Evaluación Clínica de la Deglución con Líquidos

Summary

This clinical tutorial focuses on assessing swallowing in patients post-extubation, particularly those with respiratory difficulties. It highlights the importance of monitoring respiratory function during eating, observing the coordination between swallowing and breathing, and evaluating the risk of aspiration. The assessment progresses from administering clear liquids via syringe to independent drinking with a straw, and finally, drinking from a glass. The goal is to ensure the patient can swallow safely, without aspiration, and to tailor rehabilitation or dietary interventions based on the findings.

Takeaways

• 😀 Effective assessment of swallowing involves observing coordination between breathing and swallowing, especially in patients with respiratory difficulties.
• 😀 Post-extubation patients may have increased risk of aspiration due to compromised swallowing coordination.
• 😀 Clinical monitoring, including pulse oximetry, is crucial to detect early signs of aspiration or respiratory complications.
• 😀 The saturation level should drop by at least 24% in case of aspiration, which signals the need for close monitoring.
• 😀 Water is often the first liquid used in swallowing assessments to evaluate the patient's ability to swallow safely and detect potential risks.
• 😀 During the evaluation, the patient's swallowing reflex and aspiration risk are monitored, paying close attention to their ability to manage the liquid.
• 😀 The clinician can gradually increase the volume of liquids during the assessment to assess swallowing capacity in a stepwise manner.
• 😀 Special attention is given to how the patient manages liquid intake, such as with a syringe or straw, which helps evaluate control and coordination.
• 😀 The use of a straw or bottle is tested to see if the patient can independently manage the liquid and maintain coordination during swallowing.
• 😀 A final evaluation involves the patient drinking directly from a cup, with continued monitoring for signs of aspiration and any changes in their vital signs.

Q & A

What is the main focus of the clinical swallowing evaluation described in the script?

The main focus is to assess the coordination of swallowing with respiration in a post-coital patient with respiratory difficulties, identifying potential risks such as aspiration.

Why is the coordination between respiration and swallowing important in these cases?

Coordination is crucial because difficulties in breathing, especially during feeding, can lead to disorganized swallowing and increase the risk of aspiration.

What role does extubation play in the evaluation process?

Extubation can cause secondary dysphagia, where the content might unintentionally enter the airway and potentially reach the lung parenchyma, leading to aspiration risks. The patient's vital signs should be monitored during this stage.

How is aspiration risk monitored during the evaluation?

Aspiration risk is monitored using pulse oximetry. If there's secondary bronchoconstriction or aspiration, the oxygen saturation levels are expected to drop by at least 24%.

What is the first step in the swallowing assessment with liquids?

The first step is to assess swallowing using clear liquids, such as water, typically administered through a syringe. The patient's ability to swallow, the reflex time, and aspiration signs are observed.

What specific actions are taken when administering water through a syringe?

The patient is instructed to take the syringe tip as if it were a straw, positioning the lips accordingly. After administering 12 ml of water, the swallowing reflex and aspiration risk are evaluated.

Why is the patient's head positioning important during the swallowing assessment?

The head position helps in assessing control over the posterior part of the mouth and ensuring that there is no posterior leakage during the swallow, which could lead to aspiration.

What is the purpose of using a straw or a similar device in the evaluation?

Using a straw helps to assess the patient's independent control over the suction process and coordination of swallowing with respiration. It also allows for visual monitoring of the liquid intake.

How does the evaluation process progress after the initial steps?

If the initial tests show no signs of aspiration, the evaluation progresses to more independent liquid intake, such as using a straw or drinking directly from a glass, all while monitoring the patient's control over swallowing and respiratory coordination.

What happens if the patient demonstrates difficulties during the evaluation?

If difficulties are identified, the clinician must consider how to compensate for those issues or plan a rehabilitation process to address the swallowing dysfunction.