Measurement of Oxygen Desaturation Is Not Useful for the Detection of Aspiration in Dysphagic Stroke Patients

BACKGROUND: Dysphagia is one of the most dangerous symptoms of acute stroke. Various screening tools have been suggested for the early detection of this condition. In spite of conflicting results, measurement of oxygen saturation (SpO(2)) during clinical swallowing assessment is still recommended by different national guidelines as a screening tool with a decline in SpO(2) ≥2% usually being regarded as a marker of aspiration. This paper assesses the sensitivity of SpO(2) measurements for the evaluation of aspiration risk in acute stroke patients. METHODS: Fifty acute stroke patients with moderate to severe dysphagia were included in this study. In all patients, fiberoptic endoscopic evaluation of swallowing (FEES) was performed according to a standardised protocol. Blinded to the results of FEES, SpO(2) was monitored simultaneously. The degree of desaturation during/after swallows with aspiration was compared to the degree of desaturation during/after swallows without aspiration in a swallow-to-swallow analysis of each patient. To minimise potential confounders, every patient served as their control. RESULTS: In each subject, a swallow with and a swallow without aspiration were analysed. Overall, aspiration seen in FEES was related to a minor decline in SpO(2) (mean SpO(2) without aspiration 95.54 ± 2.7% vs. mean SpO(2) with aspiration 95.28 ± 2.7%). However, a significant desaturation ≥2% occurred only in 5 patients during/after aspiration. There was no correlation between aspiration/dysphagia severity or the amount of aspirated material and SpO(2) levels. CONCLUSIONS: According to this study, measurement of oxygen desaturation is not a suitable screening tool for the detection of aspiration in stroke patients.