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28-02-2022 | Aspiration Pneumonia | Original Article

Pneumonia, Mortality, and Other Outcomes Associated with Unsafe Swallowing Detected via Fiberoptic Endoscopic Evaluation of Swallowing (FEES) in Patients with Functional Oropharyngeal Dysphagia: A Systematic Review and Meta-analysis

Authors: Luis Fernando Giraldo-Cadavid, Alirio Rodrigo Bastidas, Jorge Maldonado-Lancheros, Daniel A. Gasca-Zuluaga, Martha Johana Aguilar-Farias, Leonardo Bohorquez-Tibavisco

Published in: Dysphagia | Issue 6/2022

Abstract

The association between impairments in swallowing safety detected via fiberoptic endoscopic evaluation of swallowing (FEES) and dysphagia complications has been evaluated in small studies that have not allowed obtaining precise estimates of the presence of such an association. The objective of this study was to evaluate the risk of dysphagia complications associated with the detection of premature spillage, residue, penetration, and aspiration via FEES. A systematic review and meta-analysis of the literature were carried out. A search strategy was established using terms of controlled and free vocabulary (free text) in the PubMed, Lilacs, Embase, Medline, and Cochrane databases. The initial search in the databases identified 3545 articles, of which 321 were excluded due to duplication, 3224 were selected for review of titles and abstracts, 45 were selected for full-text review, 37 were excluded for not meeting the selection criteria, and 8 were included for the final analysis, with a total population of 1168 patients. Aspiration increased the risk of pneumonia (OR 2.97, 95% CI 1.52–5.80, P = 0.001). The number of studies that have evaluated the relationship of other FEES findings with dysphagia complications was limited (≤ 3). One study found a higher risk of mortality in patients with aspiration (OR 4.08, 95% CI 1.60–10.27, P = 0.003). Another study that evaluated the risk of mortality in a combined group of penetration and aspiration found no higher risk of mortality. Penetration, residue, and premature spillage were not found to be associated with an increased risk of pneumonia, mortality, or other outcomes. Aspiration demonstrated via FEES was associated with an increased risk of pneumonia and mortality. There is insufficient evidence for the capacity of premature spillage, penetration, and residue to predict dysphagia complications.

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Kertscher B, Speyer R, Fong E, Georgiou AM, Smith M. Prevalence of oropharyngeal dysphagia in the Netherlands: a telephone survey. Dysphagia. 2015;30:114–20. https://doi.org/10.1007/s00455-014-9584-z.CrossRefPubMed

Adkins C, Takakura W, Spiegel BMR, Lu M, Vera-Llonch M, Williams J, Almario CV. Prevalence and characteristics of dysphagia based on a population-based survey. Clin Gastroenterol Hepatol. 2020;18:1970-1979.e1972. https://doi.org/10.1016/j.cgh.2019.10.029.CrossRefPubMed

Takizawa C, Gemmell E, Kenworthy J, Speyer R. A systematic review of the prevalence of oropharyngeal dysphagia in stroke, Parkinson’s disease, Alzheimer’s disease, head injury, and pneumonia. Dysphagia. 2016;31:434–41. https://doi.org/10.1007/s00455-016-9695-9.CrossRefPubMed

Mateos-Nozal J, Montero-Errasquín B, Sánchez García E, Romero Rodríguez E, Cruz-Jentoft AJ. High prevalence of oropharyngeal dysphagia in acutely hospitalized patients aged 80 years and older. J Am Med Dir Assoc. 2020;21:2008–11. https://doi.org/10.1016/j.jamda.2020.04.032.CrossRefPubMed

Cichero JA, Altman KW. Definition, prevalence and burden of oropharyngeal dysphagia: a serious problem among older adults worldwide and the impact on prognosis and hospital resources. Nestle Nutr Inst Workshop Ser. 2012;72:1–11. https://doi.org/10.1159/000339974.CrossRefPubMed

Martino R, Foley N, Bhogal S, Diamant N, Speechley M, Teasell R. Dysphagia after stroke: incidence, diagnosis, and pulmonary complications. Stroke. 2005;36:2756–63. https://doi.org/10.1161/01.STR.0000190056.76543.eb.CrossRefPubMed

Ramsey DJ, Smithard DG, Kalra L. Early assessments of dysphagia and aspiration risk in acute stroke patients. Stroke. 2003;34:1252–7. https://doi.org/10.1161/01.STR.0000066309.06490.B8.CrossRefPubMed

Langmore SE, Shatz K, Olsen N. Fiberoptic endoscopic examination of swallowing safety: a new procedure. Dysphagia. 1988;2:216–9.CrossRefPubMed

Langmore SE, Terpenning MS, Schork A, Chen Y, Murray JT, Lopatin D, Loesche WJ. Predictors of aspiration pneumonia: how important is dysphagia? Dysphagia. 1998;13:69–81.CrossRefPubMed

10.

