Early Dysphagia Rehabilitation in Critical Care: A pilot study of Feasibility, Safety and Effectiveness of a Strength-based Dysphagia Treatment Protocol for patients with ICU Acquired Weakness

Nicola Clayton^1,2,3,4,5, Elizabeth Ward^5,6, Caroline Place^3,7, Amelia Scott^3,8, Peter Maitz^2,4, Mark Kol^3,4,
¹Speech Pathology Department, Concord Repatriation General Hospital, Sydney, NSW, Australia
²Burns Unit, Concord Repatriation General Hospital, Sydney, NSW, Australia
³Intensive Care Unit, Concord Repatriation General Hospital, Sydney, NSW, Australia
⁴Faculty of Medicine & Health, University of Sydney, Sydney, NSW, Australia
⁵School of Health & Rehabilitation Sciences, University of Queensland, Brisbane, QLD, Australia
⁶Centre for Functioning & Health Research, Queensland Health, Brisbane, QLD, Australia
⁷Physiotherapy Department, Concord Repatriation General Hospital, Sydney, NSW, Australia
⁸Nutrition & Dietetics Department, Concord Repatriation General Hospital, Sydney, NSW, Australia

Abstract

Introduction: Intensive-Care-Unit Acquired Weakness (ICUAW) is not uncommon in patients with severe burn injury who require protracted ICU treatment. The consequential dysphagia associated with ICUAW is multi-factorial, with a major precipitating factor being weakening of oropharyngeal musculature. However, evidence for dysphagia rehabilitation in ICUAW is currently lacking. We propose that a multi-modal strength-based rehabilitation training program, initiated within the ICU, may be effective in supporting dysphagia rehabilitation.

Aim(s): To determine the feasibility, safety and effectiveness of a strength-based dysphagia treatment protocol for patients with ICUAW and dysphagia.

Methods: All patients admitted to Concord Hospital ICU (March 2021-2023), diagnosed with dysphagia and ICUAW were considered for inclusion. Clinical-Swallow-Examination (CSE) and Flexible-Endoscopic-Evaluation-of-Swallowing (FEES) confirmed diagnosis and severity of dysphagia. A strength-based dysphagia treatment protocol was implemented targeting the tongue-base, pharyngeal, suprahyoid and respiratory muscles. Haemodynamic monitoring was employed during treatment sessions to ensure safety. Key swallowing and respiratory outcomes were collected weekly including: CSE (Functional-Oral-Intake-Scale), FEES (New-Zealand-Secretion-Scale, Penetration-Aspiration-Scale, Yale pharyngeal-residue-scale), Peak-Expiratory-Flow (PEF) and Maximum-Expiratory-Pressure (MEP). Nutritional outcomes (Indirect Calorimetry) were collected monthly.

Results: Eleven participants (9-male, mean age=57years) have been recruited to date. Medical diagnoses include severe burn injury, sepsis and COVID-19. All participants exhibited profound dysphagia on initial examination, completed the treatment protocol and achieved premorbid diet and fluids (with/without compensatory strategies) by hospital discharge. There were no adverse events during treatment delivery.

Conclusions: A strength-based dysphagia treatment protocol for patients with ICUAW and dysphagia is safe, feasible and effective with promising outcomes to expedite dysphagia recovery in this challenging population.

Biography

Dr Nicola Clayton is a Clinical Specialist Speech Pathologist in the Intensive Care and Severe Burn Injury Units at Concord Hospital in Sydney. She holds honorary appointments with the University of Sydney and University of Queensland. Dr Clayton is internationally recognised for her expertise, research and education in the field of complex dysphagia, critical care and severe burn injury.