From the Guidelines
Not all extubated patients require a formal speech language pathology evaluation, but they should undergo a dysphagia screening before administering anything orally, and if the screening indicates a risk of dysphagia, a formal evaluation by a speech-language pathologist is necessary 1.
Key Points
- Dysphagia screening should be performed by a nurse before oral intake, using an evidence-based tool such as the Massey Bedside Swallowing Screen or the Toronto Bedside Swallowing Screening test 1.
- If the screening indicates a risk of dysphagia, a formal evaluation by a speech-language pathologist should be performed to assess the patient's swallowing abilities and develop a plan to manage dysphagia 1.
- Patients who are at high risk for dysphagia, such as those with stroke or prolonged intubation, should be closely monitored and may require a formal speech language pathology evaluation 1.
- The goal of dysphagia management is to prevent aspiration and ensure the patient receives adequate nutrition and hydration, and an interprofessional team approach, including nurses, speech-language pathologists, dieticians, and physicians, is essential for optimal care 1.
- The nurse has a vital role in educating the patient and caregiver on dysphagia management and in organizing the interprofessional team to monitor and manage the care of the patient with dysphagia 1.
From the Research
Extubated Patients and Speech Language Pathology Evaluation
- Not all extubated patients require a formal speech language pathology evaluation, as some may be at low risk for postextubation dysphagia 2.
- However, certain risk factors, such as prolonged mechanical ventilation, can increase the likelihood of postextubation dysphagia, making a formal evaluation necessary 3, 2.
- Studies have shown that incorporating speech-language pathologists in the routine management of postextubation dysphagia can result in faster functional improvement and favorable patient outcomes 3, 4.
Screening for Postextubation Dysphagia
- Nurse-performed screening (NPS) for postextubation dysphagia has been shown to be safe and effective in identifying patients at risk 5.
- The use of a decision guide can help nurses and healthcare providers determine which patients should be referred to speech-language pathology professionals for swallowing assessment after extubation 2.
- A modified swallowing screening tool can be used to assess effective swallowing post-endotracheal extubation, promoting a nurse-led/-initiated bedside swallow screening tool that enhances patient care and patient safety 6.
Benefits of Speech Language Pathology Evaluation
- Formal speech language pathology evaluation can help identify patients with postextubation dysphagia, reducing the risk of aspiration pneumonia and other complications 3, 4.
- Early intervention by speech-language pathologists can result in faster functional improvement and favorable patient outcomes, including reduced length of hospital stay and reintubation rates 3, 5.
- The use of instrumental diagnostic tests, such as fluoroscopy and endoscopy, can provide more accurate diagnoses, but their availability may vary by hospital and geographic location 4.