What to monitor in a patient with dysphagia (difficulty swallowing)?

From the Guidelines

When monitoring a patient with dysphagia, healthcare providers should prioritize assessing for signs of aspiration, tracking nutritional status and hydration, and observing for complications like pneumonia, as these are critical for reducing morbidity, mortality, and improving quality of life. The most recent and highest quality study, 1, emphasizes the importance of early screening for dysphagia using a valid tool, ideally by a speech-language pathologist, to identify patients at risk. Key factors to monitor include:

• Signs of aspiration such as coughing, choking, gurgling voice, or respiratory distress during or after eating
• Nutritional status and hydration through weight measurements, food intake records, and signs of dehydration
• Complications like pneumonia, which can result from aspiration, characterized by fever, productive cough, and abnormal breath sounds
• Oxygen saturation levels during meals using pulse oximetry, as decreases may indicate aspiration
• Effectiveness of any swallowing strategies or modified diets implemented
• Patient's ability to manage different food textures and liquid consistencies, noting specific difficulties Regular reassessment of swallowing function is essential, as dysphagia can improve or worsen over time, and early detection of complications is vital for prompt intervention, as highlighted in 1 and 1. Additionally, providing education on swallowing and feeding recommendations to patients, families, and caregivers, and encouraging self-feeding whenever possible, can help reduce the risk of pneumonia, as noted in 1.

From the Research

Monitoring Patients with Dysphasia

When monitoring a patient with dysphasia, several factors should be considered:

• The patient's ability to swallow safely and effectively 2
• The risk of aspiration and its potential consequences, such as pneumonia and malnutrition 2, 3
• The presence of underlying conditions, such as chronic neurologic conditions or gastroesophageal reflux disease, that may be contributing to the dysphasia 4, 2
• The patient's medication regimen, including the use of anticholinergic drugs that may exacerbate dysphasia 5
• The patient's overall health status, including their age, functional ability, and frailty 5, 2

Diagnostic Tools

Several diagnostic tools can be used to monitor patients with dysphasia, including:

• Pulse oximetry to assess arterial oxygen saturation and detect aspiration 6
• Modified barium swallow studies to evaluate the patient's swallowing ability and detect penetration or aspiration 6
• Flexible Endoscopic Evaluation of Swallowing (FEES) to assess laryngeal sensation and detect aspiration 3
• Esophagogastroduodenoscopy to evaluate the esophagus and detect any abnormalities 2

Patient Management

Patients with dysphasia require careful management to prevent complications and ensure safe swallowing:

• Speech-language pathologists and other specialists can provide structured assessments and make recommendations for safe swallowing, palliative care, or rehabilitation 2
• Patients may require modified diets or feeding strategies to reduce the risk of aspiration 2, 3
• Medication regimens may need to be adjusted to minimize the risk of exacerbating dysphasia 5
• Patients and their caregivers should be educated on the risks and consequences of dysphasia and the importance of safe swallowing practices 4, 2