Hales P A, Drinnan M J, Wilson J A
Department of Speech and Language Therapy, Addenbrooke's Hospital, Cambridge, UK. pippa.hales@addenbrookes
Clin Otolaryngol. 2008 Aug;33(4):319-24. doi: 10.1111/j.1749-4486.2008.01757.x.
To determine if fibreoptic endoscopic evaluation of swallowing adds information to the clinical assessment of swallowing in tracheostomised patients.
A prospective, observational study.
Addenbrooke's Hospital, Cambridge, UK.
Twenty-five consecutive, adult, tracheostomised patients were recruited over a 3-month period. They were referred to speech and language therapy for a swallowing assessment and were ready to trial cuff deflation.
In current practice the clinical assessment is invariably a precursor to fibreoptic endoscopic evaluation of swallowing and a test would be considered positive when penetration or aspiration are detected. We considered the value of fibreoptic endoscopic evaluation of swallowing following both positive and negative outcomes of the clinical assessment.
The positive predictive value of aspiration or penetration was 91% i.e. when a clinical assessment is failed, there is a very high probability the patient would also be failed on fibreoptic endoscopic evaluation of swallowing. However, the negative predictive value was only 64% i.e. over one-third of patients who pass a clinical assessment would later fail a fibreoptic endoscopic evaluation of swallowing.
Despite a small cohort, our data suggest that the assessment of swallowing to aid weaning in tracheostomised patients is currently performed incorrectly; we estimate that over a third of all tracheostomised patients that 'pass' the clinical assessment of swallowing are, in reality, at risk from penetration, aspiration or failed decannulation. This finding supports the use of fibreoptic endoscopic evaluation of swallowing and a change in clinical practice.
确定纤维光学内镜吞咽评估是否能为气管切开患者的吞咽临床评估提供更多信息。
一项前瞻性观察研究。
英国剑桥阿登布鲁克医院。
在3个月期间连续招募了25名成年气管切开患者。他们被转介到言语和语言治疗科进行吞咽评估，并准备好试验气囊放气。
在当前实践中，临床评估始终是纤维光学内镜吞咽评估的前奏，当检测到渗透或误吸时，测试将被视为阳性。我们考虑了临床评估阳性和阴性结果后纤维光学内镜吞咽评估的价值。
误吸或渗透的阳性预测值为91%，即当临床评估不合格时，患者在纤维光学内镜吞咽评估中也不合格的可能性非常高。然而，阴性预测值仅为64%，即超过三分之一通过临床评估的患者后来在纤维光学内镜吞咽评估中不合格。
尽管样本量较小，但我们的数据表明，目前对气管切开患者进行吞咽辅助撤机评估的方法不正确；我们估计，在所有通过吞咽临床评估的气管切开患者中，超过三分之一实际上存在渗透、误吸或脱管失败的风险。这一发现支持使用纤维光学内镜吞咽评估并改变临床实践。
