lCU: intensive care unit;  FEES: fiberoptic endoscopic evaluation of swallowing;  TP: true positive;  FP: false positive;  TN: true negative;  FN: false negative; PAS: penetration aspiration scale;  PEG: percutaneous endoscopic gastrostomy;  LOS: length of stay;  VFD: ventilator free days

This figure illustrates the design of the Dysphagia ICU study. Patients will be included if they were> 18 years old, mechanically ventilated for >24 hours, extubated for >24 hours, hemodynamically stable, and able to participate in FEES within 7 days of extubation. 

Patients will be excluded if they had a gastrostomy tube or gastrojejunostomy tube, a current contraindication to oral feeding, \Vere actively palliated, bad a pre-existing history of dysphagia, were receiving respiratory support for 7 days after extubation, had a GCS score < 11, or if the caring physician declined participation.

The water sip test \Vill be used as the index test and FEES as the reference standard. The study will evaluate the diagnostic accuracy of tbe water sip test and the prevalence of dysphagia (PAS score >2 vs. PAS score 9) in the ICU population. Secondary outcomes include re-intubation, need for temporary feeding devices, placement of a PEG tube, pneumonia, ICU LOS, hospital LOS, hospital mortality, and VFD.