ABSTRACT Purpose Oropharyngeal dysphagia (OD) is one of the possible outcomes in patients hospitalized with COVID-19 and also in the population hospitalized for the treatment of cardiovascular disease. Thus, knowing the predictive risk factors for OD may help with referral and early intervention. This study aimed to verify the association of different factors with OD in hospitalized individuals with cardiovascular disease and COVID-19. Methods Cross-sectional clinical study approved by the Research Ethics Committee (4,521,771). Clinical evaluation of swallowing was carried out in 72 adult patients with cardiovascular disease and COVID-19 hospitalized from April to September 2020. Individuals under 18 years of age and without previous cardiovascular disease were excluded. The presence of general clinical and/or neurological complications, pronation, stay in the intensive care unit (ICU), orotracheal intubation (OTI), tracheostomy tube, oxygen support and age were considered as predictive risk factors for oropharyngeal dysphagia. Fisher's exact test, Mann Whitney test and logistic regression model were used for analysis. Results General clinical complications (p=0.001), pronation (p=0.003), ICU stay (p=0.043), in addition to the need for oxygen supplementation (p=0.023) and age (p= 0 .037) were statistically significant factors associated. The pronation (0.013) and age (0.038) were independently associated with dysphagia. OTI (p=0.208), tracheostomy (p=0.707) and the presence of previous cerebrovascular accidents (p=0.493) were not statistically significant. Conclusion In this study, age and prone position were factors independently associated with oropharyngeal dysphagia, complications such as the need for oxygen supplementation, in addition to the need for ICU admission, were also associated factors in the population. (OD COVID19 COVID 19 COVID-1 Thus intervention COVID19. 19. Crosssectional Cross sectional 4,521,771. 4521771 4,521,771 . 4 521 771 (4,521,771) 7 2020 1 excluded andor or ICU, , (ICU) OTI, (OTI) tube Fishers Fisher s analysis p=0.001, p0001 p p=0.001 001 (p=0.001) p=0.003, p0003 p=0.003 003 (p=0.003) p=0.043, p0043 p=0.043 043 (p=0.043) p=0.023 p0023 023 (p=0.023 p= (p .037 037 0.013 0013 013 (0.013 0.038 0038 038 (0.038 p=0.208, p0208 p=0.208 208 (p=0.208) p=0.707 p0707 707 (p=0.707 p=0.493 p0493 493 (p=0.493 admission COVID1 COVID- 452177 4,521,77 52 77 (4,521,771 202 (ICU (OTI p000 p=0.00 00 (p=0.001 (p=0.003 p004 p=0.04 04 (p=0.043 p=0.02 p002 02 (p=0.02 .03 03 0.01 01 (0.01 0.03 (0.03 p020 p=0.20 20 (p=0.208 p=0.70 p070 70 (p=0.70 p=0.49 p049 49 (p=0.49 45217 4,521,7 5 (4,521,77 p00 p=0.0 (p=0.00 (p=0.04 (p=0.0 .0 0.0 (0.0 p02 p=0.2 2 (p=0.20 p=0.7 p07 (p=0.7 p=0.4 p04 (p=0.4 4521 4,521, (4,521,7 p0 p=0. (p=0. 0. (0. (p=0.2 452 4,521 (4,521, p=0 (p=0 (0 45 4,52 (4,521 ( 4,5 (4,52 4, (4,5 (4, (4

Abstract Some conditions consolidated as risk factors for oropharyngeal dysphagia have already been identified in other diseases, such as neurological. Studies on cardiovascular diseases concentrate in individuals in the postoperative period; thus, it is unknown if these same factors occur in individuals hospitalized for clinical or surgical treatment of these diseases. Objective to correlate predictive risk factors for oropharyngeal dysphagia in individuals with cardiovascular disease admitted at a reference cardiology hospital. Methodology This is a retrospective clinical study. Medical records of 175 individuals hospitalized for clinical and/or surgical treatment at a reference cardiology hospital from January to June 2017, attendants of the Speech-Language Pathology and Nutrition team, were analyzed. Of these, 100 records were included in the study: 41 females and 59 males (mean age 67.56 years). Deaths and individuals from 0 to 18 years were excluded. Stroke, malnutrition, age and prolonged orotracheal intubation were considered predictive risk factors for oropharyngeal dysphagia. Mann-Whitney test and Fisher's test were used for statistical analysis. Results Stroke (OR=2.93 p=0.02), malnutrition (OR=2.89 p=0.02) and prolonged orotracheal intubation (OR=3.94 p=0.02) were statistically significant predictors for oropharyngeal dysphagia within this population. Age below 80 years was not significant (p=0.06), but within octogenarians, significance was found (p=0.033). Conclusion Stroke, malnutrition, prolonged orotracheal intubation and age > 80 years are predictive risk factors for oropharyngeal dysphagia in adult population with cardiovascular diseases.

