The interdisciplinary fibreoptic endoscopic evaluation of swallowing assessments in ICU patients: A file review

Background: Dysphagia is a complex condition common in critical care settings, often resulting from multifactorial causes such as trauma, neuromuscular weakness, impaired cognition, intubation and the presence of a tracheostomy. Dysphagia can have serious consequences, including aspiration pneumonia and prolonged hospital stays, which need to be avoided in resource-constrained environments such as South Africa (SA). Objectives: To investigate the characteristics of dysphagia in critically ill patients using an interdisciplinary assessment approach that utilises both bedside evaluations and fibreoptic endoscopic evaluation of swallowing (FEES). Methods: A retrospective file review was conducted of 68 adult patients who underwent interdisciplinary dysphagia assessments in a private SA hospital between July 2022 and January 2024. Data collected included clinical notes, anatomical and physiological markers, Penetration-Aspiration Scale (PAS) scores and post-assessment diagnoses. Descriptive statistics were employed to analyse variables such as age, gender, comorbidities and dysphagia symptoms. Results: The mean age of participants was 59.5 years (standard deviation (SD) 17.05 years), with the majority presenting with trauma-related injuries or cerebrovascular accidents. Dysphagia was prevalent, with 49% of patients exhibiting significant swallowing difficulties. The mean PAS score was 3.44 (SD 2.82), indicating that material often entered the airway without being ejected. Notably, 17% of patients presented with silent aspiration, highlighting the need for comprehensive interdisciplinary assessment techniques. Common symptoms included pooling, dysphonia and delayed swallow triggers, which may be identified at the bedside and confirmed using FEES. Patients were referred to speech-language therapy (SLT) after a median of 13 days in the intensive care unit (ICU). Conclusion: Dysphagia is a significant concern in critical care, necessitating early and co-ordinated assessment strategies to minimise complications and improve patient outcomes. This study advocates enhanced protocols and interdisciplinary collaboration to manage dysphagia effectively. Early referral to SLT is critical for timely intervention, which is essential in an under-resourced setting. Future research across various settings is needed to further validate the interdisciplinary model of dysphagia assessment and management and to generate additional local data on dysphagia in the ICU. Contribution of the study: This retrospective file review demonstrates the prevalence, clinical features, and consequences of dysphagia among critically ill adults assessed with an interdisciplinary FEES approach in a South African (SA) ICU. The study contributes to important local evidence by (i) quantifying the burden of dysphagia and silent aspiration in an ICU population, (ii) showing that interdisciplinary FEES (SLP + ENT) augments the standard bedside dysphagia assessment and yields important diagnostic detail that informs safer feeding and management decisions, and (iii) identified substantial delays to SLT for assessment that likely increase the risk of complications such as aspiration pneumonia. These findings support calls for earlier SLT involvement, development of context-appropriate referral pathways and practice guidelines, and wider adoption of interdisciplinary assessment models in resource-constrained SA ICU settings.