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Master Thesis

Réa-val : étude pilote de dépistage des troubles de la déglutition en réanimation neurochirurgicale

Abstract : There are various tests that can be used to screen oropharyngeal dysphagia (OPD) depending on the populations studied. Post-extubation dysphagia is being explored more and more in the face of the increase in morbidity and mortality, the medical and financial consequences it brings. However, there is no screening test for these disorders in patients with brain injury in neurosurgical-intensive care unit (ICU). The purpose of this pilot study was to conduct a feasibility study of a new OPD screening test in this population. Methods : A prospective analysis was performed in brain-injured patients hospitalized in neurosurgical-ICU, intubated for more than 72 hours. Screening for OPD at 24 hours from extubation with a new analysis protocol in bedside patients was performed. The protocol consisted of associating a V-VST, a recognized and validated test in the OPD in patients with stroke, to a GuSS-ICU, designed for the population in ICU except neurological-ICU. Sociodemographic and clinical datas were collected to highlight predictive factors of dysphagia. Results : Among the 55 hospitalized patients, about 25% of patients were eligible. 70% of the examined patients had OPD at 24 hours, contraindication per os, with a risk of major complications. Contrary to the service protocole in which 20% couldn’t be examined, the others were examined between 1 to 5 days after their extubation. We were able to screen them all at 24 hours, by all the staff, without any complication. We propose a feasible, secured protocol. It is necessary to continue the study with patient follow-up in order to have a sensitivity analysis, and favoring factors, which were not analyzed in this study. This test doesn’t replace a specialized evaluation but could answer the question of refeeding if it is normal, and the thoughtful realization of an instrumented exploration in case of failure.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-02320408
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Submitted on : Friday, October 18, 2019 - 4:36:10 PM
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Rémi Mallart. Réa-val : étude pilote de dépistage des troubles de la déglutition en réanimation neurochirurgicale. Médecine humaine et pathologie. 2019. ⟨dumas-02320408⟩

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