Efficacy of pharyngeal electrical stimulation treatment (PES) for dysphagia in critical care patients

Introduction: Pharyngeal Electrical Stimulation (PES) is a safe dysphagia treatment but is underutilised in the UK. Cost of equipment and access to FEES (Fibreoptic Endoscopic Evaluation of Swallowing) limits adoption in UK hospitals. Stroke studies show improved swallow function and feeding status following PES treatment and accelerated tracheostomy decannulation. Critical care patients often present with impaired laryngopharyngeal sensation and silent aspiration post intubation and whilst tracheostomised and/or ventilated. Evidence for the effectiveness of PES with critical care patients is lacking. Aim: To assess the effectiveness of Pharyngeal Electrical Stimulation (PES) for dysphagic critical care patients in improving sensation and functional swallow outcome. Materials and Methods: This pilot study was carried out by Speech and Language Therapists. Patient selection was based on FEES assessment findings of severe dysphagia and silent aspiration. Structural abnormality, secretion rating, penetration/aspiration rating (using standard rating scales) and feeding outcome were recorded. PES catheters (Phagenyx) were inserted by a Nutrition Specialist Nurse. Patients underwent 10 min of PES treatment over 4 consecutive days. FEES was repeated on the day of final treatment and ratings and feeding outcome compared. Results: 6 critical care patients underwent PES. Medical diagnoses included laparotomy, flu A, CVA, double lung transplant and post ECMO (extracorporeal membrane oxygenation). Duration of previous intubation was 2-54 days and duration tracheostomised 15-84 days. 5/6 patients were tracheostomised and ventilated at the time of treatment. 4/5 patients commenced oral intake, 2 PEG tubes were avoided and 1 PEG tube was able to be removed as a result of the repeat FEES findings post PES. Conclusion: PES demonstrated improvements to swallow recovery in critical care patients and has the potential to be a cost effective dysphagia treatment.