Endoscopic Assessment of Swallowing After Prolonged Intubation in the ICU Setting

Scheel, Rebecca; Pisegna, Jessica M.; McNally, Edel; Noordzij, J. Pieter; Langmore, Susan E.

doi:10.1177/0003489415596755

Cited by 87 publications

(95 citation statements)

References 34 publications

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“…There is no clear consensus about the timing of swallowing evaluations, with times varying among reports from immediately after to 48 h after extubation. As has been reported, the timing of swallowing evaluations is not correlated with the incidence of dysphagia (Scheel et al, ). In this study, we performed the swallowing screening at 4·9 h (median) after extubation, and no complications occurred from the swallowing evaluation.…”

Section: Discussionmentioning

confidence: 82%

Frequency and outcome of post‐extubation dysphagia using nurse‐performed swallowing screening protocol

Omura¹,

Komine²,

Yanagigawa³

et al. 2018

Nursing in Critical Care

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Section: Discussionmentioning

confidence: 82%

Frequency and outcome of post‐extubation dysphagia using nurse‐performed swallowing screening protocol

Omura¹,

Komine²,

Yanagigawa³

et al. 2018

Nursing in Critical Care

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“…Previous studies have shown that up to 60% of ARF survivors are at risk for aspiration after extubation. Up to 25% aspirate “silently,” without signs on clinical exam[2–8]. Aspiration is associated with pneumonia, feeding tube and tracheostomy placement, longer ICU and hospital stay, and increased hospital mortality[9–16].…”

Section: Introductionmentioning

confidence: 99%

“…None focused exclusively on ARF survivors. Suggested mechanisms for aspiration after mechanical ventilation include “unlearning” of muscle memory, residual sedative medication effects, and injury to the mucosa or peripheral nerves from the endotracheal tube[8, 19–23]. Due to differing mechanisms of aspiration in other populations, some predictive components of BSE may not apply to ARF survivors[24–27].…”

Section: Introductionmentioning

confidence: 99%

The accuracy of the bedside swallowing evaluation for detecting aspiration in survivors of acute respiratory failure

Lynch

Clark

Macht³

et al. 2017

Journal of Critical Care

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Background Dysphagia with subsequent aspiration occurs in up to 60% of acute respiratory failure (ARF) survivors. Accurate bedside tests for aspiration can reduce aspiration-related complications while minimizing delay of oral nutrition. In a cohort of ARF survivors, we determined the accuracy of the bedside swallowing evaluation (BSE) and its components for detecting aspiration. Methods Patients who were extubated after ≥24 hours of mechanical ventilation were eligible for enrollment. Within three days of extubation, patients underwent comprehensive BSE including 3-ounce water swallowing test (3-WST), followed by a gold standard test for aspiration, flexible endoscopic evaluation of swallowing (FEES). Results 45 patients were included in the analysis. Median patient age was 55 years (IQR=47- 65). Median duration of mechanical ventilation was 3.3 days (IQR 1.8–6.0). 14 patients (31%) aspirated on FEES. Physical exam findings on BSE and abnormal swallowing during trials of different consistencies were variably associated with aspiration. Compared to FEES, the 3-WST yielded a sensitivity of 77% (95%CI=50–92%), specificity of 65% (95%CI=47–79%), and AUC=0.71; an SLP’s recommendation for altered diet yielded a sensitivity of 86% (95%CI=60– 96%), specificity of 52% (95%CI=35–68%), and AUC=0.69; an SLP’s recommendation for NPO yielded a sensitivity of 50% (95%CI=27–73%), specificity of 94% (95%CI=79–98%), and AUC=0.72. Conclusions The BSE and its components, including the 3-WST, demonstrated variable accuracy for aspiration in survivors of ARF. Investigation to determine the optimal non-invasive test for aspiration in ARF survivors is warranted. Clinical Trials Registration ClinicalTrials.gov Identifier: NCT02363686, Aspiration in Acute Respiratory Failure Survivors

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“…The 1000–1500 mL of saliva produced daily may transiently be present in the oral cavity . Pooling of secretions in the pharyngolaryngeal region can be minimized by the normal swallowing function.…”

Section: Discussionmentioning

confidence: 99%

“…Fibreoptic endoscopic evaluation of swallowing (FEES) is widely used by speech‐language pathologists and otolaryngologists . FEES enables direct observation of the test food accumulating in the pyriform sinuses or entering below the vocal cords.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Oropharyngeal Dysphagia in Patients Who Underwent Percutaneous Endoscopic Gastrostomy: Stratification Risk of Pneumonia

Chang

Huang

Lin

et al. 2019

J Parenter Enteral Nutr

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Background Aspiration pneumonia is the most common cause of death in patients who undergo percutaneous endoscopic gastrostomy (PEG). This study aims to evaluate the severity of oropharyngeal dysphagia and predict the risk of pneumonia in such patients, using upper gastrointestinal endoscopy. Methods Endoscope examined the pharyngolaryngeal region in patients who underwent PEG. The severity of oropharyngeal dysphagia was evaluated according to the amount and location of pooling of secretions in the pharyngolaryngeal region. Overall, 55 patients showed absent or minimal amount of secretions (control group), 10 patients showed moderate‐to‐large amounts of secretions filling the pyriform sinus (pharyngeal group), and 23 patients showed secretions entering the laryngeal vestibule (laryngeal group). Demographic data, swallowing level scale, and occurrence of pneumonia were recorded. Results The incidence of pneumonia was the highest in the pharyngeal group (70.0%), followed by that in the laryngeal (60.9%) and control groups (30.9%; P = 0.010). Multivariable regression showed that risk of pneumonia was significantly higher in the pharyngeal and laryngeal groups. Cumulative incidence rate of pneumonia was significantly higher in the laryngeal and pharyngeal groups than in the control group (log‐rank test, P = 0.001). Mortality rate was significantly higher in patients with suboptimal protective cough reflex than in others (50.0% vs 5.9%, P = 0.034). Conclusion Accumulation of abnormal amounts of secretions in the pyriform sinus or in the laryngeal vestibule increased the risk of the hospital admission following pneumonia in patients who underwent PEG. The mortality rate was higher in patients with suboptimal protective cough reflex.

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Endoscopic Assessment of Swallowing After Prolonged Intubation in the ICU Setting

Cited by 87 publications

References 34 publications

Frequency and outcome of post‐extubation dysphagia using nurse‐performed swallowing screening protocol

Frequency and outcome of post‐extubation dysphagia using nurse‐performed swallowing screening protocol

The accuracy of the bedside swallowing evaluation for detecting aspiration in survivors of acute respiratory failure

Evaluation of Oropharyngeal Dysphagia in Patients Who Underwent Percutaneous Endoscopic Gastrostomy: Stratification Risk of Pneumonia

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