POST EXTUBATION DYSPHAGIA AND NURSING CARE

Abstract

Post extubation dysphagia is defined as dysphagia that develops within 48 hours after extubation in patients without a history of neuromuscular disease or dysphagia. The prevalence of post extubation dysphagia varies between 3% and 62% depending on factors such as intubation and extubation process, materials used and their properties, duration of intubation, patient age, and chronic diseases. This condition, which is especially common in patients intubated for long periods in intensive care units, leads to undesirable side effects. In more than 80% of patients with post extubation dysphagia hospitalized in intensive care, dysphagia persists throughout their hospital stay, and in 60% dysphagia persists even after discharge. Post extubation dysphagia may cause complications such as aspiration, pneumonia, malnutrition, dehydration, and delayed initiation of oral feeding. Post-extubation dysphagia is a risk factor that increases mortality and may prolong hospital stays. Therefore, early diagnosis of post extubation dysphagia is of critical importance. For this purpose, post extubation dysphagia screening should be performed at least 3 hours and no later than 24 hours after extubation. Nurses have an important role in screening for dysphagia in the evaluation performed with a multidisciplinary approach. Nurses, who play an active role in the early diagnosis and management of dysphagia; by giving individualized care such as oral motor exercises, salivary gland massage, positioning, and nutritional regulation, they contribute to the faster recovery of patients after extubation, facilitate the transition to oral intake, and reduce complications.

Keywords

• Intensive Care
• Nursing
• Post extubation Dysphagia

POST EKSTÜBASYON DİSFAJİSİ VE HEMŞİRELİK BAKIMI

Öz

Post ekstübasyon disfajisi, nöromüsküler hastalığı veya disfaji öyküsü olmayan hastalarda ekstübasyondan sonraki 48 saat içinde gelişen yutma güçlüğü olarak tanımlanmaktadır. Entübasyon ve ekstübasyon süreci, kullanılan malzemeler ve özellikleri, entübasyon süresi, hasta yaşı, kronik hastalıklar gibi faktörlere bağlı olarak post ekstübasyon disfaji prevalansı %3 ila %62 arasında değişmektedir. Özellikle yoğun bakım ünitelerinde uzun süreli entübe edilen hastalarda yaygın olarak görülen bu durum, istenmeyen yan etkilere yol açmaktadır. Yoğun bakımda yatan post ekstübasyon disfajisi gelişen hastaların %80’inden fazlasında disfaji, hastanede kaldıkları süre boyunca devam etmekte ve %60’ında taburculukları sonrasında da sürmektedir. Post ekstübasyon disfajisi; aspirasyon, pnömoni, yetersiz beslenme, dehidratasyon, oral beslenmeye geç başlanması gibi komplikasyonlara neden olabilmektedir. Post ekstübasyon disfajisi, mortaliteyi artıran bir risk faktörü olup hastane kalış süresini uzatabilmektedir. Bu nedenle, post ekstübasyon disfajisinin erken dönemde tanılanması kritik bir önem taşımaktadır. Bu amaçla post ekstübasyon disfaji taraması, ekstübasyondan en az 3 saat, en geç 24 saat sonra yapılmalıdır. Multidisipliner yaklaşımla yapılan değerlendirmelerde hemşireler, yutma güçlüğünü taramada önemli bir role sahiptir. Disfajinin erken tanılanması ve yönetiminde etkin rol oynayan hemşireler; oral motor egzersizler, tükürük bezi masajı, pozisyon verme ve beslenme düzenlemesi gibi bireyselleştirilmiş bakım sağlayarak hastaların ekstübasyon sonrası daha hızlı iyileşmesine, oral alıma geçişin kolaylaşmasına ve komplikasyonların azaltılmasına katkı sağlamaktadır.

Anahtar Kelimeler

• Hemşirelik
• Post Ekstübasyon Disfajisi
• Yoğun Bakım

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