Fiberoptic endoscopic evaluation of swallowing in patients with acute traumatic brain injury

Dysphagia and aspiration in intensive care unit patients with acute traumat ic brain injury (TBI) is a frequent and potentially life-threatening proble m. Any diagnostic technique used with this population, therefore, must be a ble to be performed in a timely and efficient manner while providing object ive information on the nature of the swallowing problem. The purpose of the present study was to investigate the utility of using the fiberoptic endos copic evaluation of swallowing (FEES) technique to diagnosis pharyngeal sta ge dysphagia and determine aspiration status in patients who presented with acute TBI. A total of 47 subjects were assessed with FEES. Thirty of 47 (6 4%) subjects swallowed successfully and were able to take an oral diet: 2 o f 30 (7%) thickened liquids and puree consistencies, 8 of 30 (27%) a soft d iet, and 20 of 30 (67%) a regular diet. Seventeen of 47 (36%) subjects exhi bited pharyngeal stage dysphagia with aspiration and were not permitted an oral diet based on objective results provided by FEES. Of the 17 subjects w ho aspirated, 9 of 17 (53%) exhibited silent aspiration. Younger subjects ( mean age 34 years, 3 months) aspirated significantly less often than older subjects (mean age 51 years, 8 months). No significant age difference was o bserved for gender or between overt and silent aspirators. It was concluded that FEES is an objective and sensitive tool that can be used successfully to diagnose pharyngeal stage dysphagia, determine aspiration status. and m ake recommendations for oral or nonoral feeding in patients with acute TBI.