Internal medicine

Oropharyngeal dysphagia

Stroke (engine)

Aspiration pneumonia

Strictly standardized mean difference

Relative risk

Meta-analysis

Swallowing

Psychiatry

Engineering

Surgery

Political science

Intensive care medicine

Physical therapy

Randomized controlled trial

Psychological intervention

MEDLINE

Pneumonia

Dysphagia

Anesthesiology

Intensive care

Anesthesia

Confidence interval

Medicine

Mechanical engineering

Intensive Care Medicine

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.

Interventions for oropharyngeal dysphagia in acute and critical care: a systematic review and meta-analysis