RESUMO Objetivo Este estudo tem o objetivo de identificar as evidências de validade baseadas no conteúdo e nos processos de resposta de um instrumento de Rastreamento para disfagia orofaríngea no Acidente Vascular Encefálico (RADAVE). Método Os critérios para elaborar os itens do instrumento foram baseados na revisão de literatura. Um grupo de juízes com 19 profissionais distintos e da área da saúde avaliaram a relevância e representatividade das questões e o resultado foi analisado por meio do índice de validade de conteúdo (IVC). Para evidência de validade baseada nos processos de resposta, 23 profissionais da saúde aplicaram o instrumento e analisaram as questões por meio de escala estruturada e entrevista cognitiva. Resultados O RADAVE foi estruturado para ser aplicado em duas etapas. A primeira versão foi constituída por 18 questões na etapa I e 11 questões na etapa II. Oito questões da etapa I e quatro questões da etapa II não atingiram o IVC mínimo, sendo realizadas reformulações pelos autores. A entrevista cognitiva demonstrou a necessidade de novos ajustes que resultaram na versão final com 12 questões na Etapa I e seis questões na Etapa II. Conclusão Foi possível desenvolver um instrumento de rastreamento para a disfagia no Acidente Vascular Encefálico com adequadas evidências de validade baseadas no conteúdo e nos processos de resposta. As duas evidências de validade obtidas até o momento permitiram ajustar o instrumento em relação ao seu constructo. Os próximos estudos irão analisar as demais evidências de validade e as medidas de acurácia.

ABSTRACT Purpose The aim of the present study was to identify the evidence of validity based on the content and response process of the Rastreamento de Disfagia Orofaríngea no Acidente Vascular Encefálico (RADAVE; “Screening Tool for Oropharyngeal Dysphagia in Stroke”). Methods The criteria used to elaborate the questions were based on a literature review. A group of judges consisting of 19 different health professionals evaluated the relevance and representativeness of the questions, and the results were analyzed using the Content Validity Index. In order to evidence validity based on the response processes, 23 health professionals administered the screening tool and analyzed the questions using a structured scale and cognitive interview. Results The RADAVE structured to be applied in two stages. The first version consisted of 18 questions in stage I and 11 questions in stage II. Eight questions in stage I and four in stage II did not reach the minimum Content Validity Index, requiring reformulation by the authors. The cognitive interview demonstrated some misconceptions. New adjustments were made and the final version was produced with 12 questions in stage I and six questions in stage II. Conclusion It was possible to develop a screening tool for dysphagia in stroke with adequate evidence of validity based on content and response processes. Both validity evidences obtained so far allowed to adjust the screening tool in relation to its construct. The next studies will analyze the other evidences of validity and the measures of accuracy.

RESUMO O objetivo deste estudo foi identificar e analisar, por meio de levantamento bibliográfico, a atuação fonoaudiológica em Unidades de Terapia Intensiva Neonatal (UTINs) em casos de cardiopatia congênita. Como fonte de dados foram utilizadas as seguintes plataformas: Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Medical Literature Analysis and Retrieval Sistem on-line (MEDLINE), Scielo e o serviço de pesquisa da National Library of Medicine nas bases de dados Pubmed, sistema de procura do Google Acadêmico (HTTP//scholar.google.com.br). Foram pesquisados trinta e dois trabalhos, sendo a atuação fonoaudiológica em UTINs descrita em vinte e oito deles, os quais apresentam como procedimentos avaliação e estimulação do sistema sensório-motor-oral, com uso de técnicas de sucção não-nutritiva e nutritiva, além de triagem auditiva. Porém, as características dos neonatos com cardiopatia congênita e a inserção do fonoaudiólogo em UTIN cardíaca não são citadas, pouco se caracterizando os objetivos e a prática desse profissional. Apenas uma publicação obedeceu aos critérios de inclusão do presente estudo. Trata-se de um trabalho que descreve a transição da alimentação enteral direta para o seio materno em recém-nascidos pré-termo cardiopatas, com idade corrigida, em um centro de terapia intensiva neonatal. Foi possível constatar então a escassez de trabalhos publicados sobre intervenção fonoaudiológica com RN cardiopatas, o que indica a necessidade de novos estudos sobre o tema, já que a atenção a esses pacientes deve ser diferenciada, visto que apresentam particularidades que podem comprometer o desempenho na alimentação.

