Fiberoptic endoscopic validation of a clinical screening test of swallowing function in critically ill patients performed within 24 h after extubation

Maamar, Adel; Parent, V.; Prudhomme, Emmanuelle; Guérot, Emmanuel; Berneau, Pauline; Frerou, Aurélien; Tulzo, Yves Le; Jégoux, Franck; Gacouin, Arnaud; Tadié, Jean‐Marc

doi:10.1016/j.jcrc.2022.154119

Cited by 3 publications

(2 citation statements)

References 40 publications

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“…Furthermore, the diet recommendations are not classified according to the International Dysphagia Diet Standardisation Initiative (IDDSI), which makes a transfer to international diet management systems difficult. Recently, a bedside evaluation of swallowing function showed good accuracy to detect PED in critically ill patients after extubation [ 34 ]. However, this screening has been validated on physiotherapists and does not evaluate bolus swallows.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore an easy-to-use, standardized bedside dysphagia screening tool, such as the GUSS-ICU, would allow ICU nurses to perform a systematic testing for dysphagia in the absence of dysphagia experts and/or instrumental swallowing evaluations. A recent study showed, that the FEES was not performed in 56% of critically ill patients after extubation because of the unavailability of FEES operators [ 34 ]. So far, the GUSS-ICU has not been validated for nurses in the ICU, but the original GUSS has been validated and successfully used by nurses in stroke patients [ 16 , 35 ].…”

Section: Discussionmentioning

confidence: 99%

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A bedside swallowing screen for the identification of post-extubation dysphagia on the intensive care unit – validation of the Gugging Swallowing Screen (GUSS)—ICU

et al. 2023

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Purpose Screening for dysphagia at the intensive care unit (ICU) soon after extubation can prevent aspiration, pneumonia, lower mortality, and shorten re-feeding interval. This study aimed to modify the Gugging Swallowing Screen (GUSS), which was developed for acute stroke patients, and to validate it for extubated patients in the ICU. Methods In this prospective study, forty-five patients who had been intubated for at least 24 h were recruited consecutively at the earliest 24 h after extubation. The modified GUSS-ICU was performed twice by two speech and language therapists independently. Concurrently, gold standard the flexible endoscopic evaluation of swallowing (FEES) was performed by an otorhinolaryngologist. Measurements were conducted within a three-hour period; all testers were blinded to each other’s results. Results According to FEES, 36 of 45 (80%) participants were diagnosed with dysphagia; 13 of those were severe, 12 moderate, and 11 mild. Compared to FEES, the GUSS-ICU predicted dysphagia well (area under the curve for the initial rater pair: 0.923, 95% CI 0.832–1.000 and 0.923, 95% CI 0.836 -1.000 for the second rater pair). The sensitivity was 91.7% (95% CI 77.5–98.3%) and 94.4% (95% CI 81.3–99.3%); the specificity was 88.9% (51.8–99.7%) and 66.7% (29.9–92.5%); the positive predictive values were 97.1% (83.8–99.5%) and 91.9% (81.7–96.6%), and the negative predictive values were 72.7% (46.8–89%) and 75% (41.9–92.6%) for the first and second rater pairs, respectively. Dysphagia severity classification according to FEES and GUSS-ICU correlated strongly (Spearman’s rho: 0.61 for rater 1 and 0.60 for rater 2, p < 0.001). Agreement by all testers was good (Krippendorffs Alpha: 0.73). The interrater reliability showed good agreement (Cohen`s Kappa: 0.84, p < 0.001). Conclusion The GUSS-ICU is a simple, reliable, and valid multi-consistency bedside swallowing screen to identify post-extubation dysphagia at the ICU. Trial registration ClinicalTrials.gov Identifier: NCT04532398,31/08/2020.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A bedside swallowing screen for the identification of post-extubation dysphagia on the intensive care unit – validation of the Gugging Swallowing Screen (GUSS)—ICU

et al. 2023

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Aspiration after Critical Illness: Role of Endotracheal Tube, Tracheostomy, and Swallowing Disorders

Osorio,

Krakora,

Epping

et al. 2024

Semin Respir Crit Care Med

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Swallowing is a complex process that involves over 50 muscles and nerves and has two critical roles: passing food from the oral cavity through the pharynx and into the esophagus and preventing contents from entering the airway. If a patient's swallowing physiology or airway protective mechanisms are disturbed, the airways and the lungs have innate defense systems to protect against injury and infection. However, critically ill patients are more likely to develop dysphagia, which is an impairment or malfunction in any aspect of the swallowing mechanism, due to the numerous interventions they undergo. When airway reflexes fail, commonly in the presence of dysphagia, aspiration can occur, which is the entry of a fluid or solid below the level of the true vocal cords. If left unmanaged, dysphagia has been associated with aspiration pneumonia, pneumonitis, airway obstruction, delayed enteral nutrition, prolonged length of ICU and hospital stay, reduced quality of life, and even death; in some cases, dysphagia is an independent risk factor for mortality. It is important to routinely assess dysphagia in all critically ill patients using a multimodal approach, including systematic assessments, scoring indices, trained specialists, and intensive care unit nurses. Several interventions are crucial for preventing and managing dysphagia and its associated problems. Further research is necessary to help determine the best ways to prevent and manage pulmonary aspiration in critically ill patients. Several interventions are essential in preventing and managing dysphagia and the sequelae of swallowing dysfunction. Further research is needed to help elucidate the best way to avoid and manage pulmonary aspiration in critically ill patients.

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Swallowing Rehabilitation from a Respiratory Perspective

Fujita

2024

Jpn J Rehabil Med

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Fiberoptic endoscopic validation of a clinical screening test of swallowing function in critically ill patients performed within 24 h after extubation

Cited by 3 publications

References 40 publications

A bedside swallowing screen for the identification of post-extubation dysphagia on the intensive care unit – validation of the Gugging Swallowing Screen (GUSS)—ICU

A bedside swallowing screen for the identification of post-extubation dysphagia on the intensive care unit – validation of the Gugging Swallowing Screen (GUSS)—ICU

Aspiration after Critical Illness: Role of Endotracheal Tube, Tracheostomy, and Swallowing Disorders

Swallowing Rehabilitation from a Respiratory Perspective

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