Logemann JA. Swallowing disorders. Best Pract Res Clin Gastroenterol. 2007;21:563–73. https://doi.org/10.1016/j.bpg.2007.03.006.CrossRefPubMed

11.

Espitalier F, Fanous A, Aviv J, Bassiouny S, Desuter G, Nerurkar N, Postma G, Crevier-Buchman L. International consensus (ICON) on assessment of oropharyngeal dysphagia. Eur Ann Otorhinolaryngol Head Neck Dis. 2018;135:S17-s21. https://doi.org/10.1016/j.anorl.2017.12.009.CrossRefPubMed

12.

Giraldo-Cadavid LF, Leal-Leaño LR, Leon-Basantes GA, Bastidas AR, Garcia R, Ovalle S, Abondano-Garavito JE. Accuracy of endoscopic and videofluoroscopic evaluations of swallowing for oropharyngeal dysphagia. Laryngoscope. 2017;127:2002–10. https://doi.org/10.1002/lary.26419.CrossRefPubMed

13.

Colli A, Fraquelli M, Casazza G, Conte D, Nikolova D, Duca P, Thorlund K, Gluud C. The architecture of diagnostic research: from bench to bedside–research guidelines using liver stiffness as an example. Hepatology (Baltimore, MD). 2014;60:408–18. https://doi.org/10.1002/hep.26948.CrossRef

14.

Lijmer JG, Leeflang M, Bossuyt PMM. Proposals for a phased evaluation of medical tests. Med Decis Making. 2009;29:E13-21. https://doi.org/10.1177/0272989x09336144.CrossRefPubMed

15.

Schmidt J, Holas M, Halvorson K, Reding M. Videofluoroscopic evidence of aspiration predicts pneumonia and death but not dehydration following stroke. Dysphagia. 1994;9:7–11.CrossRefPubMed

16.

Ding R, Logemann JA. Pneumonia in stroke patients: a retrospective study. Dysphagia. 2000;15:51–7. https://doi.org/10.1007/s004550010001.CrossRefPubMed

17.

Ota K, Saitoh E, Baba M, Sonoda S. The secretion severity rating scale: a potentially useful tool for management of acute-phase fasting stroke patients. J Stroke Cerebrovasc Dis. 2011;20:183–7. https://doi.org/10.1016/j.jstrokecerebrovasdis.2009.11.015.CrossRefPubMed

18.

Takahashi N, Kikutani T, Tamura F, Groher M, Kuboki T. Videoendoscopic assessment of swallowing function to predict the future incidence of pneumonia of the elderly. J Oral Rehabil. 2012;39:429–37. https://doi.org/10.1111/j.1365-2842.2011.02286.x.CrossRefPubMed

19.

Aviv JE. Prospective, randomized outcome study of endoscopy versus modified barium swallow in patients with dysphagia. Laryngoscope. 2000;110:563–74. https://doi.org/10.1097/00005537-200004000-00008.CrossRefPubMed

20.

Centre for Reviews Dissemination (2009) Systematic reviews: CRD's guidance for undertaking reviews in health care. York: University of York. University of York, York. https://www.york.ac.uk/crd/guidance/.

21.

Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA. Cochrane Handbook for Systematic Reviews of Interventions version 6.2 (updated February 2021). In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA editor. Cochrane. www.training.cochrane.org/handbook. 2021

22.

Kuo P, Holloway RH, Nguyen NQ. Current and future techniques in the evaluation of dysphagia. J Gastroenterol Hepatol. 2012;27:873–81. https://doi.org/10.1111/j.1440-1746.2012.07097.x.CrossRefPubMed

23.

Lind CD. Dysphagia: evaluation and treatment. Gastroenterol Clin North Am. 2003;32:553–75.CrossRefPubMed

24.

Langmore SE. Scoring a FEES^(R) examination. In: Langmore SE, editor. Endoscopic evaluation and treatment of swallowing disorders. 1st ed. New York: Thieme; 2001. p. 101–43.

25.

Langmore SE, Schatz K, Olson N. Endoscopic and videofluoroscopic evaluations of swallowing and aspiration. Ann Otol Rhinol Laryngol. 1991;100:678–81.CrossRefPubMed

26.

Sterne JA, Hernan MA, Reeves BC, Savovic J, Berkman ND, Viswanathan M, Henry D, Altman DG, Ansari MT, Boutron I, Carpenter JR, Chan AW, Churchill R, Deeks JJ, Hrobjartsson A, Kirkham J, Juni P, Loke YK, Pigott TD, Ramsay CR, Regidor D, Rothstein HR, Sandhu L, Santaguida PL, Schunemann HJ, Shea B, Shrier I, Tugwell P, Turner L, Valentine JC, Waddington H, Waters E, Wells GA, Whiting PF, Higgins JP. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016;355: i4919. https://doi.org/10.1136/bmj.i4919.CrossRefPubMedPubMedCentral

27.