ABSTRACT The purpose of this study is to identify and analyze, through bibliographical survey, the use of speech therapy care in Neonatal Intensive Care Unit (NICU) in cases of newborns with congenital heart disease. The source data is from Latin American and Caribbean Health Sciences (LILACS), Medical Literature Analysis and Retrieval System Online (MEDLINE), SciELO and the search engine of the National Library of Medicine in the databases PubMed, also the Google Scholar search system (http // scholar.google.com.br). Thirty two works were studied and the use of speech therapy in NICU´s was described in twenty eight of them which presented as procedures the assessment and stimulation of the sensory-motor-oral system, using nonnutritive and nutritive sucking and hearing screening techniques. However, the characteristics of newborns with congenital heart disease and the insertion of the speech therapist into cardiac neonatal ICU are not mentioned, not even the description of the objectives and practice of such professional. The care of patients with congenital heart disease should be differentiated as it has particular features that can undermine the performance concerning feeding. Only one publication followed the inclusion criteria of the present survey. It describes the transition of the direct gastric feeding to breast feeding in preterm newborns with heart disease, with age corrected, in a newborn intensive care unit. It was possible to verify the lack of works published on speech therapy intervention with newborns with heart disease, which indicates the need of new studies on the theme, as the care of such patients should be differentiated once they present particularities that could undermine the performance of feeding.

RESUMO Objetivo: Identificar os parâmetros presentes nos instrumentos de rastreio para a disfagia orofaríngea no acidente vascular encefálico, publicados na literatura. Estratégia de pesquisa: Para a seleção dos estudos, foram utilizados os descritores: transtornos de deglutição, acidente vascular cerebral, rastreio, screening, avaliação e disfagia. Foram consultadas as bases de dados MEDLINE, Embase, LILACS, SciELO e biblioteca Cochrane. Critérios de seleção: Foram selecionados artigos em inglês, português e espanhol, publicados até dezembro de 2014, cuja abordagem metodológica referisse instrumentos de rastreio para a disfagia orofaríngea, elaborados para indivíduos adultos com acidente vascular encefálico. Os parâmetros utilizados nos diferentes instrumentos de rastreio foram agrupados por igualdade e/ou semelhança. Foi realizada análise descritiva e calculada a frequência dos parâmetros encontrados. Resultados: Foram encontrados 688 artigos e, após consideração dos critérios de inclusão e exclusão, 23 artigos foram efetivamente analisados. Dos 20 instrumentos encontrados, 90% utilizaram algum tipo de oferta via oral no rastreio para a disfagia, sendo a maioria, a água. Foram encontrados 19 parâmetros distintos, não relacionados à oferta de alimento e 12 parâmetros relacionados à oferta de alimento. Conclusão: Não há consenso, entre os estudos, sobre os parâmetros mais sensíveis e específicos para compor o método de rastreio para disfagia orofaríngea na população com acidente vascular encefálico.

ABSTRACT Purpose: To identify the parameters present in the screening tools for oropharyngeal dysphagia in stroke published in the literature. Research strategy: For the selection of studies, the swallowing disorder descriptors stroke, screening, evaluation and dysphagia were used. MEDLINE, Embase, LILACS, SciELO and the Cochrane Library databases were consulted. Selection criteria: We selected articles in the English, Portuguese and Spanish languages published up to December 2014 whose methodological approach referred to screening tools for oropharyngeal dysphagia designed for adults with stroke. The parameters used in the various screening tools were grouped by equality and/or likeness. We performed a descriptive analysis and calculated the frequency of found parameters. Results: We found 688 articles and after consideration of the inclusion and exclusion criteria, 23 articles were effectively analyzed. Of the 20 tools found, 90% used some type of food offer orally in screening for dysphagia, mostly water. We found 19 different parameters not related to food offer and 12 parameters related to food offer. Conclusion: There is no consensus among the studies on the most sensitive and specific parameters to compose the screening method for oropharyngeal dysphagia in stroke.

