• da Silva Paulo Sergio Lucas PSL Pediatric Intensive Care Unit, Department of Pediatrics, Hospital Estadual de Diadema, São Paulo, Brazil., Nádia Lais Lobrigate, and Fonseca Marcelo Cunio Machado MCM Health Technology Assessment Unit, Federal University of São Paulo (UNIFESP), São Paulo, Brazil..
• Pediatric Intensive Care Unit, Department of Pediatrics, Hospital Estadual de Diadema, São Paulo, Brazil.
• Pediatr Crit Care Me. 2018 Oct 1; 19 (10): e538-e546.

ObjectivesPostextubation dysphagia is common and associated with worse outcomes in the PICU. Although there has been an increased participation of speech-language pathologists in its treatment, there is limited evidence to support speech-language pathologists as core PICU team member. We aimed to assess the impact of speech-language pathologists interventions on the treatment of postextubation dysphagia.DesignA quasi-experimental prospective study. In the historical group (controls), patients received a standard care management for dysphagia whereas the intervention group was routinely treated by speech-language pathologists.SettingPICU of a tertiary hospital.PatientsChildren who were endotracheally intubated for a period greater than 24 hours with greater oral intake limitation as defined by a Functional Oral Intake Scale less than or equal to 3.InterventionRoutine speech-language pathologist assessment.Measurements And Main ResultsA total of 74 patients were enrolled to receive intervention (January 2015 to December 2016) and 41 patients to the historical group (January 2014 to December 2014). There were no differences in the demographic and clinical characteristics. The historical group had both longer time to initiate oral intake (7 vs 4 d; p = 0.0002; hazard ratio, 2.33) and to reach full oral intake compared with intervention group (9 vs 13 d; p < 0.001; hazard ratio, 2.51). A total of 32 controls (78%) and 74 intervention patients (100%) were on total oral intake at discharge (p ≤ 0.001). Three of nine control patients were feeding tube dependent at hospital discharge. Also, controls had a longer length of hospital stay (25 vs 20 d) and a higher rate of reintubation when compared with those patients of intervention group (10% vs 2%).ConclusionsIncorporating speech-language pathologists in the routine management of postextubation dysphagia can result in faster functional improvement and favorable patient outcomes. Yet, further and larger studies in pediatric dysphagia are required to support the related interventions and strategies to guide clinical practice.

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