Sterne JA, Hernán MA, McAleenan A, Reeves BC, Higgins JP (2021) Chapter 25: Assessing risk of bias in a non-randomized study. In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA editor. Cochrane handbook for systematic reviews of interventions version 62 (updated February 2021). Cochrane. www.training.cochrane.org/handbook.

28.

McGuinness LA, Higgins JPT. Risk-of-bias visualization (robvis): an R package and Shiny web app for visualizing risk-of-bias assessments. Res Synthesis Methods. 2020;2020:1–7. https://doi.org/10.1002/jrsm.1411.CrossRef

29.

Higgins J, Deeks JJ, Altman DG, on behalf of the Cochrane Statistical Methods Group. Special topics in statistics. In: Higgins JPT, Green S editor. Cochrane handbook for systematic reviews of interventions, version 5.1.0 [updated March 2011]. The Cochrane Collaboration (2011).

30.

Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan-a web and mobile app for systematic reviews. Syst Rev. 2016;5:210. https://doi.org/10.1186/s13643-016-0384-4.CrossRefPubMedPubMedCentral

31.

Giraldo-Cadavid LF, Pantoja JA, Forero YJ, Gutiérrez HM, Bastidas AR. Aspiration in the fiberoptic endoscopic evaluation of swallowing associated with an increased risk of mortality in a cohort of patients suspected of oropharyngeal dysphagia. Dysphagia. 2020;35:369–77. https://doi.org/10.1007/s00455-019-10036-7.CrossRefPubMed

32.

Imaizumi M, Suzuki T, Ikeda M, Matsuzuka T, Goto A, Omori K. Implementing a flexible endoscopic evaluation of swallowing at elderly care facilities to reveal characteristics of elderly subjects who screened positive for a swallowing disorder. Auris Nasus Larynx. 2020;47:602–8. https://doi.org/10.1016/j.anl.2020.02.004.CrossRefPubMed

33.

Lindner-Pfleghar B, Neugebauer H, Stösser S, Kassubek J, Ludolph A, Dziewas R, Prosiegel M, Riecker A. Management of dysphagia in acute stroke: a prospective study for validation of current recommendations. Nervenarzt. 2017;88:173–9. https://doi.org/10.1007/s00115-016-0271-1.CrossRefPubMed

34.

Masiero S, Pierobon R, Previato C, Gomiero E. Pneumonia in stroke patients with oropharyngeal dysphagia: a six-month follow-up study. Neurol Sci. 2008;29:139–45. https://doi.org/10.1007/s10072-008-0925-2.CrossRefPubMed

35.

Lim SH, Lieu PK, Phua SY, Seshadri R, Venketasubramanian N, Lee SH, Choo PW. Accuracy of bedside clinical methods compared with fiberoptic endoscopic examination of swallowing (FEES) in determining the risk of aspiration in acute stroke patients. Dysphagia. 2001;16:1–6. https://doi.org/10.1007/s004550000038.CrossRefPubMed

36.

Armstrong JR, Mosher BD. Aspiration pneumonia after stroke: intervention and prevention. Neurohospitalist. 2011;1:85–93. https://doi.org/10.1177/1941875210395775.CrossRefPubMedPubMedCentral

37.

Gandolfi M, Smania N, Bisoffi G, Squaquara T, Zuccher P, Mazzucco S. Improving post-stroke dysphagia outcomes through a standardized and multidisciplinary protocol: an exploratory cohort study. Dysphagia. 2014;29:704–12. https://doi.org/10.1007/s00455-014-9565-2.CrossRefPubMed

38.

Shanahan TK, Logemann JA, Rademaker AW, Pauloski BR, Kahrilas PJ. Chin-down posture effect on aspiration in dysphagic patients. Arch Phys Med Rehabil. 1993;74:736–9. https://doi.org/10.1016/0003-9993(93)90035-9.CrossRefPubMed

39.

Luk JK, Chan DK (2014) Preventing aspiration pneumonia in older people: do we have the 'know-how'? Hong Kong Med J 20: 421–427. https://doi.org/10.12809/hkmj144251

40.

Caldeira D, Alarcão J, Vaz-Carneiro A, Costa J. Risk of pneumonia associated with use of angiotensin converting enzyme inhibitors and angiotensin receptor blockers: systematic review and meta-analysis. BMJ. 2012;345: e4260. https://doi.org/10.1136/bmj.e4260.CrossRefPubMedPubMedCentral

41.

