Serial fiberoptic endoscopic swallowing evaluations in the management of patients with dysphagia

Objective: To determine whether serial fiberoptic endoscopic evaluation of swallowing (FEES) can be used successfully and efficiently in deciding to change a patient's feeding status from nonoral (NPO to oral (PO) with no adverse health outcome. Design: A prospective, consecutive, cohort study. Setting: Inpatient population of a tertiary-care university teaching hospital. Subjects: Thirty-two adults were recruited from a cohort of 400 consecutive subjects who participated in a previous dysphagia study. Intervention: Serial FEES was performed 3 to 6 times in each subject to detect objectively pharyngeal phase dysphagia, aspiration, and aspiration risk and to provide information for recommendations regarding oral feeding status and therapeutic intervention. The number of FEES was based on the subject's medical status, evidence of dysphagia, and clinical judgement. Main Outcome Measures: Identification of pharyngeal phase dysphagia, aspiration, and aspiration risk, and recommendations for initial feeding status, when to resume oral feeding, and what bolus consistencies to use for optimal swallowing success. Results: In all subjects, serial FEES detected pharyngeal phase dysphagia, aspiration, and aspiration risk and enabled determination of initial feeding status (NPO or PO), when to resume successful oral feeding, and what bolus consistencies to use for optimal swallowing success. Specifically, 15 of 32 (47%) subjects received FEES 3 to 5 times within only 6 to 22 days. Timely serial FEES allowed 22 of 32 (69%) subjects to resume an oral diet as early and safely as possible. Conclusions: No subject who resumed an oral diet based on results of FEES developed an aspiration pneumonia. Serial FEES, therefore, enabled feeding status to be successful and efficiently changed from NPO to PO with no adverse health outcome. FEES was an efficient procedure with regard to appointment scheduling, transportation, patient issues, and personnel requirements. (C) 1998 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.