Translaryngeal intubation for the purpose of mechanical ventilatory support is a known risk factor for dysphagia and aspiration in patients following extubation. Traditional observational bedside swallowing evaluation may be inaccurate in identifying patients at risk for aspiration of oral contents into the trachea. To our knowledge, no study has been done to compare bedside evaluation to FEESST in post-extubation patients.
Retrospective review of 200 patients who underwent bedside swallowing evaluation by a speech pathologist and a subsequent FEESST study at an academic medical center. For purposes of this study, we define silent aspiration as the passage of oral contents into the trachea under fiberoptic endoscopic evaluation without patient response, (cough or clearing of throat).
98 patients were evaluated post-extubation by a speech pathologist and FEESST. Of these, 65 patients were evaluated for silent aspiration with FEESST. 51 (78%) had silent aspiration and 14 (22%) did not. Standard speech evaluation could not indentify silent aspiration. Feeding recommendations based upon standard bedside evaluation agreed with FEESST recommendation in 33% (95% CI, .21 to .48; p < 0.0241) of patients.
There is a high prevalence of silent aspiration in post-extubation patients that is detected by FEESST. Standard bedside observation for timing and type of feeding in post-extubation correlates poorly with FEESST findings.
Bedside swallowing evaluation may be inadequate to recommend initiation of feeding in post-extubation patients. Objective testing such as FEESST may be necessary.
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