What is the value of fibre-endoscopic evaluation of swallowing (FEES) in neurological patients? A cross-sectional hospital-based registry study

Braun, Tobias; Juenemann, Martin; Viard, Maxime; Meyer, Marco; Fuest, Sven; Reuter, Iris; Kaps, Manfred; Prosiegel, Mario; Tanislav, Christian

doi:10.1136/bmjopen-2017-019016

Cited by 20 publications

(26 citation statements)

References 21 publications

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“…8 patients (5.3%) died during hospitalisation; all of them suffered from dysphagia. NIHSS and mRS on admission and at discharge were higher in dysphagic patients than non-dysphagic patients (admission: median NIHSS 11 [IQR 6–17] vs 7 [4–12], p = .013; median mRS 5 [IQR 4–5] vs. 4 [IQR 3–5], p = .012; discharge: median NIHSS 7 [IQR 4–12] vs 6 [3–11], p = .05; median mRS 4 [IQR 3–5] vs. 4 [IQR 2–4], p = .002). The outcome at discharge (mRS) in relation to the FEDSS is summarized in Fig.…”

Section: Resultsmentioning

confidence: 99%

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Adjustment of oral diet based on flexible endoscopic evaluation of swallowing (FEES) in acute stroke patients: a cross-sectional hospital-based registry study

et al. 2019

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BackgroundDiagnosing dysphagia in acute stroke patients is crucial, as this comorbidity determines morbidity and mortality; we therefore investigated the impact of flexible nasolaryngeal endoscopy (FEES) in acute stroke patients.MethodsThe FEES investigation as performed in acute stroke patients treated at a large university hospital, allocated as a standard procedure for all patients suspected of dysphagia. We correlated our findings with baseline data, disability status, pneumonia, duration of hospitalisation, necessity for mechanical ventilation and treatment on the intensive care unit. The study was designed as a cross-sectional hospital-based registry.ResultsWe investigated 152 patients. The median age was 73; 94 were male. Ischemic stroke was diagnosed in 125 patients (82.2%); 27 (17.8%) suffered intracerebral haemorrhage.Oropharyngeal dysphagia was diagnosed in 72.4% of the patients, and was associated with higher stroke severity on admission (median NIHSS 11 [IQR 6–17] vs. 7 [4–12], p = .013; median mRS 5 [IQR 4–5] vs. 4 [IQR 3–5], p = .012). Short-term mortality was higher among patients diagnosed with dysphagia (7.2% vs. 0%, p = .107). FEES examinations revealed that only 30.9% of the patients had an oral diet appropriate for their swallowing abilities.A change of oral diet was associated with a better outcome at discharge (mRS; p = .006), less need of mechanical ventilation (p = .028), shorter period of hospitalisation (p = .044), and lower rates of pneumonia (p = .007) and mortality (p = .011).ConclusionDue to the inability of clinical assessments to detect silent aspiration, FEES might be better suited to identify stroke patients at risk and may contribute to a better functional outcome and lower rates of pneumonia and mortality. Our findings also point to a low awareness of dysphagia, even in a specialised stroke centre.FEES in acute stroke patients helps to adjust the oral diet for the vast majority of stroke patients (69.1%) based on their swallowing abilities, potentially avoiding severe complications.

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Section: Resultsmentioning

confidence: 99%

“…We recently published a paper on the use of FEES and adjusting the oral diet in neurological patients. In this analysis, we were able to demonstrate a lower rate of pneumonia an a lower mortality, when adjusting the oral diet [12]. This is a subgroup analysis for acute stroke patients.…”

Section: Introductionmentioning

confidence: 99%

Adjustment of oral diet based on flexible endoscopic evaluation of swallowing (FEES) in acute stroke patients: a cross-sectional hospital-based registry study

et al. 2019

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“…Moreover, we used FEES to investigate the swallowing function. FEES is one of the gold standards, and has high sensitivity and specificity to detect mild problems or non‐overt abnormalities such as small amounts of residue in the pharynx or silent aspiration 20‐23 …”

Section: Discussionmentioning

confidence: 99%

“…The Fibre‐optic endoscopic evaluation of swallowing (FEES), one of clinical standards for dysphagia diagnosis, 20‐22 can be performed at the bedside and even in unconsciousness or ventilator patients, and without radiation exposure. The follow‐up examination can also be investigated within a short period 23,24 . FEES visualises the pharyngeal and laryngeal anatomical structure and function.…”

