Safety-related outcomes for patients with a tracheostomy and the use of flexible endoscopic evaluation of swallowing (FEES) for assessment and management of swallowing: A systematic review

Abstract

Purpose

The purpose of this systematic review was to examine safety-related outcomes for patients with tracheostomy after flexible endoscopic evaluation of swallowing (FEES) to assess and manage their swallow, when compared to other non-instrumental swallow assessments such as clinical swallowing examination (CSE) and/or a modified Evans blue dye test (MEBDT).

Method

Three databases were searched for articles referring to safety-related outcome data for adults with a tracheostomy, who underwent FEES and CSE and/or MEBDT. Articles were screened using predefined inclusion/exclusion criteria.

Result

The search strategy identified 2097 articles; following abstract and full-text screening, seven were included for review. The summary of evidence found low to very low certainty that FEES was associated with improved outcomes across swallow safety, physiological outcomes, tracheostomy cannulation duration, functional outcomes, and detection of upper airway pathologies.

Conclusion

This systematic review demonstrated low to very low certainty evidence from seven heterogeneous studies with low sample sizes that incorporating FEES may be associated with improved safety-related outcomes. There is less evidence supporting the accuracy of other swallow assessments conducted at the point of care (i.e. CSE and MEBDT). Future research requires studies with larger sample sizes and routine reporting of safety-related outcomes with use of FEES.

Keywords:

• flexible endoscopic evaluation of swallowing
• clinical swallowing examination
• modified Evans blue dye test
• tracheostomy
• patient safety
• dysphagia/deglutition

Author contributions

All authors contributed to the design of this review. Katherine Morris completed database searching and all authors contributed to screening and data extraction. Katherine Morris completed the first draft of the manuscript and Amy Freeman-Sanderson and Nicholas Taylor contributed to further writing and editing of the manuscript. All data generated or analysed during this study are included in this published article.

Disclosure statement

No potential conflict of interest was reported by the authors.