Abstract
In this thesis work, the rehabilitation of a patient who suffered a left temporal and cerebellar ischemic stroke will be analyzed, leaving with motor sequelae at the level of the right hemibody and swallowing disorders that were emphasized with the use of the tracheostomy as an artificial airway mechanism. and prolonged mechanical ventilation.According to the Argentine Society of Intensive Care (2020) dysphagia as an alteration of the swallowing process is one of the most frequent problems to be treated in ICUs. This disorder causes an increase in morbidity, mortality and a prolongation of hospital stay. Currently, there are no protocols or guidelines for the early detection of dysphagia in the ICU, however, in the present work the risk factors, the prevalence, the swallowing evaluation methods and the adapted rehabilitation that were carried out will be developed. to our clinical case. The main objective will be to describe the interdisciplinary work carried out jointly by the area of respiratory kinesiology and speech therapy in order to stimulate the sensitivity of the aerodigestive crossroads and the altered swallowing mechanism. To achieve this objective, a descriptive study was carried out in which all the data and the procedures that the patient went through from the beginning of the hospitalization in the Center for the Disengagement of Mechanical Ventilation and Rehabilitation were collected, their analysis and later the final conclusion from all the information gathering.
References
1. Benítez S. Manejo integral del paciente neurológico. Rev Med Clin. 2016;22:22-28.
2. Bosso M, Lovazzano P, Plotnikov G, Setten M. Cánulas de traqueostomía para adultos. Selección y cuidados. Med Intensiva. 2014;31.
3. Federación Argentina de Cardiología. FAC [Internet]. 2021 Oct 29. Disponible en: www.fac.org.ar
4. Chiappero G, Falduti A, Campora H. Detección de la disfagia en el paciente adulto con vía aérea artificial. Rev Argent Ter Intensiva. 2020;20:20-35.
5. Harrison TR, et al. Principios de medicina interna. Chile: McGraw-Hill; 2005.
6. Latarjet RL. Anatomía humana. Buenos Aires: Panamericana; 2004.
7. Lugaro M, Rizzo Vázquez A. Trastornos deglutorios luego de la extubación en UTI. Rev Argent Ter Intensiva. 2018;35:35-46.
8. Movipride. See IUC [Internet]. 2018 Oct 18. Disponible en: www.seeiuc.org
9. Naito Y, Mima H, Itaya T, Yamazaki K, Kato H. Continuous oxygen insufflation using a speaking tracheostomy tube. Anesthesiology. 1996;84:448-450.
10. Alvarez-Larruy M, Tomsen N, Guanyabens N, Palomeras E, Clavé P, Nascimento W. Spontaneous Swallowing Frequency in Post-Stroke Patients with and Without Oropharyngeal Dysphagia: An Observational Study. Dysphagia 2023;38:200–10. https://doi.org/10.1007/s00455-022-10451-3.
11. Arnold RJ, Bausek N. Effect of respiratory muscle training on dysphagia in stroke patients—A retrospective pilot study. Laryngoscope Investigative Otolaryngology 2020;5:1050–5. https://doi.org/10.1002/lio2.483.
12. Clain AE, Samia N, Davidson K, Martin-Harris B. Characterizing physiologic swallowing impairment profiles: A large-scale exploratory study of head and neck cancer, stroke, chronic obstructive pulmonary disease, dementia, and parkinson’s disease. Journal of Speech, Language, and Hearing Research 2024;67:4689–713. https://doi.org/10.1044/2024_JSLHR-24-00091.
13. de Araújo RCP, de Brito MacEdo Ferreira LM, de Almeida Godoy CM, Magalhães H. Pharyngeal phase of swallowing in post-stroke dysphagia: videoendoscopy and speech-language-hearing assessment. CODAS 2024;36. https://doi.org/10.1590/2317-1782/20242023242en.
14. Guillén-Solà A, Messaggi-Sartor M, Ramírez-Fuentes C, Marco E, Duarte E. The Retornus-2 study: impact of respiratory muscle training in subacute stroke patients with dysphagia, study protocol of a double-blind randomized controlled trial. Trials 2021;22. https://doi.org/10.1186/s13063-021-05353-y.
15. Kovács A, Szabó PT, Folyovich A. RELATIONSHIPS BETWEEN COVID-19 DISEASE, NUTRITIONAL STATUS, AND DYSPHAGIA, PARTICULARLY IN STROKE PATIENTS. Ideggyogyaszati Szemle 2021;74:367–78.
16. Li H, Zhao L, Yuan X, Zhang Q, Pang Y, Li H. Effect of transcranial direct current stimulation combined with respiratory training on dysphagia in post-stroke patients. Technology and Health Care 2023;31:11–9. https://doi.org/10.3233/THC-213234.
17. Li Z-H, Li H-M, Ai N-N. Clinical trials of Xingnao Kaiqiao needling combined with respiratory training for post-stroke dysphagia. Zhen Ci Yan Jiu 2021;46:875–9. https://doi.org/10.13702/j.1000-0607.201011.
18. Liaw M-Y, Hsu C-H, Leong C-P, Liao C-Y, Wang L-Y, Lu C-H, et al. Respiratory muscle training in stroke patients with respiratory muscle weakness, dysphagia, and dysarthria - a prospective randomized trial. Medicine (United States) 2020;99:E19337. https://doi.org/10.1097/MD.0000000000019337.
