P A Hales1, M J Drinnan, J A Wilson. 1. Department of Speech and Language Therapy, Addenbrooke's Hospital, Cambridge, UK. pippa.hales@addenbrookes
Abstract
OBJECTIVE: To determine if fibreoptic endoscopic evaluation of swallowing adds information to the clinical assessment of swallowing in tracheostomised patients. DESIGN: A prospective, observational study. SETTING: Addenbrooke's Hospital, Cambridge, UK. PARTICIPANTS: Twenty-five consecutive, adult, tracheostomised patients were recruited over a 3-month period. They were referred to speech and language therapy for a swallowing assessment and were ready to trial cuff deflation. MAIN OUTCOME MEASURES: In current practice the clinical assessment is invariably a precursor to fibreoptic endoscopic evaluation of swallowing and a test would be considered positive when penetration or aspiration are detected. We considered the value of fibreoptic endoscopic evaluation of swallowing following both positive and negative outcomes of the clinical assessment. RESULTS: The positive predictive value of aspiration or penetration was 91% i.e. when a clinical assessment is failed, there is a very high probability the patient would also be failed on fibreoptic endoscopic evaluation of swallowing. However, the negative predictive value was only 64% i.e. over one-third of patients who pass a clinical assessment would later fail a fibreoptic endoscopic evaluation of swallowing. CONCLUSIONS: Despite a small cohort, our data suggest that the assessment of swallowing to aid weaning in tracheostomised patients is currently performed incorrectly; we estimate that over a third of all tracheostomised patients that 'pass' the clinical assessment of swallowing are, in reality, at risk from penetration, aspiration or failed decannulation. This finding supports the use of fibreoptic endoscopic evaluation of swallowing and a change in clinical practice.
OBJECTIVE: To determine if fibreoptic endoscopic evaluation of swallowing adds information to the clinical assessment of swallowing in tracheostomised patients. DESIGN: A prospective, observational study. SETTING: Addenbrooke's Hospital, Cambridge, UK. PARTICIPANTS: Twenty-five consecutive, adult, tracheostomised patients were recruited over a 3-month period. They were referred to speech and language therapy for a swallowing assessment and were ready to trial cuff deflation. MAIN OUTCOME MEASURES: In current practice the clinical assessment is invariably a precursor to fibreoptic endoscopic evaluation of swallowing and a test would be considered positive when penetration or aspiration are detected. We considered the value of fibreoptic endoscopic evaluation of swallowing following both positive and negative outcomes of the clinical assessment. RESULTS: The positive predictive value of aspiration or penetration was 91% i.e. when a clinical assessment is failed, there is a very high probability the patient would also be failed on fibreoptic endoscopic evaluation of swallowing. However, the negative predictive value was only 64% i.e. over one-third of patients who pass a clinical assessment would later fail a fibreoptic endoscopic evaluation of swallowing. CONCLUSIONS: Despite a small cohort, our data suggest that the assessment of swallowing to aid weaning in tracheostomised patients is currently performed incorrectly; we estimate that over a third of all tracheostomised patients that 'pass' the clinical assessment of swallowing are, in reality, at risk from penetration, aspiration or failed decannulation. This finding supports the use of fibreoptic endoscopic evaluation of swallowing and a change in clinical practice.
Authors: Gonzalo Hernandez; Ana Pedrosa; Ramon Ortiz; Maria del Mar Cruz Accuaroni; Rafael Cuena; Concepción Vaquero Collado; Susana García Plaza; Paloma González Arenas; Rafael Fernandez Journal: Intensive Care Med Date: 2013-03-08 Impact factor: 17.440