Flexible endoscopic evaluation of swallowing (FEES) to determine neurological intensive care patients’ oral diet

Abstract

Purpose

Dysphagia is common in critically ill neurological patients and is associated with a high mortality and morbidity. Data on the usefulness of flexible endoscopic examination of swallowing (FEES) in neurological intensive care unit (ICU) patients are lacking, raising the need for evaluation.

Method

FEES was performed in neurological intensive care patients suspected of dysphagia. We correlated findings with baseline data, disability status, pneumonia and duration of hospitalisation, as well as a need for mechanical ventilation or tracheotomy.

Result

This analysis consisted of 125 patients with suspected dysphagia. Most of the patients (81; 64,8%) suffered from acute stroke. Dysphagia was diagnosed using FEES in 90 patients (72%). FEES results led to dietary modifications in 80 patients (64%). The outcome at discharge was worse in dysphagic stroke patients diagnosed by FEES as compared to non-dysphagic stroke patients (p = 0.009). Patients without oral diet had higher need for intubation (p = 0.007), tracheotomy (p = 0.032) and higher mortality (p < 0.001) in comparison to patients with at least small amounts of oral intake.

Conclusion

As the clinical assessment of the patients often classified the dysphagia incorrectly, the broad use of FEES in ICU patients might help to adequately adjust patients’ oral diet. This knowledge might contribute to lower mortality and morbidity.

Keywords:

• Intensive care
• FEES
• dysphagia
• aspiration
• deglutition disorders

Ethics approval and consent to participate

For the data acquisition and the use of findings for scientific analyses, an ethical approval was obtained from the local ethical committee (Justus-Liebig University, protocol number 208/16). The ethical committee waived the need for the patients’ consent to participate.

Availability of data and material

The authors declare that the data supporting the findings of this study are available within the article. The data that support the findings of this study are not publicly available due to local medical data protection policies.

Disclosure statement

All authors report that there are no conflicts of interest or competing interests related to the presented manuscript.

Supplementary material

Supplemental data for this article can be accessed at https://doi.org/10.1080/17549507.2020.1744727