Ajemian M S, Nirmul G B, Anderson M T, Zirlen D M, Kwasnik E M
Department of Surgery, Waterbury Hospital Health Center, 64 Robbins St, Waterbury, CT 06721, USA.
Arch Surg. 2001 Apr;136(4):434-7. doi: 10.1001/archsurg.136.4.434.
Fiberoptic endoscopic evaluation of swallowing (FEES) will identify patients who are at high risk for pulmonary aspiration due to swallowing dysfunction after prolonged intubation. Based on the results of FEES, dietary recommendations can be made to decrease the incidence of aspiration after prolonged intubation.
Patients who were intubated for at least 48 hours were evaluated for swallowing dysfunction by bedside FEES within 48 hours of extubation. Differences in potential risk factors between aspirators and nonaspirators were analyzed. Dietary recommendations were made and patients were followed up for signs of clinically significant aspiration.
Community teaching hospital.
Fifty-one consecutive patients with no previously documented swallowing disorder who required a minimum of 48 hours of intubation for mechanical ventilation.
Fiberoptic endoscopic evaluation of swallowing was performed by a speech pathologist. Initial diet orders were determined by results of the swallowing study.
Incidence of swallowing dysfunction following prolonged intubation and incidence of clinically significant aspiration following initiation of oral feeding.
Incidence of swallowing dysfunction was 56% (27/48); 12 (25%) of 48 patients were silent aspirators. In comparing aspirators with nonaspirators, no significant differences in potential risk factors or comorbidities were seen. Nineteen (70%) of the 27 patients aspirated with thin-consistency test liquids, and the other 8 (30%) with puree consistency. No patients in this study group developed a clinically significant aspiration following initiation of appropriately modified diets.
Fiberoptic endoscopic evaluation of swallowing identified swallowing dysfunction in more than 50% of patients intubated for longer than 48 hours, many of whom are silent aspirators. Dietary recommendations based on FEES results prevented clinically significant aspiration.
纤维光学吞咽内镜评估（FEES）将识别出因长时间插管后吞咽功能障碍而有高误吸风险的患者。基于FEES的结果，可以给出饮食建议以降低长时间插管后误吸的发生率。
对插管至少48小时的患者，在拔管后48小时内通过床边FEES评估吞咽功能障碍。分析误吸者和非误吸者之间潜在风险因素的差异。给出饮食建议，并对患者进行随访以观察是否有具有临床意义的误吸迹象。
社区教学医院。
51例既往无吞咽障碍记录、因机械通气需要至少48小时插管的连续患者。
由言语病理学家进行纤维光学吞咽内镜评估。初始饮食医嘱根据吞咽研究结果确定。
长时间插管后吞咽功能障碍的发生率以及开始经口进食后具有临床意义的误吸发生率。
吞咽功能障碍发生率为56%（27/48）；48例患者中有12例（25%）为隐性误吸者。在比较误吸者和非误吸者时，未发现潜在风险因素或合并症有显著差异。27例患者中有19例（70%）在吞咽稀质测试液体时发生误吸，另外8例（30%）在吞咽泥状食物时发生误吸。该研究组中没有患者在开始适当调整饮食后出现具有临床意义的误吸。
纤维光学吞咽内镜评估发现，超过50%的插管超过48小时的患者存在吞咽功能障碍，其中许多是隐性误吸者。基于FEES结果的饮食建议可预防具有临床意义的误吸。
