探索国际言语治疗师在评估和管理接受高流量鼻氧治疗的成人吞咽功能时的实践方法与观点：一项焦点小组研究。

文献信息

中文摘要

背景： 言语治疗师（SLTs）被公认为成人重症监护多学科团队的关键成员，并且最近开始评估和管理接受高流量鼻氧（HFNO）治疗的成人的吞咽功能。HFNO是一种无创呼吸支持，可提供稳定的吸入氧浓度，范围为0.21至1.0，流速为15-60升/分钟。尽管HFNO在重症监护中常规使用，且SLTs推测HFNO对口咽吞咽有影响，但文献中关于潜在影响的证据和共识有限。因此，对于该患者队列的吞咽困难管理，没有明确的指南或实践模式。对于SLTs如何解读和应用现有文献到他们的实践模式中，了解有限。
目的： 这项定性研究的目的是探讨国际SLTs在评估和管理接受HFNO治疗的成人口咽吞咽功能时的实践方法和观点。
方法与程序： 参与者为具有至少两年重症监护工作经验的SLTs。进行了三个在线焦点小组，由来自六个国家的18名参与者组成。参与者被问及他们当前的实践、观点、考虑因素以及对评估和管理接受HFNO治疗的成人时的挑战和机遇的看法。使用归纳内容分析来分析数据。
结果： 确定了六个内容类别：“个体化和整体化考虑患者”、“评估程序类型”、“HFNO对口咽吞咽的影响”、“评估接受HFNO治疗的成人时的考虑因素”、“当前知识和实践状况”以及“协作与沟通”。进一步衍生出15个子类别。
结论： 这项研究发现，SLTs担心缺乏证据来指导接受HFNO治疗患者的吞咽困难的评估和管理。研究应侧重于阐明不同流速如何影响吞咽功能。这将有助于建立接受HFNO治疗患者吞咽筛查、评估和管理的最佳实践方法。
本文的贡献： 关于这个主题已经知道什么高流量鼻氧（HFNO）越来越多地用于治疗危重成人，然而HFNO对口咽吞咽的影响尚未完全确定。言语治疗师（SLTs）现在常规融入重症监护多学科团队，并评估接受HFNO治疗的成人。据作者所知，此前没有研究深入探讨评估和管理接受HFNO治疗的成人口咽吞咽功能的重症监护SLTs的观点。本文对现有知识的补充这是第一项探讨国际SLTs在评估和管理接受HFNO治疗的成人口咽吞咽功能时的观点和实践的定性研究。这项研究提供了关于目前国际上SLTs如何评估和管理口咽吞咽的宝贵见解，并为该领域的未来研究提供了指导。这项工作的潜在或实际临床意义是什么？这项研究的结果表明临床实践存在差异，并强调了在该患者群体中评估和管理的不确定性。一些参与者强调了仪器评估在支持临床决策中的价值。这项研究发现，目前没有针对接受HFNO治疗的成人的筛查和综合评估的标准化方案或指南。需要进一步研究来指导此类方案和指南的制定，以实现最佳实践。

英文摘要

BACKGROUND: Speech language therapists (SLTs) are recognised as key members of the multidisciplinary team in adult critical care and have more recently been assessing and managing swallowing with adults on high-flow nasal oxygen (HFNO). HFNO is a non-invasive respiratory support that delivers a stable fraction of inspired oxygen ranging from 0.21 to 1.0 with flow rates of 15-60 litres per min. Despite HFNO being used routinely in critical care and SLTs postulating an effect of HFNO on oropharyngeal swallowing, there is limited evidence and consensus of potential effects in the literature. Subsequently, there are no clear guidelines or practice patterns for managing dysphagia in this patient cohort. There is limited understanding of how SLTs are interpreting and applying the available literature to their practice patterns.
AIM: The aim of this qualitative study was to explore international SLTs' practice approaches and opinions when assessing and managing oropharyngeal swallowing in adults on HFNO.
METHODS & PROCEDURES: Participants were SLTs with at least two years of experience working in critical care. Three online focus groups consisting of 18 participants from six countries were conducted. The participants were asked about their current practices, opinions, considerations, and perceptions of challenges and opportunities when assessing and managing adults on HFNO. Inductive content analysis was used to analyse the data.
OUTCOMES & RESULTS: Six content categories were identified; 'consider the patient individually and holistically', 'types of assessment procedures', 'impact of HFNO on oropharyngeal swallowing', 'considerations when assessing adults on HFNO', 'current knowledge and practice landscape', and 'collaboration and communication'. A further 15 subcategories were derived.
CONCLUSION: This research has identified concerns amongst SLTs that there is a lack of evidence to guide assessment and management of dysphagia in patients receiving HFNO. Research efforts should focus on clarifying how different flow rates impact swallowing function. This would help establish best-practice approaches for screening, assessing, and managing swallowing in patients receiving HFNO.
WHAT THIS PAPER ADDS: What is already known on this subject High-flow nasal oxygen (HFNO) is being used more frequently to treat critically-ill adults, however the impact of HFNO on oropharyngeal swallowing has not been fully established. Speech and language therapists (SLTs) are now routinely integrated into the multidisciplinary team in critical care and assess adults on HFNO. To the authors knowledge, no study has previously explored in-depth the perspectives of critical care SLTs who assess and manage oropharyngeal swallowing in adults on HFNO. What this paper adds to the existing knowledge This is the first qualitative study exploring international SLTs opinions and practices when assessing and managing oropharyngeal swallowing in adults on HFNO. This study provides valuable insights into how oropharyngeal swallowing is currently being assessed and managed internationally by SLTs and provides guidance on future research in this area. What are the potential or actual clinical implications of this work? Findings from this study demonstrate variability in clinical practice and highlights uncertainty regarding assessment and management in this patient population. Some participants emphasised the value of instrumental assessment in supporting clinical decision making. This study identified that there are currently no standardised protocols or guidelines for the screening and comprehensive assessment for adults on HFNO. Further research is needed to guide the development of such protocols and guidelines to enable best practice.