Resumo: OBJETIVO: determinar a prevalência de disfagia orofaríngea em indivíduos submetidos à cirurgia cardíaca e que evoluíram com Acidente Vascular Cerebral em Hospital Público de Referência. MÉTODOS: estudo clínico descritivo, retrospectivo, realizado por meio da coleta de dados de protocolos de avaliação clínica da deglutição orofaríngea, no período de novembro de 2010 á novembro de 2011. Foram incluídos os 25 protocolos de avaliação clínica para disfagia orofaríngea de indivíduos que fizeram cirurgia cardíaca e evoluíram com Acidente Vascular Cerebral no pós-operatório, durante o período estudado, e que foram assistidos pela equipe de Fonoaudiologia. A avaliação clinica da deglutição foi baseada em instrumento clinico e a deglutição classificada como normal, disfagia leve, moderada e grave. RESULTADOS: dos 25 (100%) indivíduos, 24 (96%) apresentaram algum grau de disfagia orofaríngea na avaliação clínica. (95% [IC]: 79,6- 99,9). Constatou-se que 41,66% apresentaram disfagia grave, 33,66% disfagia moderada e 25% disfagia leve. CONCLUSÃO: é alta a prevalência de disfagia orofaríngea em indivíduos com Acidente Vascular Cerebral após cirurgia cardíaca.

Abstract: PURPOSE: to determine the prevalence of oropharyngeal dysphagia in patients undergoing cardiac surgery and who developed stroke in a public referral hospital. METHODS: a retrospective descriptive clinical cross-sectional study conducted by collecting data on clinical assessment protocols of oropharyngeal swallowing in the period November 2010 to November 2011, including the protocols of 25 individuals for clinical evaluation of oropharyngeal dysphagia with post-operative stroke during the study period who were assisted by the Speech-Language Pathology team. Clinical swallowing assessment was based on clinical tools and swallowing classified as normal, mild, moderate and severe dysphagia. RESULTS: of the twenty-five (100%) patients, 24 (96%) presented dysphagia in clinical evaluation and 1 (4%) did not (95% [IC]: 79.6- 99.9). It was found that 41.66% had severe dysphagia, 33.66% moderate and 25% mild dysphagia. CONCLUSION: there was a high prevalence of oropharyngeal dysphagia in patients with stroke after cardiac surgery.

OBJETIVO:associar o grau de disfagia orofaríngea e o tempo de intubação orotraqueal no indivíduo pós-acidente vascular encefálico após cirurgia cardíaca.MÉTODOS:estudo clínico transversal descritivo, retrospectivo, realizado por meio da coleta de dados de protocolos e registros de prontuário, durante seis meses, em Hospital Público de Referência em Cardiologia. Foram analisados 25 protocolos e prontuários de indivíduos submetidos à cirurgia cardíaca, que evoluíram com acidente vascular encefálico e foram assistidos pela equipe de Fonoaudiologia. Os indivíduos foram divididos em dois grupos. O Grupo I (GI) constou de 10 indivíduos com intubação orotraqueal menor que 24 horas e o Grupo II (GII) de 15 indivíduos com intubação orotraqueal maior que 24 horas. Realizada avaliação clínica da deglutição e analisada a associação entre a classificação clínica do grau de comprometimento para disfagia e o tempo de intubação orotraqueal.RESULTADOS:verificou-se que no GI 40% apresentaram disfagia leve, 30% moderada e 20% grave. No GII 13,3% apresentaram disfagia leve, 33,3% moderada e 53,33% grave. Verificou-se associação linear significante entre o grau de disfagia e o tempo de IOT (p= 0,031), indicando que o número de indivíduos com disfagia moderada e grave foi maior no grupo com mais tempo de intubaçao.CONCLUSÕES:constatou-se que o tempo de intubação orotraqueal maior que 24 horas aumentou o grau da disfagia orofaríngea nesta população.

PURPOSE: to associate the degree of oropharyngeal dysphagia and orotracheal intubation time in post stroke individuals after cardiac surgery.METHODS: a cross-sectional retrospective descriptive clinical study carried out by means of protocols data collection and chart records during six months in a public hospital of reference in cardiology. We analyzed 25 protocols and medical records of individuals undergoing cardiac surgery who evolved with stroke and were assisted by a team of speech and language pathology. The subjects were divided into two groups. Group I (GI) consisted of 10 individuals with orotracheal intubation less than 24 hours and Group II (GII) of 15 individuals with orotracheal intubation more than 24 hours. After performing swallowing clinical evaluation and analyzing the association between the clinical classification of degree of commitment for dysphagia and orotracheal intubation time.RESULTS: it was found that 40% of the individuals in GI presented mild dysphagia, 30% moderate and 20% severe. In GII, 13.3 % presented mild dysphagia, 33.3% moderate and 53.33% severe. There was a significant linear association between the degree of dysphagia and the duration of intubation (p = 0.031), indicating that the number of individuals with moderate and severe dysphagia was higher in the group with a longer intubation.CONCLUSIONS: we could observe that time of orotracheal intubation more than 24 hours increases the degree of oropharyngeal dysphagia in this population.