title: The accuracy of the bedside swallowing evaluation for detecting aspiration in survivors of acute respiratory failure.
abstract: 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.
  
  
  
  Patients who were extubated after at least 24hours of mechanical ventilation were eligible for enrollment. Within 3 days of extubation, patients underwent comprehensive BSE including 3-oz water swallowing test (3-WST), followed by a criterion standard test for aspiration, flexible endoscopic evaluation of swallowing (FEES).
  
  
  
  Forty-five patients were included in the analysis. Median patient age was 55years (interquartile range, 47-65). Median duration of mechanical ventilation was 3.3days (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 AUCof 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 AUCof 0.72.
  
  
  
  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.
  
  
  
  ClinicalTrials.gov identifier: NCT02363686, Aspiration in Acute Respiratory Failure Survivors.
authors.affiliation: Division of Pulmonary and Critical Care, University of Washington, Seattle, WA.
authors.forename: Ylinne T
authors.initials: YT
authors.lastname: Lynch
authors.affiliation: Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado, Aurora, CO.
authors.forename: Brendan J
authors.initials: BJ
authors.lastname: Clark
authors.affiliation: Critical Care, Pulmonary, and Sleep Associates, Lakewood, CO.
authors.forename: Madison
authors.initials: M
authors.lastname: Macht
authors.affiliation: Rehabilitation Therapy, University of Colorado Hospital, Aurora, CO.
authors.forename: S David
authors.initials: SD
authors.lastname: White
authors.affiliation: Rehabilitation Therapy, University of Colorado Hospital, Aurora, CO.
authors.forename: Heather
authors.initials: H
authors.lastname: Taylor
authors.affiliation: Rehabilitation Therapy, University of Colorado Hospital, Aurora, CO.
authors.forename: Tim
authors.initials: T
authors.lastname: Wimbish
authors.affiliation: Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado, Aurora, CO. Electronic address: marc.moss@ucdenver.edu.
authors.forename: Marc
authors.initials: M
authors.lastname: Moss
mesh_terms: D000368:Aged; D060666:Airway Extubation / Q000009:adverse effects; D015331:Cohort Studies; D003679:Deglutition / Q000502:physiology*; D003680:Deglutition Disorders / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000067716:Point-of-Care Testing; D012372:ROC Curve; D053120:Respiratory Aspiration / Q000175:diagnosis* / Q000209:etiology; D012131:Respiratory Insufficiency / Q000150:complications*; D012680:Sensitivity and Specificity; D017741:Survivors