Introdução da fonoaudiologia e da alimentação oral para pacientes adultos na UTI: critérios técnicos e subjetivos

Abstract

In speech therapy and deglutition rehabilitation, an early intervention is usually recommended. In Brazil, the decisions of beginning treatment with a speech therapist, in the Adult Intensive Care Unit (ICU), are recent. This study has tried to thoroughly examine some questions referring to the beginning of a speech therapist's evaluation as well as his/her intervention in the ICU and the criteria that determine when to introduce a diet by oral means. The methodology used was the gathering of data from specialized literature, interviews with speech therapists and medical doctors describing their experiences and the description of two clinic cases that illustrate the discussed themes. As a result, we may conclude that despite the consensus of recommending patients to start speech therapy as soon as possible, the professional practice of the speech therapist in an Adult ICU, until the present moment, is still restricted and characterized by divergent concepts and experiences. Many criteria that define the possibility of initiating therapy are consensual: clinic state, stable metabolic, respiratory and cardiac systems, as well as preserved cognition. Indirect intervention is still controversial regarding its objective and efficiency. For the beginning of a functional evaluation, besides the criteria mentioned above, the use of mechanical ventilation and insufflated cuff most of the time is considered to be an obstacle. This study has lead us to question the standardization of strict conduct at the detriment of broader evaluations that include subjective aspects of patients in speech therapy interventions and in the oral introduction of food in ICU patients