Visual Analysis of Swallowing Efficiency and Safety (VASES)

Visual Analysis of Swallowing Efficiency and Safety (VASES) is a standardized approach for rating pharyngeal residue, penetration, and aspiration during FEES. It establishes clearly defined anatomic and temporal boundaries within which rate functional swallowing outcomes in order to increase the transparency and standardization of FEES analysis. Furthermore, VASES uses 100-point scales to more precisely, sensitively, and reliably measure the presence and amount of pharyngeal residue, penetration, and aspiration.

For written instructions on how to interpret FEES using VASES, please refer to the original publication (copy-edited version; free self-archived version) and the free supplemental training document to learn more. After you have read the aforementioned material, you may consider viewing the below videos.

VASES Training Video

Below is a video recorded during a live stream on YouTube of a free, public, online VASES training webinar that we gave on August 25th, 2021. Feel free to view it and share it with others as you begin to train your FEES interpretation skills using VASES.

How to Use VASES in Clinical Practice

Ideally, each bolus trial that is part of your standardized FEES protocol will be rated using VASES. However, as you first begin to use VASES and balance FEES interpretation with workflow, you may consider starting off with rating just one swallowing condition (e.g., all trials of a patient preferred volume of thin liquid cup sips) or one trial for each swallowing condition (e.g., the first trial of each bolus volume and consistency). As you get faster and more efficient with ratings, you should consider rating every swallowing trial. On average, it is estimated that rating all seven outcome measures with VASES will take ~1 minute to complete.


The original VASES publication used visual analogue scales to estimate the amount of residue seen on each of the six anatomic landmarks. However, visual analogue scales may not be feasible for many clinicians who rely on electronic medical records. Therefore, you may consider substituting visual analogue scales with numerical ratings instead. For example, if you estimate that ~25% of the valleculae is full with oropharyngeal residue, then you could simply type '25' as your rating rather than needing to use a visual analogue scale. This will save time and should be easier to complete. Importantly, we found that visual analogue scales and numerical ratings have 'substantial/near perfect agreement' with each other for VASES, and therefore, numerical ratings are a valid (and more feasible) substitute (submitted for publication).


You may consider downloading an unofficial "VASES Rating Template" that I put together as an example Excel template to assist with VASES ratings. See below video on how VASES ratings can be completed using the rating template.

Rating Template_Using VASES in Clinical Practice.mov

References

Curtis, J.A., Borders, J.C., Perry, S.E., Dakin, A.E., Seikaly, Z.N., Troche, M.S. (2021). Visual Analysis of Swallowing Efficiency and Safety (VASES): A standardized approach to rating pharyngeal residue, penetration, and aspiration during FEES. Dysphagia. DOI: 10.1007/s00455-021-10293-5