Routine fiberoptic endoscopic evaluation of swallowing following prolongedintubation - Implications for management

Hypothesis: Fiberoptic endoscopic evaluation of swallowing (FEES) will iden tify patients who are at high risk for pulmonary aspiration due to swallowi ng dysfunction after prolonged intubation. Based on the results of FEES, di etary recommendations can be made to decrease the incidence of aspiration a fter prolonged intubation. Design: Patients who were intubated for at least 48 hours were evaluated fo r swallowing dysfunction by bedside FEES within 48 hours of extubation. Dif ferences in potential risk factors between aspirators and nonaspirators wer e analyzed. Dietary recommendations were made and patients were followed up for signs of clinically significant aspiration. Setting: Community teaching hospital. Patients: Fifty-one consecutive patients with no previously documented swal lowing disorder who required a minimum of 48 hours of intubation for mechan ical ventilation. Interventions: Fiberoptic endoscopic evaluation of swallowing was performed by a speech pathologist. Initial diet orders were determined by results of the swallowing study. Main Outcome Measures: Incidence of swallowing dysfunction following prolon ged intubation and incidence of clinically significant aspiration following initiation of oral feeding. Results Incidence of swallowing dysfunction was 56%, (27/48); 12 (25%) of 4 8 patients were silent aspirators. In comparing aspirators with nonaspirato rs, no significant differences in potential risk factors or comorbidities w ere seen. Nineteen (70%;) of the 27 patients aspirated with thin-consistenc y test liquids, and the other 8 (30%) with puree consistency. No patients i n this study group developed a clinically significant aspiration following initiation of appropriately modified diets. Conclusions: Fiberoptic endoscopic evaluation of swallowing identified swal lowing dysfunction in more than 50%;, of patients intubated for longer than 48 hours, many of whom are silent aspirators. Dietary recommendations base d on FEES results prevented clinically significant aspiration.