Section: Introductionmentioning

confidence: 99%

The prevalence and findings of fibre‐optic endoscopic evaluation of swallowing in hospitalised patients with dysphagia

Benjapornlert

Kagaya

Shibata

et al. 2020

J of Oral Rehabilitation

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Swallowing disorder or dysphagia is quite common in hospitalised patients. Using fibre‐optic endoscopic evaluation of swallowing (FEES) is one of the clinical standards for evaluating swallowing disorder to prevent serious consequences such as aspiration pneumonia. This study aimed to determine the prevalence and the associated risk of dysphagia in hospitalised patients by using FEES finding. We retrospectively analysed the FEES records from the patients who were screened and suspected of swallowing problems by a certified nurse of dysphagia nursing (CNDN). The FEES findings were compared between dysphagia and without dysphagia to evaluate the associated risk of dysphagia. Six‐hundred and nine FEES records were analysed. We found dysphagia 76% in patients who suspected swallowing problems by CNDN. FEES was assessed after the subjects had been admitted for 22 days on average. There was no difference in age between dysphagia and without dysphagia participants. However, the advanced age (age > 85 years old) increased the odd of dysphagia 1.18, P = .03. The primary disease of the subjects was mainly cerebrovascular disease (24%) and pneumonia (22%). Abnormal FEES findings including soft palate elevation, velopharyngeal contraction, whiteout, volitional cough, glottis closure during breath holding, cough reflex and presence of secretion in pharynx were found in hospitalised patients with dysphagia. The prevalence of dysphagia was high in hospitalised patients. Hence, screening the swallowing problem by nurse and FEES evaluation is essential to detect and prevent the complication in the patient who has dysphagia.

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“…FEES being the method of first choice is easy to use, with bedside evaluation, and can help remove misjudgment in dysphagia diagnosis and help revise diet in around 70% cases. 14 To assess swallowing reflex, the integrity of the Oropharyngeal-cortical afferent pathways can be assessed by electroencephalography (EEG) while generating sensory-evoked potentials by pharyngeal electrical stimulation and the Corticalpharyngeal efferent pathways can be considered by electromyography through motor-evoked potentials by transcranial magnetic stimulation. 15 When tracheostomy tube is in place, swallowing can be assessed by oral motor and vocal cord assessment with adduction of vocal cord by phonation and strength of cough reflex and Pharyngeal assessment with per oral trials.…”

Section: Discussionmentioning

confidence: 99%

Swallowing Difficulties with Tracheostomy: A Neuro-Rehabilitation Perspective

Saqulain

Mumtaz

2020

JIMDC

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Swallowing and breathing are complex and highly coordinated functions. These functions depend on well-coordinated work of many organs with larynx and nervous system playing a critical role. Disturbance in one of these functions negatively affects the other. Surgical airways like tracheostomies are required in a number of situations, including but not limited to major head and neck procedures, cases with decreased lung function, excessive bronchial secretions and cases requiring neuro-rehabilitation when prolonged airway is required for mechanical ventilation. Extensive neuro-rehabilitation is required since patients with surgical airway may develop swallowing difficulties including dysphagia and/or aspiration with a very high prevalence, which can pose a threat to life. This article reviews the current status of the diagnostic and therapeutic modalities for swallowing difficulties with special emphasis on current neuro-rehabilitative strategies. Electronic databases including Medline, Web-of-science, Cochrane Library, and Google scholar were used for literature search. Downloaded articles were subsequently assessed independently by two researchers to determine suitability for inclusion in the study.Key words: Neurorehabilitation, Tracheostomy, Transcranial direct current stimulation, Transcranial magnetic stimulation, swallowing difficulty

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What is the value of fibre-endoscopic evaluation of swallowing (FEES) in neurological patients? A cross-sectional hospital-based registry study

Cited by 20 publications

References 21 publications

Adjustment of oral diet based on flexible endoscopic evaluation of swallowing (FEES) in acute stroke patients: a cross-sectional hospital-based registry study

Adjustment of oral diet based on flexible endoscopic evaluation of swallowing (FEES) in acute stroke patients: a cross-sectional hospital-based registry study

The prevalence and findings of fibre‐optic endoscopic evaluation of swallowing in hospitalised patients with dysphagia

Swallowing Difficulties with Tracheostomy: A Neuro-Rehabilitation Perspective

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