Dataset Information

Association between clinical risk factors and severity of dysphagia after extubation based on a videofluoroscopic swallowing study.

ABSTRACT:

Background/aims

This study aimed to evaluate the correlation between clinical risk factors of post-extubation dysphagia (PED) and the severity of impaired pharyngeal swallowing function assessed via videofluoroscopic swallowing studies (VFSSs).

Methods

This study was a retrospective review of medical records. Of 116 patients who were admitted to the intensive care unit and underwent VFSS, 32 who had non-neurologic disorders and experienced prolonged intubation (for more than 48 hours) were diagnosed with PED. The severity of PED was evaluated by using a functional dysphagia scale (FDS) and a penetration aspiration scale (PAS), on the basis of VFSS.

Results

The Simplified Acute Physiology Score 3 and total FDS score were positively correlated (r = 0.40, p = 0.02). Intubation duration was positively correlated with total PAS and FDS scores (r = 0.62, p < 0.001; r = 0.65, p < 0.001, respectively). The amounts of residue in the valleculae (RV) and pyriform sinuses (RP) were associated with intubation duration (r = 0.58, p < 0.001; r = 0.57, p < 0.001, respectively). Multivariate regression analysis revealed that intubation duration was significantly associated with the total FDS score, RV and RP subscales of the FDS, and total PAS score.

Conclusion

The severity of impaired swallowing function, particularly the amount of residue in the pharyngeal recesses assessed via VFSS, was strongly associated with both severity of medical illness and intubation duration. Intubation duration could be a prognostic factor for assessing impaired swallowing function on the basis of VFSS.

SUBMITTER: Yang WJ

PROVIDER: S-EPMC6960055 | biostudies-literature | 2020 Jan

REPOSITORIES: biostudies-literature

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Publications

Association between clinical risk factors and severity of dysphagia after extubation based on a videofluoroscopic swallowing study.

Yang Won-Jong WJ Park Eunhee E Min Yu-Sun YS Huh Jae-Won JW Kim Ae Ryoung AR Oh Hyun-Min HM Nam Tae-Woo TW Jung Tae-Du TD

The Korean journal of internal medicine 20200102 1

<h4>Background/aims</h4>This study aimed to evaluate the correlation between clinical risk factors of post-extubation dysphagia (PED) and the severity of impaired pharyngeal swallowing function assessed via videofluoroscopic swallowing studies (VFSSs).<h4>Methods</h4>This study was a retrospective review of medical records. Of 116 patients who were admitted to the intensive care unit and underwent VFSS, 32 who had non-neurologic disorders and experienced prolonged intubation (for more than 48 ho ...[more]

PMID: 31935322

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Project description:PurposeScreening 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.MethodsIn 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.ResultsAccording 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).ConclusionThe GUSS-ICU is a simple, reliable, and valid multi-consistency bedside swallowing screen to identify post-extubation dysphagia at the ICU.Trial registrationClinicalTrials.gov Identifier: NCT04532398,31/08/2020.

Project description:PurposeIt is essential that clinicians have evidence-based benchmarks to support accurate diagnosis and clinical decision making. Recent studies report poor reliability for diagnostic judgments and identifying mechanisms of impairment from videofluoroscopy (VFSS). Establishing VFSS reference values for healthy swallowing would help resolve such discrepancies. Steele et al. (2019) released preliminary reference data for quantitative VFSS measures in healthy adults aged < 60 years. Here, we extend that work to provide reference percentiles for VFSS measures across a larger age span.MethodData for 16 VFSS parameters were collected from 78 healthy adults aged 21-82 years (39 male). Participants swallowed three comfortable sips each of thin, slightly, mildly, moderately, and extremely thick barium (20% w/v). VFSS recordings were analyzed in duplicate by trained raters, blind to participant and task, using the Analysis of Swallowing Physiology: Events, Kinematics and Timing (ASPEKT) Method. Reference percentiles (p2.5, 5, 25, 50, 75, 95, and 97.5) were determined as per Clinical and Laboratory Standards Institute EP28-A3c guidelines.ResultsWe present VFSS reference percentile tables, by consistency, for (a) timing parameters (swallow reaction time; the hyoid burst-to-upper esophageal sphincter (UES)-opening interval; UES opening duration; time-to-laryngeal vestibule closure (LVC); and LVC duration) and (b) anatomically scaled pixel-based measures of maximum UES diameter, pharyngeal area at maximum pharyngeal constriction and rest, residue (vallecular, pyriform, other pharyngeal locations, total), and hyoid kinematics (X, Y, XY coordinates of peak position; speed). Clinical decision limits are proposed to demarcate atypical values of potential clinical concern.ConclusionThese updated reference percentiles and proposed clinical decision limits are intended to support interpretation and reliability for VFSS assessment data.Supplemental materialhttps://doi.org/10.23641/asha.24043041.

