Epworth Healthcare, 29 Erin Street, Richmond, VIC, 3121, Australia.
NeuroRehab Allied Health Network, 76 Mahoneys Rd, Thomastown, VIC, 3074, Australia.
Dysphagia. 2022 Aug;37(4):778-787. doi: 10.1007/s00455-021-10327-y. Epub 2021 Jun 17.
People with disorders of consciousness (DoC) often receive nutrition via a feeding tube and the swallowing ability in this population is not fully understood. In particular, fiberoptic endoscopic evaluation of swallowing (FEES) with people with DoC requires further investigation. The aim of this systematic review is to collate, assess and summarise the current evidence of whether FEES is feasible and safe with people with DoC. Multiple health databases were searched in November 2019 to identify studies which used FEES with people with DoC. Data extraction included demographic information, adverse events reported and outcomes related to oral feeding. The Diagnostic Accuracy Quality Scale (DAQS) was used to assess the quality of the studies. In total only four studies were found, all of which had a high risk of bias. Many participants went from nil by mouth to some degree of oral diet sometime after the FEES was completed with low reporting of adverse events associated with FEES. This suggests a potential for the use of FEES in people with DoC. However, the evidence is low and further studies are recommended to improve understanding of FEES with people with DoC. Recommendations for clinical practice and areas for future research are outlined.
意识障碍（DoC）患者常通过饲管进食，人们对该人群的吞咽能力了解并不全面。特别地，应用纤维内镜吞咽评估（FEES）对 DoC 患者进行评估需要进一步研究。本系统综述旨在整理、评估并总结当前有关 FEES 对 DoC 患者是否可行和安全的证据。2019 年 11 月，检索了多个健康数据库以确定使用 FEES 对 DoC 患者进行评估的研究。数据提取包括人口统计学信息、报告的不良事件以及与口服喂养相关的结局。应用诊断准确性质量量表（DAQS）评估研究质量。总共仅发现了四项研究，均具有较高的偏倚风险。许多患者在 FEES 完成后，从完全禁食逐渐恢复到某种程度的口服饮食，且与 FEES 相关的不良事件报告较少。这表明 FEES 可能适用于 DoC 患者。然而，证据质量较低，建议进一步研究以增进对 DoC 患者 FEES 的了解。概述了临床实践建议和未来研究领域。
