Nurse-Administered and Nurse-Feasible Post-Extubation Dysphagia Screening in Adult Intensive Care Units: A Scoping Review of Test Performance, Implementation and Patient Outcomes.

چکیده اصلی

BACKGROUND: Post-extubation dysphagia (PED) is common after invasive mechanical ventilation. Nurses can provide timely bedside risk screening, but instrument validity, performance in nurses' hands and implementation effectiveness are distinct questions. AIM: To map direct nurse-administered evidence, transferability of nurse-feasible tools, nursing implementation context, and reported patient outcomes in adult intensive care units (ICUs). METHODS: Literature searches were conducted in six databases, with the search updated in August 2026. Evidence was stratified according to the actual screening administrator and reference-standard assessment. Criterion-level MMAT and QUADAS-2 assessments were applied without summary scores. RESULTS: The source-verified map comprised 34 reports representing 31 study families. Instrumental-reference evidence with nurse or nursing-assistant administration included two complete-verification cohorts: modified Volume-Viscosity Swallow Test versus FEES in 44 extubated patients (sensitivity 89.5%, specificity 72%) and GUSS-IVA versus FEES in 51 of 56 enrolled patients (81.0%, 88.9%). A third nurse screen had optional FEES in 38 of 123 patients (86%, 21%). Other nurse-administered studies used clinical or proxy comparators or positive-only verification. SLP-administered FEES studies informed transferability, not nurse-administered accuracy. Implementation fidelity varied, and outcome studies were non-randomised. CONCLUSIONS: Nursing involvement in structured PED screening is feasible, but direct accuracy and patient-outcome evidence remain heterogeneous and at risk of selection, verification and confounding bias. ICUs may pilot governed pathways with competency assessment, documentation, specialist escalation and outcome audit; no single screen is established as standard care. RELEVANCE TO CLINICAL PRACTICE: Bedside screening is risk stratification rather than diagnosis. Failed, discordant or high-risk screens require prompt specialist assessment and, where indicated, FEES or VFSS.

ترجمه فارسی چکیده

دیسفاژی پس از قطع تنفس مصنوعی (PED) پس از تنفس مصنوعی تهاجمی شایع است. پرستاران می‌توانند غربالگری ریسک در تخت بیمار را به موقع انجام دهند، اما اعتبار ابزار، عملکرد در دستان پرستاران و اثربخشی پیاده‌سازی سوالات مستقلی هستند. هدف این مطالعه نقشه‌برداری از شواهد مستقیم توسط پرستار، انتقال‌پذیری ابزارهای قابل انجام توسط پرستار، زمینه پیاده‌سازی پرستاری و نتایج بیمار گزارش‌شده در واحدهای مراقبت‌های ویژه بالغین است. نتایج نشان می‌دهد که شواهد مربوط به دقت مستقیم و نتایج بیمار هنوز متنوع است و در معرض خطاهای انتخاب، تأیید و تداخل قرار دارد. پیاده‌سازی پرستار در غربالگری ساختاریافته PED امکان‌پذیر است، اما هیچ غربالگری منسجم به عنوان مراقبت استاندارد تأیید نشده است.

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