The Safety of Fiberoptic Endoscopic Evaluation of Swallowing in Acute Stroke Patients

Abstract

Background and Purpose-Fiberoptic endoscopic evaluation of swallowing (FEES) is an excellent method for the accurate examination of swallowing function in the acute phase of stroke. The present study investigates the safety of FEES related to patients characteristics in a setting of acute stroke care. Methods-A prospective study of FEES-associated complications was carried out in 300 acute stroke patients over a 1-year period. A neurologist and a speech-language pathologist of the stroke unit team performed FEES within a mean time interval of 1.9Ϯ0.8 days after stroke onset. A closely meshed monitoring of cardiovascular parameters was done during each examination. A discomfort rating was obtained from the patients. Results-In none of the 300 subjects any airway comprise, decrease in the level of consciousness, symptomatic bradycardia/tachycardia, laryngospasm, or epistaxis requiring special treatment was observed. The incidence of self-limiting nosebleeds was 6% and did not significantly differ in relation to major stroke types (ischemic versus hemorrhagic), acute treatment strategy (thrombolysis versus no thrombolysis), or secondary prevention regime (anticoagulant therapy versus antiplatelet drugs). Whereas no alterations in diastolic blood pressure were noted, statistically significant changes in systolic blood pressure, heart rate, and oxygen saturation occurred. However, these alterations did not cause any severe adverse event and were clinically judged as being mild. The assessment of comfort revealed an excellent tolerance of FEES in Ͼ80% of patients. Conclusion-This study demonstrates that FEES is a well-tolerated and safe method to assess swallowing function when performed by a speech-language pathologist and a neurologist in a stroke unit setting.

Fiberoptic Endoscopic Dysphagia Severity Scale Predicts Outcome after Acute Stroke

“…and a speech-language pathologist (S.O. ), all having several years of experience with this diagnostic tool [13]. …”

“…Thus, additional apparative techniques are recommended for an objective and more differentiated swallowing assessment in acute stroke patients [6]. Fiberoptic endoscopic evaluation of swallowing (FEES) has been shown to be an excellent bedside method for a quick, safe and precise dysphagia assessment in the first days after stroke [13,14,15,16,17,18]. Recently, we developed and evaluated a FEES-based swallowing performance scale for acute stroke patients that allows for a differentiated and reliable classification of stroke-related dysphagia into 6 severity codes based on easy-to-identify endoscopic findings (see below) [14, 19].…”

Guidelines for the Early Management of Patients With Acute Ischemic Stroke

“…Clinical signs may not identify patients at risk for aspiration, and further testing, including a video fluoroscopic evaluation of swallow or a fiber optic endoscopic evaluation of swallow, may be performed if indicated. [919][920][921] Most patients are treated initially with intravenous fluids. Intravenous hyperalimentation is rarely necessary.…”

Predictive Factors for Percutaneous Endoscopic Gastrostomy in Patients with Spontaneous Intracranial Hemorrhage

“…If aspiration was assumed because of pathological water swallowing tests [42][43][44][45] , fiberoptic endoscopic evaluation of swallowing was performed [46][47][48][49][50][51] . Patients with aspiration were monitored for at least fourteen days.…”