Initiating safe oral feeding in critical care

Criteria for a successful swallow screen include sensitivity >95 % for accurate identification of patients with aspiration risk, use by a variety of trained healthcare professionals, quick to perform, easy to interpret, cost-effective, and, importantly, effective with all patients regardless of diagnosis. The decision-making process for determining which intensive care unit (ICU) patients require a swallow screen and when to recommend oral alimentation is discussed. The Yale Swallow Protocol, comprised of a brief cognitive screen, oral mechanism evaluation, and drinking 3 oz of water completely and uninterrupted, has been shown to have a 96.5 % sensitivity, 97.9 % negative predictive value, and a false-negative rate. Importantly, when the protocol was passed, a 100 % success rate with subsequent oral ingestion of foods and fluids was observed with all ICU patients.