Swallowing screening practice patterns for nurses in the cardiac surgery intensive care unit

York, Justine Dallal; Miller, Sarah; Chapin, Jennifer; Gore, Stephanie; Jeng, Eric I.; Plowman, Emily K.

doi:10.1111/jocn.15490

Cited by 12 publications

(7 citation statements)

References 38 publications

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“…The three currently available PED screens all focus on aspiration and utilize a 3-oz water swallowing test [ 7 ], whereas growing data suggest that not all nurses are confident in performing these screens, correctly identifying signs of aspiration (i.e., wet voice). One recent study revealed that 81% of nurses working in the cardiac ICU reported having no formal training in swallow screening [ 12 ]. Nearly half, 48%, of ICU nurses reported feeling “somewhat” or “not” confident in performing screens [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…One recent study revealed that 81% of nurses working in the cardiac ICU reported having no formal training in swallow screening [ 12 ]. Nearly half, 48%, of ICU nurses reported feeling “somewhat” or “not” confident in performing screens [ 12 ]. Our two-item swallowing screen provides important alternatives.…”

Section: Discussionmentioning

confidence: 99%

“…However, these screening tools are not yet consistently applied clinically [ 11 ], resulting in a theory–practice gap. This underuse of screening tools is due to several reasons, including lack of guidelines to recommend their use, uncertainty about what to do with the screening results, and lack of time and specialized trained personnel to administer the screens [ 12 – 15 ]. In many cases, nurses are responsible for administering these screens, i.e., introducing liquids or foods that result in clinical signs of aspiration such as coughing, choking, and wet vocal quality that usually indicate PED [ 16 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

“…In many cases, nurses are responsible for administering these screens, i.e., introducing liquids or foods that result in clinical signs of aspiration such as coughing, choking, and wet vocal quality that usually indicate PED [ 16 , 17 ]. Although the resulting clinical signs are seemingly straightforward, many nurses do not feel confident in judging them [ 12 ], especially when it has been suggested that 25% of patients aspirate silently [ 18 ]. On the other hand, nurses are concerned that aspiration triggered by water swallow tests can harm frail ICU patients even further [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

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Predicting feeding-tube dependence in patients following endotracheal extubation: a two-item swallowing screen

et al. 2021

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Background To meet the surging demands for intubation and invasive ventilation as more COVID-19 patients begin their recovery, clinicians are challenged to find an ultra-brief and minimally invasive screen for postextubation dysphagia predicting feeding-tube dependence persisting for 72 h after extubation. Methods This study examined the predictive validity of a two-item swallowing screen on feeding-tube dependence over 72 h in patients following endotracheal extubation. Intensive-care-unit (ICU) patients (≥ 20 years) successfully extubated after ≥ 48 h endotracheal intubation were screened by trained nurses using the swallowing screen (comprising oral stereognosis and cough-reflex tests) 24 h postextubation. Feeding-tube dependence persisting for 72 h postextubation was abstracted from the medical record by an independent rater. To verify the results and cross-check whether the screen predicted penetration and/or aspiration during fiberoptic endoscopic evaluation of swallowing (FEES), participants agreeing to receive FEES were analyzed within 30 min of screening. Results The results showed that 95/123 participants (77.2%) failed the screen, which predicted ICU patients’ prolonged (> 72 h) feeding-tube dependence, yielding sensitivity of 0.83, specificity of 0.35, and accuracy of 0.68. Failed-screen participants had 2.96-fold higher odds of feeding-tube dependence (95% CI, 1.13–7.76). For the 38 participants receiving FEES, the swallowing screen had 0.89 sensitivity to detect feeding-tube dependence and 0.86 sensitivity to predict penetration/aspiration, although specificity had room for improvement (0.36 and 0.21, respectively). Conclusion This ultra-brief swallowing screen is sufficiently sensitive to identify high-risk patients for feeding-tube dependence persisting over 72 h after extubation. Once identified, a further assessment and care are indicated to ensure the prompt return of patients’ oral feeding. Trial registration NCT03284892, registered on September 15, 2017.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Predicting feeding-tube dependence in patients following endotracheal extubation: a two-item swallowing screen

et al. 2021

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“…In the reference book of osteopathic medicine, an example is given of altered systemic reflexes following surgery, which can be felt through palpation of the spinal musculature showing rigid muscles and the limitation of vertebral movement [2]. After an event, surgery, for example, in the cardiovascular field, patients present with problems in lingual function, with the presence of dysphagia [68,69]. Surgery to remove tumor masses from the neck or head generally favors the onset of dysphagia [70].…”

Section: The Neurological Model and The Tonguementioning

confidence: 99%

A Missing Voice: The Lingual Complex and Osteopathic Manual Medicine in the Context of Five Osteopathic Models

Bordoni¹,

Escher²

2021

Cureus

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The five osteopathic models recognized by the American Association of Colleges of Osteopathic Medicine guide clinicians in the evaluation and therapeutic choice which must be the most appropriate concerning the patient's needs. Skeletal muscles represent an important interpretation, such as screening and treatment, on which these models are based. A muscle district that is not considered by the usual osteopathic practice is the tongue. The lingual complex has numerous functions, both local and systemic; it can adapt negatively in the presence of pathology, just as it can influence the body system in a non-physiological manner if it is a source of dysfunctions. This paper, the first of its kind in the panorama of scientific literature, briefly reviews the anatomy and neurophysiology of the tongue, trying to highlight the logic and the need to insert this muscle in the context of the five osteopathic models. The clinician's goal is to restore the patient's homeostasis, and we believe that this task is more concrete if the patient is approached after understanding all the contractile districts, including the tongue.

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Discriminant Ability of the 3-Ounce Water Swallow Test to Detect Aspiration in Acute Postoperative Cardiac Surgical Patients

et al. 2021

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Swallowing screening practice patterns for nurses in the cardiac surgery intensive care unit

Abstract: This article has been contributed to by US Government employees and their work is in the public domain in the USA.

Cited by 12 publications

References 38 publications

Predicting feeding-tube dependence in patients following endotracheal extubation: a two-item swallowing screen

Predicting feeding-tube dependence in patients following endotracheal extubation: a two-item swallowing screen

A Missing Voice: The Lingual Complex and Osteopathic Manual Medicine in the Context of Five Osteopathic Models

Discriminant Ability of the 3-Ounce Water Swallow Test to Detect Aspiration in Acute Postoperative Cardiac Surgical Patients

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