Lynch Ylinne T, Clark Brendan J, Macht Madison, White S David, Taylor Heather, Wimbish Tim, Moss Marc
Division of Pulmonary and Critical Care, University of Washington, Seattle, WA.
Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado, Aurora, CO.
J Crit Care. 2017 Jun;39:143-148. doi: 10.1016/j.jcrc.2017.02.013. Epub 2017 Feb 15.
Dysphagia with subsequent aspiration occurs in up to 60% of acute respiratory failure (ARF) survivors. Accurate bedside tests for aspiration can reduce aspiration-related complications while minimizing delay of oral nutrition. In a cohort of ARF survivors, we determined the accuracy of the bedside swallowing evaluation (BSE) and its components for detecting aspiration.
Patients who were extubated after at least 24hours of mechanical ventilation were eligible for enrollment. Within 3 days of extubation, patients underwent comprehensive BSE including 3-oz water swallowing test (3-WST), followed by a criterion standard test for aspiration, flexible endoscopic evaluation of swallowing (FEES).
Forty-five patients were included in the analysis. Median patient age was 55years (interquartile range, 47-65). Median duration of mechanical ventilation was 3.3days (interquartile range 1.8-6.0). Fourteen patients (31%) aspirated on FEES. Physical examination findings on BSE and abnormal swallowing during trials of different consistencies were variably associated with aspiration. Compared with FEES, the 3-WST yielded a sensitivity of 77% (95% confidence interval [CI], 50%-92%), specificity of 65% (95% CI, 47%-79%), and an area under the receiver operating characteristic curve (AUC) of 0.71; a speech language pathologist's recommendation for altered diet yielded a sensitivity of 86% (95% CI, 60%-96%), a specificity of 52% (95% CI, 35%-68%), and an AUCof 0.69; an speech language pathologist's recommendation for nil per os (nothing by mouth) yielded a sensitivity of 50% (95% CI, 27%-73%), a specificity of 94% (95% CI, 79%-98%), and an AUCof 0.72.
The BSE and its components, including the 3-WST, demonstrated variable accuracy for aspiration in survivors of ARF. Investigation to determine the optimal noninvasive test for aspiration in ARF survivors is warranted.
ClinicalTrials.gov identifier: NCT02363686, Aspiration in Acute Respiratory Failure Survivors.
高达60%的急性呼吸衰竭（ARF）幸存者会出现吞咽困难并伴有误吸。准确的床边误吸检测试验可减少与误吸相关的并发症，同时尽量减少肠内营养延迟。在一组ARF幸存者中，我们确定了床边吞咽评估（BSE）及其各组成部分检测误吸的准确性。
机械通气至少24小时后拔管的患者符合入组条件。在拔管后3天内，患者接受全面的BSE，包括3盎司水吞咽试验（3-WST），随后进行误吸的标准检测——吞咽功能的软性内镜评估（FEES）。
45例患者纳入分析。患者年龄中位数为55岁（四分位间距为47 - 65岁）。机械通气持续时间中位数为3.3天（四分位间距为1.8 - 6.0天）。14例患者（31%）在FEES检查中存在误吸。BSE的体格检查结果以及不同黏稠度试验期间的吞咽异常与误吸的相关性各不相同。与FEES相比，3-WST的敏感性为77%（95%置信区间[CI]，50% - 92%），特异性为65%（95% CI，47% - 79%），受试者工作特征曲线下面积（AUC）为0.71；言语语言病理学家关于调整饮食方案的建议敏感性为86%（95% CI，60% - 96%），特异性为52%（95% CI，35% - 68%），AUC为0.69；言语语言病理学家关于禁食的建议敏感性为50%（95% CI，27% - 73%），特异性为94%（95% CI，79% - 98%），AUC为0.72。
BSE及其组成部分，包括3-WST，在ARF幸存者误吸检测中的准确性各不相同。有必要开展研究以确定ARF幸存者误吸的最佳无创检测方法。
ClinicalTrials.gov标识符：NCT02363686，急性呼吸衰竭幸存者的误吸。
