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

Abstract

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.

Reassessment of Poststroke Dysphagia in Rehabilitation Facility Results in Reduction in Diet Restrictions

“…Based on the FEES results, a significant change in diet occurred in 65% of the patient cohort in this study, with diet restrictions being decreased in 60% and increased in 5% of patients. These results are supported by a recent German hospital study by Braun et al [ 28 ]. In 72% of their study cohort, the FEES investigation found relevant dysphagia, which led to an adjustment of diet.…”

“…According to Cohen et al, pneumonia prevention does not only include the early detection of swallowing disorders [ 28 ]. Both therapeutic and dietary interventions to reduce aspiration volume and frequency, as well as procedures to reduce the pathogenicity of aspiration, improve larynx sensitivity and respiratory protection mechanisms, as well as cough, and promote cortical plasticity to restore the swallowing function [ 30 ].…”

Isolated Dysphagia in a Patient with Medial Medullary Infarction – Effects of Evidence-Based Dysphagia Therapy: A Case Report

“…In this study significant lower rates of mortality and aspiration pneumonia were recorded after the change of oral diet based on FEES findings. In only 31% of investigated dysphagic cases on a stroke unit (SU) did the clinical assessment identify a proper oral diet [15]. In this study the change of oral diet based on FEES findings correlated with a better overall outcome at discharge from SU, shorter length of stay, lower rate of aspiration pneumonia, and lower need for mechanical ventilation.…”

Poremećaji gutanja u neuroloških bolesnika

“…Zbog praktičnih razloga sve se više upotrebljava fiberendoskopska evalu- acija gutanja [4][5][6] . Kao prednosti fiberendoskopske evaluacije gutanja ističu se mogućnost obavljanja pretrage uz postelju bolesnika, izbjegavanje zračenja te mogućnost jednostavnog ponavljanja pretrage u više navrata, a komplikacije kao što su epistaksa i vazovagalna sinkopa su rijetke 60,61 . Fiberendoskopijom je moguće prikazati područje ždrijela i grkljana u trenutku neposredno prije i neposredno nakon gutanja.…”