Modified Mondays: Prioritizing

One thing we have heard over and over this past year is how much clinicians are having to assess clinically, with decreased access to instrumental assessment. I have had a lot of conversations with SLPs that were needing to “prioritize” their patients for MBS and FEES studies. Frequently, I would encourage SLPs to think about their patients with trachs/vents. We know that there is an increased incidence of aspiration in patients with a trach on mechanical ventilation, and that the incidence of “silent” aspiration is higher in this patient group also. (It is important to realize that it is not necessarily the trach itself that is “causing” the dysphagia and aspiration, but more likely the severity of the medical status that required the trach in the first place.)

This clip is a great example of a trach/vent patient with silent aspiration. I am not overly reactive to aspiration, but this patient in particular had a pretty fragile respiratory status and was pretty medically compromised-so we really wanted to take a good look at it here. This patient has fairly consistent aspiration with all consistencies-all with no cough or throat clear. The fact that the aspiration was trace-minimal also means that it may not have been detected on blue dye assessment. In fact, this patient had “passed” a blue dye screen a few days before the MBS was completed. Thankfully, we are starting to see less prioritizing and an increased return to instrumentals lately. And while I love a good problem solving session, clinical assessment only, especially in patients with a trach/vent, is far less than ideal-and our patients all deserve to be the priority.

See the links below for some additional reading:

Incidence and Type of Aspiration in Acute Care Patients Requiring Mechanical Ventilation via a New Tracheotomy (

Diagnostic Accuracy of the Modified Evan's Blue Dye Test in Detecting Aspiration in Patients with Tracheostomy: A Systematic Review of the Evidence - PubMed (

Incidence and Risk of Aspiration in Mechanically Ventilated Patients | Request PDF (

Pulmonary aspiration in mechanically ventilated patients with tracheostomies - PubMed (

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