19. Liaw M-Y, Lin M-C, Leong C-P, Wang L-Y, Pong Y-P, Yang T-H, et al. Electromyographic study assessing swallowing function in subacute stroke patients with respiratory muscle weakness. Medicine (United States) 2021;100. https://doi.org/10.1097/MD.0000000000027780.
20. Maciejewska O, Kepczyńska K, Polit M, Domitrz I. Dysphagia in Ischaemic Stroke Patients: One Centre Retrospective Study. Nutrients 2024;16. https://doi.org/10.3390/nu16081196.
21. Silva A, Carmezim I, Oliveira C, Peixoto I, Vaz M, Teixeira P, et al. Dysphagia and pulmonary complications in acute cerebrovascular disease: A retrospective observational study. Rehabilitacion 2023;57. https://doi.org/10.1016/j.rh.2023.100804.
22. Terré R. Oropharyngeal dysphagia in stroke: Diagnostic and therapeutic aspects. Revista de Neurologia 2020;70:444–52. https://doi.org/10.33588/RN.7012.2019447.
23. van den Boom M. Dysphagia, 2023, p. 239–51. https://doi.org/10.1007/978-3-662-64196-5_18.
24. Wu L, Cui Y, Zhang Y, Lei S, Yang F. Systematic analysis of the effect of intensive breathing training on the application of rehabilitation for patients with post-stroke dysphagia. Chinese Journal of General Practice 2024;22:1967–70. https://doi.org/10.16766/j.cnki.issn.1674-4152.003776.
25. Zapata-Soria M, Cabrera-Martos I, Heredia-Ciuró A, Prados-Román E, Martín-Núñez J, Valenza MC. Effects of Home-Based Daily Respiratory Muscle Training on Swallowing Outcomes in Patients with Chronic Stroke: Protocol for a Randomized Controlled Trial. Journal of Clinical Medicine 2024;13. https://doi.org/10.3390/jcm13185547.
26. Zhang W, Pan H, Zong Y, Wang J, Xie Q. Respiratory Muscle Training Reduces Respiratory Complications and Improves Swallowing Function After Stroke: A Systematic Review and Meta-Analysis. Archives of Physical Medicine and Rehabilitation 2022;103:1179–91. https://doi.org/10.1016/j.apmr.2021.10.020.
27. Zidan MS, Elsayed MM, Ismail AF, Ahmed SM, Obaya HE. Expiratory Muscle Training Versus Functional Electrical Stimulation on Pulmonary and Swallowing Functions in Acute Stroke Patients. Vestnik Vosstanovitel’noj Mediciny 2023;22:30–9. https://doi.org/10.38025/2078-1962-2023-22-5-30-39.
28. Solná G, Václavík D, Pavlík O, Gwardová B, Staníková L, Komínek P. Flexible endoscopic evaluation of swallowing vs. screening tests for dysphagia and their effect on the final outcome in post-acute stroke patients. Ceska a Slovenska Neurologie a Neurochirurgie 2020;83:614–20. https://doi.org/10.48095/cccsnn2020614.
29. Xiao LJ, Guo Q, Huang FY, Liao MX, Zhang LL, Yan TB. Correlation between swallowing function and pulmonary ventilation function and respiratory muscles strength in patients with dysphagia after stroke. National Medical Journal of China 2020;100:504–8. https://doi.org/10.3760/cma.j.issn.0376-2491.2020.07.005.
30. Ramos Gómez L, Benito Vales S. Fundamentos de la ventilación mecánica. Barcelona: Marge Médica; 2012.
31. Rodríguez P, Brochard L. Ventilación mecánica asistida: hacia una mejor adaptación del respirador a las necesidades del paciente. Med Intensiva. 2008;32:28-38.
32. Ministerio de Salud de la Nación. Argentina.gob.ar [Internet]. 2021 Feb 6. Disponible en: www.argentina.gob.ar
33. Organización Mundial de la Salud. Constitución de la Organización Mundial de la Salud. En: Official Records of the World Health Organization. New York: Conferencia Sanitaria Internacional; 1946. p. 1-178.
34. Torres Castro R, Monge G, Vera R. Estrategias terapéuticas para aumentar la eficacia de la tos en pacientes con enfermedad neuromuscular. Rev Med Chile. 2014;142:238-245.
35. Uri de Jesús M, Gochicoa-Rangel L. Presiones inspiratorias y espiratorias máximas: revisión y procedimiento. Neumol Cir Torax. 2014;73:247-253.
36. Vademecum. Vademécum médico [Internet]. 2015 Feb 1. Disponible en: www.vademecum.es
37. Valega DM. Diarrea clostridial, un patógeno nosocomial a tener en cuenta. Rev Asoc Med Argent. 2020;133(3):26-30.
38. Vidal JA. Diccionario de medicina. Barcelona: Océano; 2018.
39. West JB. Fisiopatología pulmonar. Buenos Aires: Panamericana; 2004.

This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2023 Aldana Micaela Figueroa, Alejandro Patrinos (Author)