Moss et al reported a simple bedside decision tree to determine if a survivor of acute respiratory failure is at increased risk for aspiration. The authors are from multiple institutions in the United States.
Patient selection: survivor of acute respiratory failure with history of intubation and respiratory support
Parameters:
(1) length of intubation in hours
(2) 2 ounce water swallowing test (pass/fail)
(3) APACHE II score (timing not specified; it could be that at the onset of respiratory failure or the maximum while intubated.)
(4) voice quality
(5) type of ICU patient
Findings associated with increased aspiration risk:
(1) length of intubation >= 200 hours
(2) failure of the water swallowing test
(3) APACHE II score >= 29
(4) abnormal voice quality AND other than medical or cardiac ICU patient
Findings associated no aspiration risk - all of the following:
(1) length of intubation < 200 hours
(2) passes the water swallowing test
(3) APACHE II score < 29
(4) voice quality one of the following:
(4a) normal
(4b) abnormal AND medical ICU patient
(4c) abnormal and cardiac ICU patient (which presumably includes cardiac surgery)
