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    Pharyngeal electrical stimulation for neurogenic dysphagia

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    1 Draft recommendations

    People with neurogenic dysphagia who have a tracheostomy after stroke

    1.1 For people with neurogenic dysphagia who have a tracheostomy after stroke, pharyngeal electrical stimulation should only be used with special arrangements for clinical governance, consent, and audit or research. Find out what special arrangements mean on the NICE interventional procedures guidance page.

    1.2 Clinicians wanting to do pharyngeal electrical stimulation for people with neurogenic dysphagia who have a tracheostomy after stroke should:

    • Inform the clinical governance leads in their healthcare organisation.

    • Ensure that people (and their families and carers as appropriate) understand the procedure's safety and efficacy, and any uncertainties about these.

    • Take account of NICE's advice on shared decision making, including NICE's information for the public.

    • Audit and review clinical outcomes of everyone having the procedure. The main efficacy and safety outcomes identified in this guidance can be entered into NICE's interventional procedure outcomes audit tool (for use at local discretion).

    • Discuss the outcomes of the procedure during their annual appraisal to reflect, learn and improve.

    1.3 Healthcare organisations should:

    • Ensure systems are in place that support clinicians to collect and report data on outcomes and safety for everyone having this procedure.

    • Regularly review data on outcomes and safety for this procedure.

    1.4 Patient selection should be done by healthcare professionals experienced in managing neurogenic dysphagia with specific training in the procedure. An endoscopic assessment may be used.

    1.5 The procedure should only be done by healthcare professionals with specific training in the procedure.

    People with neurogenic dysphagia after stroke who do not have a tracheostomy, and people with other causes of neurogenic dysphagia

    1.6 For people with neurogenic dysphagia after stroke who do not have a tracheostomy and people with other causes of neurogenic dysphagia, pharyngeal electrical stimulation should be used only in research. Find out what only in research means on the NICE interventional procedures guidance page.

    1.7 Further research should report:

    • details of patient selection (including the cause of dysphagia and the timing of the intervention)

    • the treatment protocol (including the method of stimulation, stimulation intensity and duration of delivery)

    • effects on length of hospital stay compared with usual care.

    Why the committee made these recommendations

    People with neurogenic dysphagia have an increased risk of getting food or drink in the lungs, which can cause infection (aspiration pneumonia). In severe cases, they may need ventilation in an intensive care unit, and a tracheostomy and feeding tubes. There are limited treatment options for people with neurogenic dysphagia. There are no safety concerns about pharyngeal electrical stimulation, but there is more evidence on clinical efficacy for 1 group of people than for the others.

    Clinical trial and registry evidence shows that pharyngeal electrical stimulation allows the tracheostomy tube to be removed earlier for people with neurogenic dysphagia after stroke. This helps with recovery, because having a tracheostomy makes it difficult to take part in other rehabilitation treatments. Tracheostomy removal also allows earlier transfer out of intensive care and may reduce overall length of hospital stay. This is an important benefit for these people, but more data on other clinical efficacy outcomes is needed. So, for people with neurogenic dysphagia who have a tracheostomy after stroke, this procedure should only be used with special arrangements.

    The evidence on clinical efficacy of pharyngeal electrical stimulation for people with neurogenic dysphagia after stroke who do not have a tracheostomy is not clear. There is also not enough evidence to show clinical efficacy for people with other causes of neurogenic dysphagia. So, for people with neurogenic dysphagia after stroke who do not have a tracheostomy, and people with other causes of neurogenic dysphagia, this procedure should be used only in research.