Research report: Management of dysphagia using pharyngeal electrical stimulation in the general intensive care population – A service development

Author:

Williams Thomas1,Walkden Elizabeth234,Patel Karishma5,Cochrane Naomi E3ORCID,McGrath Brendan A346,Wallace Sarah2346ORCID

Affiliation:

1. University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, UK

2. Department of Speech, Voice and Swallowing, Wythenshawe Hospital, Wythenshawe, UK

3. Manchester University NHS Foundation Trust, Manchester, UK

4. Acute Intensive Care Unit, Wythenshawe Hospital, Wythenshawe, UK

5. The University of Manchester Medical School, Manchester, UK

6. Manchester Academic Critical Care, Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK

Abstract

Background: Dysphagia places a substantial burden on the critically ill, affecting 12%–84% of this cohort, and is independently associated with worse outcomes. Pharyngeal electrical stimulation (PES-treatment) is a novel dysphagia therapy with an emerging evidence base. This retrospective observational study describes our dysphagia service and reports the use of PES-treatment as a standard of care in recovering critically ill patients at a single-site tertiary UK hospital. Methods: Patients admitted to Acute or Cardio-Thoracic adult intensive care units between 1st July 2017 and 30th June 2022 were routinely referred to Speech and Language Therapy (SLT) following tracheostomy, or suspected dysphonia/dysphagia. Clinical assessments and direct laryngeal visualisation using Fibreoptic Evaluation of Swallowing (FEES) were performed. Severe dysphagia was defined as Penetration-Aspiration Score of ⩾6 and patients were offered PES-treatment when staffing allowed. Results: Of 289 patients with severe dysphagia, 19 underwent a course of PES-treatment with the remaining patients receiving standard care. PES-treatment patients were significantly less likely to remain nil-by-mouth (11.1% vs 62.5%, Chi2 p < 0.001) or to have an enteral feeding tube in situ at discharge from critical care (27.8% vs 62.5%, p = 0.006) than those receiving standard dysphagia care. Both groups demonstrated an improvement in Penetration-Aspiration Score at repeat FEES: PES-treatment mean difference −2.0 ( p = 0.003); non-PES-treatment −1.68 ( p < 0.001); (61% PES-treatment improved vs 40% non-PES-treatment, p = 0.09). Conclusion: Our observations suggest that PES may be effective in the general critical care population. PES may offer new treatment options for patients and healthcare staff managing severe dysphagia and its significant consequences.

Publisher

SAGE Publications

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