Background: Prolonged mechanical ventilation is associated with muscle weakness, pharyngeal dysfunction, and symptomatic aspiration. The authors hypothesized that muscle strength measurements can be used to predict pharyngeal dysfunction (endoscopic evaluation-primary hypothesis), as well as symptomatic aspiration occurring during a 3-month follow-up period. Methods: Thirty long-term ventilated patients admitted in two intensive care units at Massachusetts General Hospital were included. The authors conducted a fiberoptic endoscopic evaluation of swallowing and measured muscle strength using medical research council score within 24 h of each fiberoptic endoscopic evaluation of swallowing. A medical research council score less than 48 was considered clinically meaningful muscle weakness. A retrospective chart review was conducted to identify symptomatic aspiration events.Results: Muscle weakness predicted pharyngeal dysfunction, defined as either valleculae and pyriform sinus residue scale of more than 1, or penetration aspiration scale of more than 1. Area under the curve of the receiver-operating curves for muscle strength (medical research council score) to predict pharyngeal, valleculae, and pyriform sinus residue scale of more than 1, penetration aspiration scale of more than 1, and symptomatic aspiration were 0.77 (95% CI, 0.63-0.97; P = 0.012), 0.79 (95% CI, 0.56-1; P = 0.02), and 0.74 (95% CI, 0.56-0.93; P = 0.02), respectively. Seventy percent of patients with muscle weakness showed symptomatic aspiration events. Muscle weakness was associated with an almost 10-fold increase in the symptomatic aspiration risk (odds ratio = 9.8; 95% CI, 1.6-60; P = 0.009). Conclusion: In critically ill patients, muscle weakness is an independent predictor of pharyngeal dysfunction and symptomatic aspiration. Manual muscle strength testing may help identify patients at risk of symptomatic aspiration.

P rolonged mechanical ventilation is associated with muscle weakness, pharyngeal dysfunction, and symptomatic aspiration. It was hypothesized that muscle strength measurements can be used to predict pharyngeal dysfunction (endoscopic evaluation-primary hypothesis) as well as symptomatic aspiration that occurs during a 3-month follow-up period. Thirty long-term ventilated patients who were admitted to 2 intensive care units at the Massachusetts General Hospital were included. Fiberoptic endoscopic evaluation was performed of swallowing and measured muscle strength using a Medical Research Council score within 24 hours of each fiberoptic endoscopic evaluation of swallowing (FEES). A score of less than 48 was considered clinically meaningful muscle weakness. Symptomatic aspiration events were identified by a retrospective chart review. Muscle weakness was predictive of pharyngeal dysfunction, which was defined as either valleculae and pyriform sinus residue scale of more than 1 or penetration aspiration scale of more than 1. The area under the curve of the receiveroperating curves for muscle strength (Medical Research Council score) to predict pharyngeal, valleculae, and pyriform sinus residue scale of more than 1, penetration aspiration scale of more than 1, and symptomatic aspiration were 0.77 (95% confidence interval [CI], 0.63-0.97]), 0.79 (95% CI, 0.56-1), and 0.74 (95% CI, 0.56-0.93), respectively. Seventy percent of those with muscle weakness displayed symptomatic aspiration events. Muscle weakness was associated with an almost 10-fold increase in the symptomatic risk (odds ratio, 9.8; 95% CI, 1.6-60; P = 0.009). Among critically ill patients, muscle weakness is independently predictive of pharyngeal dysfunction and symptomatic aspiration. Manual muscle strength testing may assist in identifying patients at risk for symptomatic aspiration.

Clinicians should routinely consider tracheostomized, acute rehabilitation hospital inpatients with severely disordered consciousness post-TBI potential MBS candidates. Implications and continued research needs are discussed.

We developed and validated an abbreviated version of the Coma Recovery Scale‐Revised (CRS‐R), the CRS‐R For Accelerated Standardized Testing (CRSR‐FAST), to detect conscious awareness in patients with severe traumatic brain injury in the intensive care unit. In 45 consecutively enrolled patients, CRSR‐FAST administration time was approximately one‐third of the full‐length CRS‐R (mean [SD] 6.5 [3.3] vs 20.1 [7.2] minutes, p < 0.0001). Concurrent validity (simple kappa 0.68), test–retest (Mak's ρ = 0.76), and interrater (Mak's ρ = 0.91) reliability were substantial. Sensitivity, specificity, and accuracy for detecting consciousness were 81%, 89%, and 84%, respectively. The CRSR‐FAST facilitates serial assessment of consciousness, which is essential for diagnostic and prognostic accuracy. ANN NEUROL 2023

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