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Table 1 Definition of behavioral variables and oromotor test on the Dysphagia Risk Evaluation Protocol (DREP)

From: Clinical prognostic indicators of dysphagia following prolonged orotracheal intubation in ICU patients

 

Variable

Clinician’s judgment

Water swallow test (5 ml)

Extra oral loss

Water does not escape from the lips, manages bolus adequately - pass

Difficulty in managing bolus, presents drooling/spillage from the mouth - fail

Oral transit time

Swallows the bolus within 4 seconds - pass

Takes longer than 4 seconds to swallow bolus or does not swallow - fail

Nasal reflux

Water does not escape from the nasal cavities - pass

Water comes out from the nasal cavities - fail

Multiple swallows per bolus

Presents one swallow per bolus - pass

Presents more than one swallow per bolus, presents drooling/spillage from the mouth, needs cues to complete the task - fail

Laryngeal elevation (monitored by positioning the index and middle fingers over the hyoid bone and the thyroid cartilage)

Reaches an average elevation of two fingers of the examiner - pass

Does not present laryngeal elevation or presents average elevation of less than two fingers of the examiner - fail

Cervical auscultation (a stethoscope is placed at the lateral aspects above the cricoids cartilage in front of the sternocleidomastoid muscle and large vessels)

Presents the three characteristic sounds indicating that the bolus has gone through the pharynx - two clicks followed by an expiratory sound - pass

Does not present any sound or sounds other than those described above - fail

Oxygen saturation (baseline oxygen saturation registered prior to the swallowing test using a monitor or pulse oximetry)

Does not present changes in oxygen saturation in more than 4 units - pass

Presents changes in oxygen saturation in more than 4 units - fail

Voice quality

Does not present any alterations within the first minute after swallowing - pass

Voice becomes gurgly (‘wet’) within the first minute after swallowing - fail

Cough

Does not cough within the first minute after swallowing - pass

Presence of cough (voluntary or not) followed or not by throat clearing within the first minute after swallowing - fail

Choking

Does not choke after swallowing - pass

Chokes during and/or after swallowing - fail

Other signs (cardiac and respiratory frequencies)

Does not present significant changes in cardiac frequency (60–100 beats per minute) and in respiratory frequency (12–20 breaths per minute) - pass

Presents signs of cyanoses, bronchospasm and significant alterations of the vital signs - fail

Puree/solid swallow test (3, 5, 10 ml; half a piece of bread)

Extra oral loss

Bolus does not escape from the lips, manages bolus adequately - pass

Difficulty in managing the bolus, presents spillage from the mouth - fail

Oral transit time

Swallows the bolus within 20 seconds - pass

Takes longer than 20 seconds to swallow the bolus or does not swallow - fail

Nasal reflux

The bolus does not escape from the nasal cavities - pass

The bolus comes out from the nasal cavities - fail

Oral residue

Presents absence or up to 25% of bolus residue in the oral cavity - pass

Presents more than 25% of bolus residue in the oral cavity - fail

Multiple swallows per bolus

Presents one to three swallows per bolus - pass

Presents more than three swallows per bolus, presents drooling/spillage from the mouth, needs cues to complete task - fail

Laryngeal elevation (monitored with the positioning of the index and middle fingers over the hyoid bone and the thyroid cartilage)

Reaches an average elevation of two fingers of the examiner - pass

Does not present laryngeal elevation or presents average elevation of less than two fingers of the examiner - fail

Cervical auscultation (a stethoscope is placed at the lateral aspects above the cricoids cartilage in front of the sternocleidomastoid muscle and large vessels)

Presents the three characteristic sounds indicating that the bolus has gone through the pharynx - two clicks followed by an expiratory sound - pass

Does not present any sound or sounds other than those described above - fail

Oxygen saturation (baseline oxygen saturation registered prior to the swallowing test using a monitor or pulse oximetry)

Does not present changes in oxygen saturation in more than 4 units - pass

Presents changes in oxygen saturation in more than 4 units - fail

Voice quality

Does not present any alterations within the first minute after swallowing - pass

Voice becomes gurgly (‘wet’) within the first minute after swallowing - fail

Cough

Does not cough within the first minute after swallowing - pass

Presence of cough (voluntary or not) followed or not by throat clearing within the first minute after swallowing - fail

Choking

Does not choke after swallowing - pass

Chokes during and/or after swallowing - fail

Other signs (cardiac and respiratory frequencies)

Does not present significant changes in cardiac frequency (60–100 beats per minute) and in respiratory frequency (12–20 breaths per minute) - pass

Presents signs of cyanoses, bronchospasm and significant alterations of the vital signs - fail