Assessment of Dysphagia: Difference between revisions
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Revision as of 15:32, 17 June 2024
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Introduction[edit | edit source]
Dysphagia screening and assessment helps with early identification, management, prevention and mitigation of complications related to swallowing difficulties. It is important with optimisation of nutritional support and can enhance patient overall health outcomes. However, according to Freeman-Sanderson et al.[1] a formal dysphagia training and administartion of dysphagia protocol is completed by thirty percent of practitioners working on the ICU.
Dysphagia screening and assessment alidated non-instrumental dysphagia screening and assessment methods specifically developed for ICU patients are conspicuously absent
Patient History[edit | edit source]
Observation[edit | edit source]
Palpation[edit | edit source]
Examination[edit | edit source]
General Rules[edit | edit source]
Dry Swallowing[edit | edit source]
Water Swallowing Test[edit | edit source]
Modified Water Swallowing Test[edit | edit source]
Bedside Swallowing Evaluation (BSE)[edit | edit source]
- Completed by the speech language pathologists (SLPs)
- Assess swallowing function and airway safety during swallowing[2]
- Helps to identify the risk of aspiration [2]
- Used by SLPs to provide feeding recommendations
- According to Moss et al.[2], "BSEs are relatively inaccurate for the detection of aspiration"
Standardised Protocol for BSE evaluation include the following elements:[2]
- review of the patient’s medical record
- physical examination:
- lip movement and seal
- tongue movement and strength
- volitional cough strength
- dentition
- voice quality
- amount of assistance required with feeding
- patient is positioned as upright as possible
- The SLP administered five standard consistencies: (1) ice chips, (2) nectar thin liquids, (3) pureed solids , (4) thin liquids, and (5) solids in successive boluses that increased in size
- The SLP administers all boluses unless they consider it unsafe based on the patient's response
- The SLP observes for five clinical signs for aspiration after each bolus: cough, throat clearing, change in vocal quality, wet breath sounds, or stridor.
Swallowing Reflex Test (Cough Reflex Test)[edit | edit source]
Videofluoroscopic Swallow Study (VFSS)[edit | edit source]
Fiberoptic Endoscopic Evaluation of Swallowing (FEES)[edit | edit source]
- administered by SLPs trained in FEES examination
- fiber-optic or distal chip endoscopes are used for the evaluation
- every institution must develop protocol for FEES administration
- video and sound is recorded and use to determine a penetration-aspiration scale (PAS) score for each of the boluses administered
- PAS is an 8-point, equal-appearing interval scale describing penetration and aspiration events: [3]
- score of 6 or more indicates aspiration
- score of 6 or 7 indicates nonsilent aspiration
- score of 8 represents silent aspiration
- PAS is an 8-point, equal-appearing interval scale describing penetration and aspiration events: [3]
Resources[edit | edit source]
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References[edit | edit source]
- ↑ Freeman-Sanderson A, Hemsley B, Thompson K, Rogers KD, Knowles S, Hammond NE. Dysphagia in adult intensive care patients: Results of a prospective, multicentre binational point prevalence study. Australian Critical Care. 2023 Nov 1;36(6):961-6.
- ↑ 2.0 2.1 2.2 2.3 Moss M, White SD, Warner H, Dvorkin D, Fink D, Gomez-Taborda S, Higgins C, Krisciunas GP, Levitt JE, McKeehan J, McNally E, Rubio A, Scheel R, Siner JM, Vojnik R, Langmore SE. Development of an Accurate Bedside Swallowing Evaluation Decision Tree Algorithm for Detecting Aspiration in Acute Respiratory Failure Survivors. Chest. 2020 Nov;158(5):1923-1933.
- ↑ Rosenbek JC, Robbins JA, Roecker EB, Coyle JL, Wood JL. A penetration-aspiration scale. Dysphagia. 1996 Spring;11(2):93-8.
