Aspiration in Acute Respiratory Failure Survivors 2

Inclusion Criteria: 1. Admission to an ICU. 2. Mechanical ventilation with an endotracheal tube for greater than 48 hours. Exclusion Criteria: 1. Likely persistent contraindications to enteral/oral nutrition administration. 2. Pre-existing history of dysphagia or aspiration. 3. Pre-existing or acute primary central or peripheral neuromuscular disorder. 4. Presence of a chronic tracheostomy (present prior to ICU admission). 5. Pre-existing head and neck cancer or surgery. 6. Coagulopathy resulting in uncontrolled nasal or pharyngeal bleeding. 7. Delirium for more than 96 hours after extubation as assessed by Confusion Assessment Method (CAM-ICU). 8. Extubated for greater than 96 hours. 9. Inability to obtain informed consent from patient or an appropriate surrogate. 10. Age \< 18 years.