclusion: The findings build upon previous work identifying rehabilitation interventions for patients with post-extubation dysphagia, establishing a consensus-based foundation that may be tested in future clinical settings for its effectiveness and safety.
Dysphagia, or compromised swallowing, is a common condition among individuals undergoing invasive mechanical ventilation, with an estimated incidence of 41%. This clinical condition leads to a range of complications that negatively impact quality of life. Therefore, the implementation of targeted rehabilitation programs for dysphagia in post-extubation patients is essential to ensure successful recovery. Objective: This study aimed to validate, through a panel of experts, a set of interventions for the rehabilitation of patients with post-extubation dysphagia. Methods: A modified Delphi method was adopted for the validation process, carried out over three rounds with a heterogeneous sample representative of national clinical practice. A priori criteria included: ≥75% agreement for consensus; mixed-method analysis (descriptive statistics and content analysis); and final prioritization based on clinical applicability. Results: Thirteen interventions were validated and hierarchized for clinical practice. Systematic dysphagia screening starting one hour after extubation, when clinically safe, was given the highest priority. Positive screening required mandatory clinical assessment, complemented by instrumental evaluation when the clinical assessment was inconclusive. Emphasis was placed on the importance of adopting compensatory strategies and individualized rehabilitation programs, which may include strengthening and/or respiratory rehabilitation exercises, vocal exercises, sensory stimulation, orofacial therapy, and cervical mobility training. Cautious use of neurostimulation was recommended, and telerehabilitation was identified as an emerging tool to ensure continuity of care and to support the empowerment of families and informal caregivers. Conclusion: The findings build upon previous work identifying rehabilitation interventions for patients with post-extubation dysphagia, establishing a consensus-based foundation that may be tested in future clinical settings for its effectiveness and safety.
Descrição
Palavras-chave
Transtornos da deglutição Unidades de terapia intensiva Técnica Delphi Enfermagem em reabilitação Ventilação mecânica