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Patient perspectives of dysphagia following critical illness and artificial airway use Fullerton, Geoff


Patients requiring artificial airways and prolonged mechanical ventilation while in critical care frequently suffer from various iatrogenic complications during and after hospitalization. One of these is dysphagia, or disordered swallowing, which can affect over 90% of this population. Patients unable to swallow safely are often at risk of other adverse sequelae, including serious pulmonary complications. Intervention may necessitate tube feeding and/or modified food and/or liquid; as a result, the treatments necessary to sustain life during critical illness may affect psychosocial well-being and quality of life. To date, no study has examined the perspectives of patients with dysphagia following critical illness and artificial airway use. Using a prospective study design, we recruited a convenience sample of patients who had swallowing impairment following artificial airway use from three healthcare facilities in a single health care region. Four patients were recruited to this study from January to April 2021. Using a semi-structured interview format, one interviewer explored their experiences. Following interview transcription, results were analyzed thematically by two reviewers. We identified several common themes reflecting participants’ beliefs and values around eating and drinking, in the context of: 1) connectedness with family, 2) recovery and overall health, and 3) personal autonomy and dignity. We further identified latent patient perceptions of swallowing and instrumental assessment – in particular that swallowing was a volitional action, and that assessments were a test of ability with a binary outcome. This study is the first to investigate the perspectives of a sample of this population. As communication specialists, S-LPs have a vital role to play in fostering effective multi-directional communication between all members of the care team, including the patient and their family. Understanding this role within the context of these patients’ perspectives will enable clinicians to deliver enhanced patient-centered care.

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