Nursing in critical care · 2026
Nurse-Administered and Nurse-Feasible Post-Extubation Dysphagia Screening in Adult Intensive Care Units: A Scoping Review of Test Performance, Implementation and Patient Outcomes.
СтатьяScoping ReviewОбзорНазвание и аннотация: Перевод в очереди
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Elkasaby Wesam Hamdy, Shalaby Youssef Mohamed, Shaban Mostafa
Аннотация
BACKGROUND: Post-extubation dysphagia (PED) is common after invasive mechanical ventilation. Nurses can provide timely bedside risk screening, but instrument validity, performance in nurses' hands and implementation effectiveness are distinct questions.
AIM: To map direct nurse-administered evidence, transferability of nurse-feasible tools, nursing implementation context, and reported patient outcomes in adult intensive care units (ICUs).
METHODS: Literature searches were conducted in six databases, with the search updated in August 2026. Evidence was stratified according to the actual screening administrator and reference-standard assessment. Criterion-level MMAT and QUADAS-2 assessments were applied without summary scores.
RESULTS: The source-verified map comprised 34 reports representing 31 study families. Instrumental-reference evidence with nurse or nursing-assistant administration included two complete-verification cohorts: modified Volume-Viscosity Swallow Test versus FEES in 44 extubated patients (sensitivity 89.5%, specificity 72%) and GUSS-IVA versus FEES in 51 of 56 enrolled patients (81.0%, 88.9%). A third nurse screen had optional FEES in 38 of 123 patients (86%, 21%). Other nurse-administered studies used clinical or proxy comparators or positive-only verification. SLP-administered FEES studies informed transferability, not nurse-administered accuracy. Implementation fidelity varied, and outcome studies were non-randomised.
CONCLUSIONS: Nursing involvement in structured PED screening is feasible, but direct accuracy and patient-outcome evidence remain heterogeneous and at risk of selection, verification and confounding bias. ICUs may pilot governed pathways with competency assessment, documentation, specialist escalation and outcome audit; no single screen is established as standard care.
RELEVANCE TO CLINICAL PRACTICE: Bedside screening is risk stratification rather than diagnosis. Failed, discordant or high-risk screens require prompt specialist assessment and, where indicated, FEES or VFSS.
AIM: To map direct nurse-administered evidence, transferability of nurse-feasible tools, nursing implementation context, and reported patient outcomes in adult intensive care units (ICUs).
METHODS: Literature searches were conducted in six databases, with the search updated in August 2026. Evidence was stratified according to the actual screening administrator and reference-standard assessment. Criterion-level MMAT and QUADAS-2 assessments were applied without summary scores.
RESULTS: The source-verified map comprised 34 reports representing 31 study families. Instrumental-reference evidence with nurse or nursing-assistant administration included two complete-verification cohorts: modified Volume-Viscosity Swallow Test versus FEES in 44 extubated patients (sensitivity 89.5%, specificity 72%) and GUSS-IVA versus FEES in 51 of 56 enrolled patients (81.0%, 88.9%). A third nurse screen had optional FEES in 38 of 123 patients (86%, 21%). Other nurse-administered studies used clinical or proxy comparators or positive-only verification. SLP-administered FEES studies informed transferability, not nurse-administered accuracy. Implementation fidelity varied, and outcome studies were non-randomised.
CONCLUSIONS: Nursing involvement in structured PED screening is feasible, but direct accuracy and patient-outcome evidence remain heterogeneous and at risk of selection, verification and confounding bias. ICUs may pilot governed pathways with competency assessment, documentation, specialist escalation and outcome audit; no single screen is established as standard care.
RELEVANCE TO CLINICAL PRACTICE: Bedside screening is risk stratification rather than diagnosis. Failed, discordant or high-risk screens require prompt specialist assessment and, where indicated, FEES or VFSS.