[Dysphagia] Pulse Oximetry

[brenda.liddle at algonquinhs.on.ca (Liddle, Brenda)]

I've just done some lit search on this looking for its application to
SCREENING, not assessment, so I can tell you what I've found if that
helps. Thanks Irene for providing those very recent articles - I hadn't
seen 2 of them.

The purpose for most of the studies was to see if using 02 monitoring
IMPROVED the ability to identify aspiration risk, over bedside
assessment alone. There was also concern of over-diagnosing aspiration
with bedside ax only and thereby restricting oral intake for any length
of time when it need not occur. The good studies did SIMULTANEOUS 02 sat
and VF/FEES.

There was an article by Zaidi, NH et al. in 1995, but I don't believe
they used any instrumental means. The following 5 are from Medline :

Database Ovid MEDLINE(R)
Unique Identifier 11191240
Authors Smith HA. Lee SH. O'Neill PA. Connolly MJ.
Institution Department of Speech and Language Therapy, Manchester Royal
Infirmary, UK.
Title The combination of bedside swallowing assessment and oxygen
saturation monitoring of swallowing in acute stroke: a safe and humane
screening tool.[see comment].
Source Age & Ageing. 29(6):495-9, 2000 Nov.
 
Abstract BACKGROUND: dysphagia is common in acute stroke. Accurate
detection of the presence or absence of aspiration by bedside swallowing
assessment is difficult without objective methods, tending to
over-diagnose aspiration. As a result, some patients suffer restricted
oral intake unnecessarily. OBJECTIVE: we examined the predictive values
of pulse oximetry and speech and language therapy bedside swallowing
assessment in the detection of aspiration compared with
videofluoroscopy. DESIGN: a double-blind observational study. SETTING:
two university teaching hospitals. SUBJECTS: we studied 53 patients
whose acute strokes were confirmed by computed tomography scan. METHODS:
Each subject had initial standard bedside swallowing assessment, closely
followed by simultaneous and mutually blinded pulse oximetry, swallowing
assessment and videofluoroscopy. RESULTS: 15 of 53 subjects aspirated.
Bedside swallowing assessment and saturation assessment at > or = 2%
desaturation gave good sensitivity (80% and 87% respectively), but low
positive predictive values (50% and 36% respectively). Both assessments
mistook laryngeal penetration for aspiration. Re-analysis with
aspiration +/- penetration as a new endpoint improved bedside swallowing
assessment positive predictive values to 83% (chi2 =3.59, P=0.032).
Sensitivity of saturation assessment was maintained at 86%, positive
predictive values of saturation assessment improved to 69% (chi2=6.74,
P=0.009). The combination of bedside swallowing assessment and
saturation assessment versus aspiration + penetration gave a positive
predictive value of 95%. CONCLUSIONS: screening by saturation
assessments detects 86% of aspirators/penetrators and should be followed
immediately by bedside swallowing assessment, as the combination of the
two assessments gives the best positive predictive value. For patients
with acute stroke, we advocate a 10 ml water-swallow screening test with
simultaneous pulse oximetry by suitably trained medical and nursing
staff. Use of this screening test would improve dysphagia detection
whilst minimizing unnecessary restriction of oral intake in stroke
patients.


Database Ovid MEDLINE(R)
Unique Identifier 9303024
Authors Collins MJ. Bakheit AM.
Institution University Rehabilitation Research Unit, Southampton (UK)
General Hospital, UK.
Title Does pulse oximetry reliably detect aspiration in dysphagic stroke
patients?.
Source Stroke. 28(9):1773-5, 1997 Sep.
 
Abstract BACKGROUND AND PURPOSE: The aim of the present study was to
examine the value of pulse oximetry in the diagnosis of aspiration by
comparing it with the gold standard, videofluoroscopy, by use of a
prospective, controlled, single-blind study design. METHODS: Pulse
oximetry was performed simultaneously with videofluoroscopy in 54
consecutive dysphagic stroke patients. Oxygen saturation measurements
were taken before the video-fluoroscopic examination (baseline), on
swallowing and continuously for 2 minutes after swallowing, and 10
minutes later. RESULTS: Pulse oximetry reliably predicted aspiration or
lack of it in 81.5% of cases. The predictive value of the test was low
in patients aged > or = 65 years and possibly those with chronic lung
disease. One smoker also had a false-negative pulse oximetry result, ie,
normal oxygen saturation despite radiological evidence of aspiration.
CONCLUSIONS: Pulse oximetry is a reliable method of diagnosis of
aspiration in most dysphagic patients. However, careful interpretation
of pulse oximetry data is necessary in older subjects, possibly those
with chronic pulmonary disease, and smokers. The method is noninvasive,
simple, and quick, and can be used routinely in the clinical assessment
of dysphagic patients.

Database Ovid MEDLINE(R)
Unique Identifier 14716948
Authors Chong MS. Lieu PK. Sitoh YY. Meng YY. Leow LP.
Institution Department of Geriatric Medicine, Tan Tock Seng Hospital, 11
Jalan Tan Tock Seng, Singapore 308433. Mei_Sian_Chong@ttsh.com.sg
Title Bedside clinical methods useful as screening test for aspiration
in elderly patients with recent and previous strokes.
Source Annals of the Academy of Medicine, Singapore. 32(6):790-4, 2003
Nov.
 
