A pilot study of fibreoptic endoscopic evaluation of swallowing in patients with cuffed tracheostomies in neurological intensive care

Abstract

Patients on neurological intensive care units (NICU) who require ventilatory support often suffer from co-existing bulbar dysfunction, either because of their underlying disease or because of their decreased level of consciousness. For this reason, most patients are ventilated through a cuffed tracheostomy tube, which allows a degree of protection from tracheal aspiration of saliva and gastric contents. Patients who are awake often complain of thirst, but traditionally are only offered oral fluids when the cuff of the tracheostomy tube has been deflated. Given that many patients in NICU cannot tolerate cuff deflation, a reliable technique is needed to assess the adequacy of the patient's swallow and therefore the risk of aspiration when the tracheostomy cuff is inflated. The aim of this feasibility study was to examine the viability of Fibreoptic Endoscopic Evaluation of Swallowing (FEES) as a diagnostic tool to assess the effectiveness of swallowing in four NICU patients with cuffed tracheostomies. The technique was successful in all of the four patients. One patient was found to have a normal swallow. Two patients were seen to have laryngeal penetration of fluids and one patient aspirated the fluid challenge. This pilot study has demonstrated the feasibility of using the FEES technique for assessment of swallowing in patients with cuffed tracheostomy tubes; it therefore presents the prospect of allowing earlier drinking in such patients whilst helping confirm the safety of such a strategy.