The accuracy of the bedside swallowing evaluation for detecting aspiration in survivors of acute respiratory failure

Background: 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. Methods: Patients who were extubated after at least 24 hours of mechanical ventilation were eligible for enrollment. Within 3 days of extubation, patients underwent comprehensive BSE including 3-ozwater swallowing test (3-WST), followed by a criterion standard test for aspiration, flexible endoscopic evaluation of swallowing (FEES). Results: Forty-five patients were included in the analysis. Median patient age was 55 years (interquartile range, 47-65). Median duration of mechanical ventilation was 3.3 days (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 AUC of 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 AUC of 0.72. Conclusions: 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. (C) 2017 Elsevier Inc. All rights reserved.