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Abstract：
To determine the effectiveness of dysphagia interventions compared to standard care in improving oral intake and reducing aspiration for adults in acute and critical care.
We searched electronic literature for randomised and quasi-randomised trials and bibliography lists of included studies to March 2020. Study screening, data extraction, risk of bias and quality assessments were conducted independently by two reviewers. Meta-analysis used fixed effects modelling. The systematic review protocol is registered and published.
We identified 22 studies (19 stroke, 2 intensive care stroke and 1 general intensive care) testing 9 interventions and representing 1700 patients. Swallowing treatment showed no evidence of a difference in the time to return to oral intake (n = 33, MD (days) - 4.5, 95% CI - 10.6 to 1.6, 1 study, P = 0.15) (very low certainty) or in aspiration following treatment (n = 113, RR 0.79, 95% CI 0.44 to 1.45, 4 studies, I2 = 0%, P = 0.45) (low certainty). Swallowing treatment showed evidence of a reduced risk of pneumonia (n = 719, RR 0.71, 95% CI 0.56 to 0.89, 8 studies, I2 = 15%, P = 0.004) (low certainty) but no evidence of a difference in swallowing quality of life scores (n = 239, MD - 11.38, 95% CI - 23.83 to 1.08, I 2 = 78%, P = 0.07) (very low certainty).
There is limited evidence for the effectiveness of swallowing treatments in the acute and critical care setting. Clinical trials consistently measuring patient-centred outcomes are needed.
We searched electronic literature for randomised and quasi-randomised trials and bibliography lists of included studies to March 2020. Study screening, data extraction, risk of bias and quality assessments were conducted independently by two reviewers. Meta-analysis used fixed effects modelling. The systematic review protocol is registered and published.
We identified 22 studies (19 stroke, 2 intensive care stroke and 1 general intensive care) testing 9 interventions and representing 1700 patients. Swallowing treatment showed no evidence of a difference in the time to return to oral intake (n = 33, MD (days) - 4.5, 95% CI - 10.6 to 1.6, 1 study, P = 0.15) (very low certainty) or in aspiration following treatment (n = 113, RR 0.79, 95% CI 0.44 to 1.45, 4 studies, I2 = 0%, P = 0.45) (low certainty). Swallowing treatment showed evidence of a reduced risk of pneumonia (n = 719, RR 0.71, 95% CI 0.56 to 0.89, 8 studies, I2 = 15%, P = 0.004) (low certainty) but no evidence of a difference in swallowing quality of life scores (n = 239, MD - 11.38, 95% CI - 23.83 to 1.08, I 2 = 78%, P = 0.07) (very low certainty).
There is limited evidence for the effectiveness of swallowing treatments in the acute and critical care setting. Clinical trials consistently measuring patient-centred outcomes are needed.
摘要：
确定吞咽困难干预措施与标准护理相比在改善急性和重症监护成人口服摄入和减少误吸方面的有效性。
我们搜索了截至2020年3月的随机和准随机试验以及纳入研究的参考书目列表的电子文献。研究筛选,数据提取,偏倚风险和质量评估由两名评审员独立进行.Meta分析采用固定效应模型。注册并发布系统审查方案。
我们确定了22项研究(19项中风，2例重症监护中风和1例一般重症监护）测试9例干预措施，代表1700例患者。吞咽治疗没有证据表明恢复口服摄入的时间有差异（n=33，MD（天）-4.5，95％CI-10.6至1.6，1项研究，P=0.15）（非常低的确定性）或治疗后的误吸（n=113，RR0.79，95％CI0.44至1.45，4项研究，I2=0%，P=0.45)(低确定性)。吞咽治疗显示肺炎风险降低的证据（n=719，RR0.71，95％CI0.56至0.89，8项研究，I2=15%，P=0.004）（低确定性），但没有证据表明吞咽生活质量评分存在差异（n=239，MD-11.38，95％CI-23.83至1.08，I2=78％，P=0.07)(非常低的确定性)。
在急性和重症监护环境中吞咽治疗的有效性证据有限。需要持续测量以患者为中心的结果的临床试验。
我们搜索了截至2020年3月的随机和准随机试验以及纳入研究的参考书目列表的电子文献。研究筛选,数据提取,偏倚风险和质量评估由两名评审员独立进行.Meta分析采用固定效应模型。注册并发布系统审查方案。
我们确定了22项研究(19项中风，2例重症监护中风和1例一般重症监护）测试9例干预措施，代表1700例患者。吞咽治疗没有证据表明恢复口服摄入的时间有差异（n=33，MD（天）-4.5，95％CI-10.6至1.6，1项研究，P=0.15）（非常低的确定性）或治疗后的误吸（n=113，RR0.79，95％CI0.44至1.45，4项研究，I2=0%，P=0.45)(低确定性)。吞咽治疗显示肺炎风险降低的证据（n=719，RR0.71，95％CI0.56至0.89，8项研究，I2=15%，P=0.004）（低确定性），但没有证据表明吞咽生活质量评分存在差异（n=239，MD-11.38，95％CI-23.83至1.08，I2=78％，P=0.07)(非常低的确定性)。
在急性和重症监护环境中吞咽治疗的有效性证据有限。需要持续测量以患者为中心的结果的临床试验。
