The incidence of post-extubation dysphagia (PED) is reported to be about 12% in the general ICU population and around 18% in patients admitted to ICU as emergencies. PED was found to be an independent predictor of 28-day and 90-day mortality. Thus, the authors have proposed a pragmatic screening algorithm for PED. In this paper, they outline the findings of a systematic review of non-instrumental approaches to assessing dysphagia that informed their algorithm. Using standard systematic review methodology and Cochrane risk of bias tools, they found 19 articles that reported on 12 different non-instrumental approaches for assessing oropharyngeal dysphagia. These included the Bedside Swallow Evaluation (BSE), Volume-Viscosity Swallowing Test (V-VST), Mann Assessment of Swallowing Ability (MASA), McGill Ingestive Swallowing Assessment (MISA), Gugging Swallowing Screen (GUSS), Northwestern Dysphagia Patient Check Sheet (NDPCS), Dysphagia Disorder Survey (DDS), Practical Aspiration Screening Scheme (PASS), Kuchi-Kara Taberu Index (KT index) and the Practical Assessment of Dysphagia. Based on their evaluations they concluded that the BSE and V-VST were the most feasible assessments for the critically ill PED population on ICU. Their two-step algorithm therefore included a systematic bedside screening performed by trained nurses within three hours of extubation. Positive screens could then be referred for confirmation via either non-instrumental (V-VST) or instrumental assessment (FEES, VFS) depending on availability at the institution. This paper provides a very helpful overview of the above-listed dysphagia assessment tools and gives a useful critique for why the authors selected the approach used in their PED screening algorithm.

Clinical Approaches to Assess Post-extubation Dysphagia (PED) in the Critically Ill.
Perren A, Zürcher P, Schefold JC.
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Roganie Govender

University College London Hospital, Head & Neck Academic Centre, UK.

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