Abstract INTRODUCTION: This study was undertaken to ascertain the
usefulness of clinical screening tools for dysphagia in a heterogeneous
group of older stroke patients. The usefulness of bedside clinical
assessment tools for detecting dysphagia on different consistencies of
feeds was also studied. MATERIALS AND METHODS: Fifty patients referred
to a speech therapist for the assessment of possible dysphagia were
recruited. The clinical tools studied included the water swallow test,
the oxygen desaturation test and the combination of both tests (termed
"clinical aspiration test"). The outcomes of the clinical assessments
were compared with a fibreoptic endoscopic examination of swallowing
(FEES) conducted at the same sitting. Fifty patients underwent an
examination of their ability to swallow 50 mL of water in 10-mL
aliquots. They underwent a FEES with different food consistencies by a
speech therapist and oxygen saturation with pulse oximetry was monitored
during the procedure. Oxygen desaturation of more than 2% was considered
to be clinically significant. RESULTS: The water swallow test had a
sensitivity of 79.4% and specificity of 62.5% for the detection of
aspiration, with a positive predictive value (PPV) of 81.8% and a
negative predictive value (NPV) of 58.8%. The oxygen desaturation test
had a sensitivity of 55.9% and a specificity of 100% with PPV of 100%
and NPV of 51.6%. When both tests were combined, a sensitivity of 94.1%
and a specificity of 62.5% was attained, with PPV of 84.2% and NPV of
83.3%. Using the clinical assessment test, we were able to pick up 3
aspirators who would otherwise have been missed if they were assessed
with the water swallow test using thin fluids alone. CONCLUSION: Simple
clinical assessment tools can be used to screen for dysphagia in a
heterogeneous group of older patients with stroke disease, and clinical
testing using feeds of different consistencies should be considered.

Database Ovid MEDLINE(R)
Unique Identifier 10341112
Authors Sherman B. Nisenboum JM. Jesberger BL. Morrow CA. Jesberger JA.
Institution Department of Rehabilitation Services, Mount Sinai Medical
Center, Cleveland, Ohio 44106, USA.
Title Assessment of dysphagia with the use of pulse oximetry.
Source Dysphagia. 14(3):152-6, 1999.
 
Abstract Recent anecdotal literature has shown a relation between
arterial oxygen saturation (SpO2), as measured by pulse oximetry, and
aspiration during eating. The present study was designed to determine
whether bedside pulse oximetry has a role in the assessment of
pharyngeal phase dysphagia. Forty-six adult patients with clinically
suspected swallowing abnormalities underwent modified barium swallow to
evaluate dysphagia. After determining baseline oxygen saturation by
pulse oximetry, different consistencies of barium were sequentially
ingested. Patients were monitored for radiographic evidence of
penetration or aspiration, which was correlated with continuous SpO2
recording. Patients who exhibited aspiration or penetration without
clearing had a significant decline in SpO2 compared with those patients
who penetrated but cleared or in whom no penetration was observed. These
relations were not associated with age, gender, or diagnosis. These
preliminary data indicate that bedside pulse oximetry may be a useful
tool in the evaluation of patients with dysphagia.

Database Ovid MEDLINE(R)
Unique Identifier 11014882
Authors Leder SB.
Institution Yale University School of Medicine, New Haven, Connecticut
06504, USA. Steven.Leder@Yale.edu
Title Use of arterial oxygen saturation, heart rate, and blood pressure
as indirect objective physiologic markers to predict aspiration.
Source Dysphagia. 15(4):201-5, 2000.
 
Abstract If an indirect bedside variable can reliably predict whether an
objective instrumental dysphagia evaluation is needed, time and money
can be saved without compromising patient care. To date, the search for
a reliable indirect subjective marker of aspiration has not been
successful. However, research on indirect objective markers of
aspiration is alluring. The purpose of the present study was to
investigate changes, if any, in the physiologic parameters of arterial
oxygen saturation (SpO(2)), heart rate, and blood pressure during
simultaneous objective confirmation of aspiration status with Fiberoptic
Endoscopic Evaluation of Swallowing (FEES). Sixty adult subjects were
divided into 4 groups of 15. Group 1 did not require supplemental oxygen
and did not aspirate. Group 2 did not require supplemental oxygen and
exhibited aspiration. Group 3 required supplemental oxygen and did not
aspirate. Group 4 required supplemental oxygen and exhibited aspiration.
Simultaneous SpO(2), heart rate, and blood pressure measurements were
collected at 1-min intervals, i.e., pre-FEES baseline for 5 min; during
FEES; and post-FEES for 5 min. Results indicated no significant
differences in SpO(2) levels based on aspiration status or oxygen
requirements for any of the 4 groups. A consistent pattern of higher
heart rate values during FEES and continuing for 5 min post-FEES was
observed for all 4 groups. A consistent pattern of higher blood pressure
values during FEES and then lower blood pressure values post-FEES was
observed for all 4 groups. It was concluded that the use of changes in
SpO(2), heart rate, or blood pressure values as indirect objective
markers of aspiration was not supported.

-----Original Message-----
From: dysphagia-bounces@b9.com [mailto:dysphagia-bounces@b9.com] On
Behalf Of M. Tervo
Sent: Wednesday, September 14, 2005 6:50 PM
To: dysphagia@b9.com
Subject: [Dysphagia] Pulse Oximetry

I've learned that signs of aspiration can be identified using pulse
oximetry.  If the O2 level drops more than 2% after the swallow and
slowly rises back to baseline this indicates aspiration.  After the
course where this was taught I found a research article confirming this
however I'm not sure if it was a peer-reviewed article because I don't
have access to Medline, Psychinfo, etc.  Any thoughts and/or opinions?
Can anyone shed some light.  Thank you.

		
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