GISELE CHAGAS DE MEDEIROS
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
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- Diagnostic precision for bronchopulmonary aspiration in a heterogeneous population(2020) LIMA, Maira Santilli de; SASSI, Fernanda Chiarion; MEDEIROS, Gisele Chagas de; JAYANTHI, Shri Krishna; ANDRADE, Claudia Regina Furquim dePurpose: The purpose of the present study was to assess the validity of a simple instrument for screening dysphagia used in a large public hospital in Brazil with heterogeneous adult population. Method: The Dysphagia Risk Evaluation Protocol (DREP) - screening version contains four items (altered cervical auscultation, altered vocal quality, coughing and choking before / during / after swallowing) that were previously indicated as independent risk factors associated to the presence of dysphagia in the swallowing test with water. Trained speech therapists administered and scored DREP - screening version to consecutive patients referred by hospital's medical team to perform Video Fluoroscopic for Swallowing Study (VFSS). Results: 211 patients received the swallowing screen (DREP): 99 failed and 112 passed. One in every five patients was randomized to receive a VFSS. The DREP screening version demonstrated excellent validity with sensitivity at 92.9%, specificity at 75.0%, negative predictive values at 95.5% and an accuracy of 80.9%. Conclusion: The DREP - screening version is a simple and accurate tool to identify the risk for penetration and / or aspiration in patients who are not tube-fed, who have a good level of alertness, have no history of recurrent pneumonia, are not on pneumonia, and that do not use a tracheostomy cannula.
- Oral transit time: a critical review of the literature(2015) SOARES, Thais Jacóe; MORAES, Danielle Pedroni; MEDEIROS, Gisele Chagas de; SASSI, Fernanda Chiarion; ZILBERSTEIN, Bruno; ANDRADE, Claudia Regina Furquim deINTRODUCTION: Oral transit time is one of the parameters observed during the clinical assessment of the swallowing function. The importance of this parameter is due to its impact on the total duration of a meal, whose consequence can be an unfavorable nutritional prognostic. OBJECTIVE: To document scientific papers that measure oral transit time in healthy subjects. METHOD: The review followed the steps proposed by the Cochrane Handbook. The search was done via the PubMed database through the use of descriptors related to the oral phase of swallowing, as well as to types of food consistency. RESULTS: The articles on the theme had different definitions for oral transit time, as well as heterogeneity of tested volumes, age and gender of the participants. The times found varied from 0.35 s to 1.54 s for liquids, from 0.39 s to 1.05 s for pasty foods and from 1 s to 12.8 s for solid foods. Also, regardless of volume or consistency, oral transit time in elderly people is significantly longer than in adults. CONCLUSION: There's no consensus in the literature about oral transit time in healthy subjects. However, this parameter should be valued during the assessment of the swallowing function due to its negative impact on the dynamics of swallowing, which can cause high energy expenditure during feeding.
- Clinical dysphagia risk predictors after prolonged orotracheal intubation(2014) MEDEIROS, Gisele Chagas de; SASSI, Fernanda Chiarion; MANGILLI, Laura Davison; ZILBERSTEIN, Bruno; ANDRADE, Claudia Regina Furquim deOBJECTIVES: To elucidate independent risk factors for dysphagia after prolonged orotracheal intubation. METHODS: The participants were 148 consecutive patients who underwent clinical bedside swallowing assessments from September 2009 to September 2011. All patients had received prolonged orotracheal intubations and were admitted to one of several intensive care units of a large Brazilian school hospital. The correlations between the conducted water swallow test results and dysphagia risk levels were analyzed for statistical significance. RESULTS: Of the 148 patients included in the study, 91 were male and 57 were female (mean age, 53.64 years). The univariate analysis results indicated that specific variables, including extraoral loss, multiple swallows, cervical auscultation, vocal quality, cough, choking, and other signs, were possible significant high-risk indicators of dysphagia onset. The multivariate analysis results indicated that cervical auscultation and coughing were independent predictive variables for high dysphagia risk. CONCLUSIONS: Patients displaying extraoral loss, multiple swallows, cervical auscultation, vocal quality, cough, choking and other signs should benefit from early swallowing evaluations. Additionally, early post-extubation dysfunction recognition is paramount in reducing the morbidity rate in this high-risk population.
- Criteria for tracheostomy decannulation: literature review(2019) MEDEIROS, Gisele Chagas de; SASSI, Fernanda Chiarion; LIRANI-SILVA, Camila; ANDRADE, Claudia Regina Furquim dePurpose: To perform a literature review on the existing international criteria and protocols for tracheostomy decannulation. Research strategies: Literature review using the PubMed database with the English keywords ""Tracheostomy"", ""Weaning"", ""Decannulation"", ""Removal Tube"", ""Speech, Language and Hearing Sciences"", ""Intensive Care Units"", ""Dysphagia"", ""Swallowing"", ""Deglutition"" and ""Deglutition Disorders "". Selection criteria: Studies published in the last five years (2012 to 2017); studies with human adult population (i.e. ages above 18 years); articles published in English; unrestricted full access articles; and research related to the objectives of the study. Data analysis: we analyzed sample characterization; professionals involved in the decannulation process; steps of the decannulation process; total time in days of tracheostomy use; total time in days to complete decannulation process; and failure factors to complete the decannulation process. Results: Most of the studies investigated tracheostomy decannulation in a sample of males with neurological impairments. The professionals involved in the decannulation process were doctors, speech therapists, physiotherapists and nurses. The most cited decannulation steps were: swallowing assessment; occlusion training; evaluation of air permeability; ability to manipulate secretion and exchange of cannula; cuff deflation and cough training; use of speech valve. Conclusion: Speech therapists are of great help during the decannulation process, since the assessment of swallowing was one of the decisive steps of the investigated studies. The processes of decannulation includes a multidisciplinary approach and should be performed by the cooperation between physicians, physiotherapists and speech therapists.