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Cited by 91Dysphagia Assessment and ManagementVoice and Speech DisordersClinical Nutrition and Gastroenterology

Interventions for oropharyngeal dysphagia in acute and critical care: a systematic review and meta-analysis

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Duncan, Sallyanne, McAuley, Daniel F., Walshe, Margaret, McGaughey, Jennifer, Anand, Rohan, Fallis, Richard, Blackwood, Bronagh·2020·Intensive Care Medicine
DOI 10.1007/s00134-020-06126-yPMC PMC7334257
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Abstract

To determine the effectiveness of dysphagia interventions compared to standard care in improving oral intake and reducing aspiration for adults in acute and critical care. We searched electronic literature for randomised and quasi-randomised trials and bibliography lists of included studies to March 2020. Study screening, data extraction, risk of bias and quality assessments were conducted independently by two reviewers. Meta-analysis used fixed effects modelling. The systematic review protocol is registered and published. We identified 22 studies (19 stroke, 2 intensive care stroke and 1 general intensive care) testing 9 interventions and representing 1700 patients. Swallowing treatment showed no evidence of a difference in the time to return to oral intake ( n = 33, MD (days) − 4.5, 95% CI − 10.6 to 1.6, 1 study, P = 0.15) (very low certainty) or in aspiration following treatment ( n = 113, RR 0.79, 95% CI 0.44 to 1.45, 4 studies, I 2 = 0%, P = 0.45) (low certainty). Swallowing treatment showed evidence of a reduced risk of pneumonia ( n = 719, RR 0.71, 95% CI 0.56 to 0.89, 8 studies, I 2 = 15%, P = 0.004) (low certainty) but no evidence of a difference in swallowing quality of life scores ( n = 239, MD − 11.38, 95% CI − 23.83 to 1.08, I 2 = 78%, P = 0.07) (very low certainty). There is limited evidence for the effectiveness of swallowing treatments in the acute and critical care setting. Clinical trials consistently measuring patient-centred outcomes are needed.

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  • Enteral feeding strategies may be needed when aspiration risk is high in acute stroke.

    “Early screening and structured dysphagia management improve outcomes (Arnold et al., 2016; Martino et al., 2005), and enteral feeding strategies may be needed when aspiration risk is high (Duncan et al., 2020; Geeganage et al., 2012).”

    From Autonomic nervous system and gastrointestinal manifestations with an emphasis on gastric dysfunction (2026) · cites this paper as Duncan et al., 2020

    The Discussion (page unavailable) mentions tube-feeding cessation in studies of tracheostomised acute stroke patients, and the Introduction discusses aspiration as a symptom of dysphagia. The paper does not say that high aspiration risk is an indication for enteral feeding or recommend an enteral feeding strategy. (LLM, conf=0.72)

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References 65 · Cited by 91

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Authors
Duncan, S., McAuley, D. F., Walshe, M., McGaughey, J., Anand, R., Fallis, R., & Blackwood, B.
Affiliations
  • Queen's University Belfast (GB)
  • Trinity College Dublin (IE)
Corresponding author
Duncan, Sallyanne
ORCID
Venue
Intensive Care Medicine
Publisher
Springer Science and Business Media LLC
Published
2020-06-08
Volume
46
Issue
7
Pages
1326-1338
ISSN
  • 0342-4642 (ISSN-L)
  • 1432-1238
DOI
10.1007/s00134-020-06126-y
PMC
PMC7334257
OpenAlex
W3027450625
Cited by
91
References
65
Citations by year
2026: 6 · 2025: 12 · 2024: 20 · 2023: 20 · 2022: 19 · 2021: 11 · 2020: 3
FWCI
3.20
Type
journal article
Language
en
Open access
Licence
Locations
  • Intensive Care Medicine (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • Ulster University Research Portal (Ulster University) (acceptedVersion, cc-by-nc)
  • Research Portal (Queen's University Belfast) (submittedVersion, cc-by)
  • Arrow@dit (Dublin Institute of Technology) (submittedVersion, cc-by-nc-sa)
  • Trinity's Access to Research Output (TARA) (Trinity College Dublin) (submittedVersion)
  • Lenus, The Irish Health Repository (Dr Steevens Hospital Library) (submittedVersion)
Funders
Public Health Agency Northern Ireland ((EAT/5382/17))
Topics
  • Health Sciences › Health Professions › Speech and Hearing › Dysphagia Assessment and Management
  • Health Sciences › Medicine › Physiology › Voice and Speech Disorders
  • Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
Keywords
oropharyngeal dysphagia, dysphagia management, aspiration, oral intake, stroke, intensive care, pneumonia, swallowing quality of life
MeSH terms
Adult, Critical Care, Deglutition Disorders, Humans, Pneumonia, Quality of Life, Stroke

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