Project description:PurposeInformation on reliability of outcome measures used to assess the effectiveness of interventions in dysphagia rehabilitation is lacking, particularly when used by different research groups. Here, we report on reliability of the penetration-aspiration scale (PAS) and temporal and clearance measures, determined using videofluoroscopy.MethodSecondary analysis used videofluoroscopies from the Swallowing Treatment using Electrical Pharyngeal Stimulation trial in subacute stroke. PAS scores (719 scores from 18 participants) were evaluated and compared to the original PAS scores from the trial. Five conditions were assessed, including reliability for every swallow and overall mean of the worst PAS score. Operational rules for assessing temporal and clearance measures were also developed using the same data, and reliability of these rules was assessed. Reliability of component-level and derivative-level scores was assessed using the intraclass correlation coefficient (ICC) and weighted kappa.ResultsImage quality was variable. Interrater reliability for the overall mean of the worst PAS score was excellent (ICC = .914, 95% confidence interval [CI] [.853, .951]) but moderate for every swallow in the bolus (ICC = .743, 95% CI [.708, .775]). Intrarater reliability for PAS was excellent (all conditions). Excellent reliability (both inter- and intrarater > .90) was seen for temporal measures of stage transition duration (ICC = .998, 95% CI [.993, .999] and ICC = .995, 95% CI [.987, .998], respectively) as well as initiation of laryngeal closure and pharyngeal transit time and all individual swallow events. Strong scores were obtained for some clearance measures; others were moderate or weak.ConclusionsInterrater reliability for PAS is acceptable but depends on how the PAS scores are handled in the analysis. Interrater reliability for most temporal measures was high, although some measures required additional training. No clearance measures had excellent reliability.Supplemental materialhttps://doi.org/10.23641/asha.19090088.

Project description:BackgroundElderly patients are being increasingly admitted to the intensive care unit (ICU) for mechanical ventilation. Previous studies demonstrated that 20% to 35% of elderly patients were reintubated within 48 to 72 hours after extubation. Given the age-related physiologic changes and multiple comorbidities in elderly patients, the current conventional parameters for predicting extubation outcomes may not be applicable to this population. This study was performed to identify the association between age-related parameters and extubation failure in elderly patients.MethodsIntubated elderly patients (age of ≥60 years) admitted to the medical ICU of a university-based hospital from October 2014 to July 2015 were included. Failed extubation was defined as reintubation within 48 hours after the first extubation. The associations of extubation failure with demographic data, vital signs, cognition and anxiety, and ventilator parameters at the time of intubation and extubation were analyzed.ResultsIn total, 127 intubated elderly patients were recruited. Extubation failure occurred in 15 patients (11.8%). Patients with failed extubation had a lower body temperature (37.0°C vs. 37.3°C, P < 0.05) but a higher Facial Anxiety Scale (FAS) score than those with successful extubation (3 vs. 2, P < 0.05). Patients with extubation failure had significantly higher levels of blood urea nitrogen (BUN) (39.88 vs. 58.47 g/dL), serum sodium (137.66 vs. 141.47 mmol/L), and serum calcium (9.52 vs. 10.0 g/dL) but a wider anion gap (12.23 vs. 9.97), but no significant differences in respiratory parameters were found between the two groups. Multiple logistic regression revealed no independent factors associated with successful extubation.ConclusionThis study revealed no strong predictive factors. However, several physiological parameters (lower body temperature and higher FAS scores) and metabolic parameters (BUN, sodium, calcium, and anion gap) were significantly associated with the rate of extubation failure.

Project description:BackgroundVideofluoroscopic swallow studies (VFSS) are multidisciplinary swallowing assessments led by speech-language therapists (SLTs). The purpose of oesophageal screening in VFSS is to guide further diagnostic assessment and treatment of possible oesophageal abnormalities. Yet, internationally standard protocols and clinical pathways for oesophageal screening in VFSS have not been established.Aim(s)The aim of this study was to refine and optimise oesophageal screening in VFSS at one Australian metropolitan hospital by incorporating expertise of the multidisciplinary dysphagia team.Methods and proceduresFocus groups/semi-structured interviews were conducted with SLTs, radiologists (RADs), gastroenterologists (GEs), referring medical officers (MEDs) and medical radiation technicians (MRTs, also known as radiographers) working in VFSS. Interview questions explored oesophageal screening approaches, interpretation and reporting practices, GE referral criteria and clinical recommendations. Data were analysed via qualitative content analysis to determine meaning units, sub-categories, and categories.Outcomes and resultsTwenty-six health professionals were interviewed (n = 8 SLTs, n = 6 RADs, n = 5 MEDs, n = 4 MRTs, n = 3 GEs). Four categories were identified: (1) oesophageal screening in VFSS adds clinical information but has limitations; (2) specific knowledge, skills and organisational factors are needed to optimise oesophageal screening, including in procedure, interpretation, reporting, GE referral pathway and intervention selection; (3) multidisciplinary consensus is needed regarding normal versus abnormal oesophageal transit and GE referral criteria; and (4) patient context, preferences and reported symptoms should primarily guide dysphagia decision-making. Each category had several component subcategories. The local clinical pathway (also known as care pathway or care map) for oesophageal screening in VFSS was refined by incorporating multidisciplinary dysphagia team expertise.Conclusions and implicationsThere was a willingness from the multidisciplinary dysphagia team to refine the local clinical pathway for oesophageal screening in VFSS. Detailed clinical pathways that guide workflow and decision-making should be considered when introducing oesophageal screening into VFSS protocols.What this paper addsWhat is already known on the subject Despite the recognised benefits of including oesophageal screening in VFSS, there has been limited uptake of oesophageal screening protocols internationally. Implementation research is needed that supports clinicians to embed oesophageal screening into routine VFSS practice. What this study adds This is the first published study that explores in-depth the perspectives of the multidisciplinary dysphagia team regarding oesophageal screening in VFSS. What are the clinical implications of this work? This study proposes a clinical pathway refined by the multidisciplinary dysphagia team to support clinicians in embedding oesophageal screening and its findings into routine dysphagia practice.

Dataset Information

Association between clinical risk factors and severity of dysphagia after extubation based on a videofluoroscopic swallowing study.

Background/aims

Methods

Results

Conclusion

Publications

Association between clinical risk factors and severity of dysphagia after extubation based on a videofluoroscopic swallowing study.

Similar Datasets

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