Perioperative Management of Dysphagia Within the Cardiac Intensive Care Unit Utilizing Flexible Endoscopic Evaluation of Swallowing: A Survey of Practice.

INTRODUCTION

Perioperative management of dysphagia is essential in critical care models for infants with complex congenital heart disease (cCHD). Although there is literature supporting the utilization of the flexible endoscopic evaluation of swallowing (FEES) procedure in the neonatal intensive care unit (NICU), there is a lack of literature extending into hospitalized infants with cCHD within a surgical cardiac intensive care unit (CICU).

AIM: The aim of this study was to (a) describe current practice trends for perioperative use of FEES for hospitalized infants with cCHD within a surgical CICU and (b) identify perceived barriers of utilization of FEES in this population.

METHOD: This was a cross-sectional, descriptive, survey design to assess practice trends of using FEES for infants with cCHD by clinicians working in institutions with embedded CICUs.

RESULTS

Fifty-eight percent of the respondents reported using FEES in the CICU. Seventy-one percent of the respondents who utilize FEES in this setting report a preference for using videofluoroscopic swallowing study (VFSS) over FEES. The most common reasons given for using VFSS over FEES included lack of sensitivity of the FEES exam, parent and patient stress, lack of adequate training, and concerns about the infants' physiological stability and tolerance of the procedure. Most hospitals that use FEES in their CICU do not have inclusion/exclusion criteria based on cardiac lesion nor predetermined parameters in place that would indicate cessation of the exam.

CONCLUSIONS

Although there is a paucity of literature describing the utilization of FEES for the perioperative management of dysphagia in the CICU, this evaluation is performed in this setting. There continues to be a lack of inclusion/exclusion criteria in place to guide utilization of this procedure in this critical population as well as barriers to implementation that includes coordination of providers, equipment, and staff training.

SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.31297390.