Sarin J, Balasubramaniam R, Corcoran AM, Laudenbach JM, Stoopler ET. Reducing the risk of aspiration pneumonia among elderly patients in long-term care facilities through oral health interventions. J Am Med Dir Assoc. 2008;9:128–35. https://doi.org/10.1016/j.jamda.2007.10.003.CrossRefPubMed

42.

Klompas M, Branson R, Eichenwald EC, Greene LR, Howell MD, Lee G, Magill SS, Maragakis LL, Priebe GP, Speck K, Yokoe DS, Berenholtz SM. Strategies to prevent ventilator-associated pneumonia in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol. 2014;35(Suppl 2):S133-154. https://doi.org/10.1017/s0899823x00193894.CrossRefPubMed

43.

Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, Dowell SF, File TM Jr, Musher DM, Niederman MS, Torres A, Whitney CG. Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults. Clin Infect Dis. 2007;44:S27–72.CrossRefPubMed

44.

Logemann JA. Mechanisms of normal and abnormal swallowing. In: Flint PW, Haughey BH, Lund V, Niparko JK, Robbins KT, Thomas JR, Lesperance MM, editors. Cummings: otolaryngology: head & neck surgery. 6th ed. Philadelphia: Elsevier; 2015. p. 1500–6.

45.

Langmore SE, Krisciunas GP, Warner H, White SD, Dvorkin D, Fink D, McNally E, Scheel R, Higgins C, Levitt JE, McKeehan J, Deane S, Siner JM, Vojnik R, Moss M. Abnormalities of aspiration and swallowing function in survivors of acute respiratory failure. Dysphagia. 2021;36:831–41. https://doi.org/10.1007/s00455-020-10199-8.CrossRefPubMed

46.

Farneti D. Pooling score: an endoscopic model for evaluating severity of dysphagia. Acta Otorhinolaryngol Ital. 2008;28:135–40.PubMedPubMedCentral

47.

Braun T, Juenemann M, Viard M, Meyer M, Reuter I, Prosiegel M, Kaps M, Tanislav C. Adjustment of oral diet based on flexible endoscopic evaluation of swallowing (FEES) in acute stroke patients: a cross-sectional hospital-based registry study. BMC Neurol. 2019;19:282. https://doi.org/10.1186/s12883-019-1499-8.CrossRefPubMedPubMedCentral

48.

Lijmer JG, Mol BW, Heisterkamp S, Bonsel GJ, Prins MH, van der Meulen JH, Bossuyt PM. Empirical evidence of design-related bias in studies of diagnostic tests. JAMA. 1999;282:1061–6.CrossRefPubMed

49.

Warnecke T, Teismann I, Oelenberg S, Hamacher C, Ringelstein EB, Schabitz WR, Dziewas R. Towards a basic endoscopic evaluation of swallowing in acute stroke—identification of salient findings by the inexperienced examiner. BMC Med Educ. 2009;9:13. https://doi.org/10.1186/1472-6920-9-13.CrossRefPubMedPubMedCentral

50.

Pisegna JM, Borders JC, Kaneoka A, Coster WJ, Leonard R, Langmore SE. Reliability of untrained and experienced raters on FEES: rating overall residue is a simple task. Dysphagia. 2018;33:645–54. https://doi.org/10.1007/s00455-018-9883-x.CrossRefPubMed

51.

Pilz W, Vanbelle S, Kremer B, van Hooren MR, van Becelaere T, Roodenburg N, Baijens LW. Observers’ agreement on measurements in fiberoptic endoscopic evaluation of swallowing. Dysphagia. 2016;31:180–7. https://doi.org/10.1007/s00455-015-9673-7.CrossRefPubMedPubMedCentral

Title: Pneumonia, Mortality, and Other Outcomes Associated with Unsafe Swallowing Detected via Fiberoptic Endoscopic Evaluation of Swallowing (FEES) in Patients with Functional Oropharyngeal Dysphagia: A Systematic Review and Meta-analysis
Authors: Luis Fernando Giraldo-Cadavid
Alirio Rodrigo Bastidas
Jorge Maldonado-Lancheros
Daniel A. Gasca-Zuluaga
Martha Johana Aguilar-Farias
Leonardo Bohorquez-Tibavisco
Publication date: 28-02-2022
Publisher: Springer US
Keywords: Aspiration Pneumonia
Foreign Body Aspiration
Foreign Body Aspiration
Aspiration
Pneumonia
Dysphagia
Dysphagia
Dysphagia
Published in: Dysphagia / Issue 6/2022
Print ISSN: 0179-051X
Electronic ISSN: 1432-0460
DOI: https://doi.org/10.1007/s00455-022-10427-3

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Pneumonia, Mortality, and Other Outcomes Associated with Unsafe Swallowing Detected via Fiberoptic Endoscopic Evaluation of Swallowing (FEES) in Patients with Functional Oropharyngeal Dysphagia: A Systematic Review and Meta-analysis

Abstract

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