Diagnosis and treatment of post-extubation dysphagia: Results from a national survey

Abstract

Purpose This study sought to determine the utilization of speech-language pathologist (SLPs) for the diagnosis and treatment of post-extubation dysphagia in survivors of mechanical ventilation. Methods We designed, validated, and mailed a survey to 1,966 inpatient SLPs who routinely evaluate patients for post-extubation dysphagia. Results The majority of SLP diagnostic evaluations (60%; 95% CI = 59–62%) were performed using clinical techniques with uncertain accuracy. Instrumental diagnostic tests (such as fluoroscopy and endoscopy) are more likely to be available at university than community hospitals. After adjusting for hospital size and academic affiliation, instrumental test use varied significantly by geographical region. Treatments for post-extubation dysphagia usually involved dietary adjustment (76%; 95% CI = 73–79%) and postural changes/compensatory maneuvers (86%; 95% CI = 84–88%), rather than on interventions aimed to improve swallowing function (24%; 95% CI = 21–27%). Conclusions SLPs frequently evaluate acute respiratory failure survivors. However, diagnostic evaluations rely mainly upon bedside techniques with uncertain accuracy. The use of instrumental tests varies by geographic location and university affiliation. Current diagnostic practices and feeding decisions for critically ill patients should be viewed with caution until further studies determine the accuracy of bedside detection methods.

Recovery from Dysphagia Symptoms after Oral Endotracheal Intubation in Acute Respiratory Distress Syndrome Survivors. A 5-Year Longitudinal Study

“…Prospective studies using standard clinical practice demonstrate referral for swallowing assessment by speech-language pathologists is highly variable in patients extubated from oral intubation with mechanical ventilation (10,37,38). Our data suggest that approximately one-third of orally intubated ARDS survivors have symptomatic dysphagia at hospital discharge on the basis of the validated SSQ self-report survey.…”

Swallowing Dysfunction After Critical Illness

“…Components of the bedside evaluation can be performed in isolation, or in series, and frequently involve a patient interview, and an examination of tongue, lip, and oral motor and sensory function before and aft er the swallowing trials. 7 To streamline the diagnostic evaluation for swallowing disorders, some of the more sensitive components of the bedside swallow evaluation can be used as an initial screening test. Nearly all of these screening tests involve attempts to swallow small quantities of water and/or ice chips under the observation of a nurse, speech-language pathologist, or physician.…”

“…6 Ninety percent of the time, a speech-language pathologist requires a consult from the treating physician to become involved in the care of critical illness survivors. 7 In part due to the morbidity of dysfunctional swallowing and the increasing resources required to evaluate and treat swallowing disorders, the national yearly cost of swallowing problems in hospitalized patients is estimated to be over $500 million dollars. 8 Th is review seeks to shed light on the particular questions faced by critical care practitioners.…”

Dysphagia after Acute Respiratory Distress Syndrome. Another Lasting Legacy of Critical Illness

“…Only a minority of critically ill patients are assessed for dysphagia after extubation (6,8). In addition, fewer than half of the hospitals in the United States have an established screening protocol for postextubation dysphagia (9), and the rate of swallowing assessment after extubation varies significantly between hospitals (8).…”