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"Emergency medicine" №6(101), 2019

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Dysphagia in the intensive care unit: epidemiology, mechanisms, and clinical management

Authors: Мальцева Л.А., Мищенко Е.А., Мосенцев Н.Ф., Мосенцев Н.Н., Голуб А.В.
ГУ «Днепропетровская медицинская академия МЗ Украины», г. Днепр, Украина

Categories: Medicine of emergency

Sections: Specialist manual

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Summary

Дисфагія може бути в усіх критичних пацієнтів; клінічні дані показують, що постекстубаційна дисфагія (ПЕД) зазвичай спостерігається у пацієнтів відділення інтенсивної терапії (ВІТ). Останні дані показують, що дисфагія в основному зберігається і її наявність незалежно пов’язана з несприятливими клінічними наслідками. Хоча було запропоновано кілька факторів ризику, що, можливо, сприяють розвитку дисфагії, проте точні механізми у пацієнтів ВІТ залишаються в повному обсязі не зрозумілими, і на даний час немає єдиної думки про те, як найкращим чином підходити до пацієнтів ВІТ у групі ризику. З клінічної точки зору, як відомо, дисфагія пов’язана з підвищеним ризиком аспірації та індукованою аспіра­цією пневмонією, відстроченням відновлення харчування/недоїданням, зниженням якості життя, тривалим перебуванням у ВІТ, а також збільшенням захворюваності та смертності. Крім того, високим є економічне навантаження на систему охорони здоров’я. У світлі високих показників смертності, пов’язаних з дисфагією і спостереженням, що її систематично не перевіряють у більшості ВІТ, цей огляд описує епідеміологію, термінологію і потенційні механізми дисфагії у ВІТ. Крім того, обговорюється вплив дисфагії на окремих людей, систему охорони здоров’я і суспільство у доповнення до сучасних і майбутніх терапевтичних підходів.

Дисфагия может присутствовать у всех критических пациентов; клинические данные показывают, что постэкстубационная дисфагия (ПЭД) обычно наблюдается у пациентов отделения интенсивной терапии (ОИТ). Последние данные свидетельствуют, что дисфагия в основном сохраняется и что ее наличие независимо связано с неблагоприятными клиническими исходами, ориентированными на пациента. Хотя было предложено несколько факторов риска, возможно, способствующих развитию дисфагии, однако лежащие в основе точные механизмы у пациентов в ОИТ остаются не полностью понятными, и в настоящее время нет единого мнения о том, как наилучшим образом подходить к пациентам ОИТ группы риска (ПЭД). С клинической точки зрения дисфагия связана с повышенным риском аспирации и индуцированной аспирацией пневмонии, отсроченным возобновлением питания/недоеданием, снижением качества жизни, длительным пребыванием в ОИТ, а также с увеличением заболеваемости и смертности. Кроме того, экономическая нагрузка на систему общественного здравоохранения является высокой. В свете высоких показателей смертности, связанных с наличием дисфагии и наблюдением, что дисфагию систематически не диагностируют в большинстве ОИТ, этот обзор описывает эпидемиологию, терминологию и потенциальные механизмы дисфагии в ОИТ. Кроме того, обсуждается влияние дисфагии на отдельных пациентов, систему здравоохранения и общество в дополнение к существующим и будущим потенциальным терапевтическим подходам.

Dysphagia may present in all critically ill patients and large-scale clinical data show that e.g. post-extubation dysphagia (PED) is commonly observed in intensive care unit (ICU) patients. Recent data demonstrate that dysphagia is mostly persisting and that its presence is independently associated with adverse patient-centred clinical outcomes. Although several risk factors possibly contributing to dysphagia development were proposed; the underlying exact mechanisms in ICU patients remain incompletely understood and no current consensus exists on how to best approach to ICU patients at risk. From a clinical perspective, dysphagia is well-known to be associated with an increased risk of aspiration and aspiration-induced pneumonia, delayed resumption of oral intake/malnutrition, decreased quality of life, prolonged staying in ICU and hospital, and increased morbidity and mortality. Moreover, the economic burden on public health care systems is high. In light of high mortality rates associated with the presence of dysphagia and the observation that dysphagia is not systematically screened for on most ICUs, this review describes the epidemiology, terminology, and potential mechanisms of dysphagia in the ICU. Furthermore, the impact of dysphagia on affected individuals, health care systems, and society is discussed in addition to current and future potential therapeutic approaches.


Keywords

розлад ковтання; набута у ВІТ ковтальна дисфункція; набута у ВІТ слабкість; критичні захворювання; сепсис; огляд

расстройство глотания; приобретенная в ОИТ глотательная дисфункция; приобретенная в ОИТ слабость; критические заболевания; сепсис; обзор

deglutition disorder; ICU-acquired swallowing dysfunction; ICU-acquired weakness; critical illness; sepsis; review


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