Penetration–Aspiration: Is Their Detection in FEES® Reliable Without Video Recording?

Hey, Christiane; Pluschinski, P; Pajunk, Raissa; Almahameed, A.; Girth, Lara; Sader, Robert; Stöver, Timo; Zaretsky, E. V.

doi:10.1007/s00455-015-9616-3

Cited by 41 publications

(26 citation statements)

References 18 publications

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“…Therefore, the reliability of the OPHL-PAS seems to be comparable to the reliability of the PAS in FEES. Slight differences of the reliability of the PAS among the studies may be the result of the influence of several factors, such as the clinical experience of the raters, the training, the number of views for each video and the retest interval [27,28,30]. Moreover, the different the statistical method used in the studies does not allow a direct comparison of the results as different concepts were tested.…”

Section: Discussionmentioning

confidence: 99%

The Penetration–Aspiration Scale: Adaptation to Open Partial Laryngectomy and Reliability Analysis

et al. 2019

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A standard for assessing swallowing function after open partial horizontal laryngectomy (OPHL) is still not established. The variability in the measures used to investigate swallowing functional outcomes after OPHL limits the communication among clinicians and the possibility to compare and combine results from different studies. The study aims to adapt the PAS to the altered anatomy after OPHLs using fiberoptic endoscopic evaluation of swallowing (FEES) and to test its reliability. To adapt the PAS, two landmarks were identified: the entry of the laryngeal vestibule and the neoglottis. Ninety patients who underwent an OPHL were recruited (27 type I, 31 type II and 32 type III). FEES was performed and video-recorded. Two speech and language therapists (SLTs) independently rated each FEES using the PAS adapted for OPHL (OPHL-PAS). FEES recordings were rated for a second time by both SLTs at least 15 days from the first video analysis. Inter-and intra-rater agreement was assessed using unweighted Cohen's kappa. Overall, inter-rater agreement of the OPHL-PAS was k = 0.863, while intra-rater agreement was k = 0.854. Concerning different OPHL types, inter-and intra-rater agreement were k = 0.924 and k = 0.914 for type I, k = 0.865 and k = 0.790 for type II, and k = 0.808 and k = 0.858 for type III, respectively. The OPHL-PAS is a reliable scale to assess the invasion of lower airway during swallowing in patients with OPHL using FEES. The study represents the first attempt to define standard tools to assess swallowing functional outcome in this population.

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Section: Discussionmentioning

confidence: 99%

The Penetration–Aspiration Scale: Adaptation to Open Partial Laryngectomy and Reliability Analysis

et al. 2019

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“…Although VFSS is more widely available, we used FEES as our gold standard instrumental exam[18]. Prior studies have demonstrated excellent agreement between VFSS and FEES as well as good inter- and intra-rater reliability for both, however FEES is more sensitive for penetration and aspiration[44–49]. VFSS requires transportation to fluoroscopy, which can be challenging in critically ill patients, whereas FEES can be performed at the bedside.…”

Section: Discussionmentioning

confidence: 99%

The accuracy of the bedside swallowing evaluation for detecting aspiration in survivors of acute respiratory failure

Lynch

Clark

Macht³

et al. 2017

Journal of Critical Care

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Background Dysphagia with subsequent aspiration occurs in up to 60% of acute respiratory failure (ARF) survivors. Accurate bedside tests for aspiration can reduce aspiration-related complications while minimizing delay of oral nutrition. In a cohort of ARF survivors, we determined the accuracy of the bedside swallowing evaluation (BSE) and its components for detecting aspiration. Methods Patients who were extubated after ≥24 hours of mechanical ventilation were eligible for enrollment. Within three days of extubation, patients underwent comprehensive BSE including 3-ounce water swallowing test (3-WST), followed by a gold standard test for aspiration, flexible endoscopic evaluation of swallowing (FEES). Results 45 patients were included in the analysis. Median patient age was 55 years (IQR=47- 65). Median duration of mechanical ventilation was 3.3 days (IQR 1.8–6.0). 14 patients (31%) aspirated on FEES. Physical exam findings on BSE and abnormal swallowing during trials of different consistencies were variably associated with aspiration. Compared to FEES, the 3-WST yielded a sensitivity of 77% (95%CI=50–92%), specificity of 65% (95%CI=47–79%), and AUC=0.71; an SLP’s recommendation for altered diet yielded a sensitivity of 86% (95%CI=60– 96%), specificity of 52% (95%CI=35–68%), and AUC=0.69; an SLP’s recommendation for NPO yielded a sensitivity of 50% (95%CI=27–73%), specificity of 94% (95%CI=79–98%), and AUC=0.72. Conclusions The BSE and its components, including the 3-WST, demonstrated variable accuracy for aspiration in survivors of ARF. Investigation to determine the optimal non-invasive test for aspiration in ARF survivors is warranted. Clinical Trials Registration ClinicalTrials.gov Identifier: NCT02363686, Aspiration in Acute Respiratory Failure Survivors

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“…Comorbidities that are considered risk factors of dysphagia were also surveyed. The Penetration–Aspiration Scale (PAS), which is an eight‐point clinical scale for rating penetration and aspiration, was originally designed for videofluoroscopy; however, it was also used to compare the two groups because recent studies have reported the reliability of the PAS for FEES . The questionnaires, general conditions, functional impairment status, clinical assistance requirements, oral intake ability, and consciousness level were answered by a subject, a care person, and/or family caregiver in charge.…”

Section: Methodsmentioning

confidence: 99%

Low‐risk assessment of swallowing impairment using flexible endoscopy without food or liquid

et al. 2019

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Objectives/Hypothesis Flexible endoscopic evaluation of swallowing (FEES) is a relatively safe procedure to determine the safety of oral feeding, and consists of the introduction of food and liquid as well as a sensitivity test. However, the introduction of food and liquid can cause pneumonia or suffocation secondary to aspiration. To solve this problem, we investigated the possibility of performing FEES without introduction of food or liquid (referred to hereafter as FEES screen) to assess swallowing impairment severity. Study Design Retrospective study. Methods A total of 106 subjects with swallowing impairment underwent conventional FEES, and both their salivary pooling degree and larynx sensitivity were analyzed to detect swallowing impairment without the introduction of food or liquid. The subjects were divided into two groups: an undetectable swallowing impairment (USI) group and a detectable swallowing impairment (DSI) group. The general characteristics, functional impairment status, and clinical assistance requirements of the two groups were investigated and compared. Results The numbers of subjects in the USI and DSI groups were 64 and 42, respectively. The DSI group showed a significantly higher prevalence of aspiration during FEES, and their required levels of care were also significantly higher. Additionally, their levels of consciousness, oral intake ability, and activities of daily living were significantly low compared to the USI group. Conclusions This study demonstrated the feasibility of FEES screen for assessment of swallowing impairment severity. Using our low‐risk assessment, we were able to identify subjects with low oral intake ability as well as those who required intervention. Level of Evidence 4 Laryngoscope, 129:2249–2252, 2019

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Penetration–Aspiration: Is Their Detection in FEES® Reliable Without Video Recording?

Cited by 41 publications

References 18 publications

The Penetration–Aspiration Scale: Adaptation to Open Partial Laryngectomy and Reliability Analysis

The Penetration–Aspiration Scale: Adaptation to Open Partial Laryngectomy and Reliability Analysis

The accuracy of the bedside swallowing evaluation for detecting aspiration in survivors of acute respiratory failure

Low‐risk assessment of swallowing impairment using flexible endoscopy without food or liquid

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