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[Dysphagia] thickened liquids
Chris and Claire Langdon <chris_claire@bigpond.com> wrote:
>From the Garon article.....
In each case we follow the protocol of explaining the risks to
patients and families,
*** What "risks"? There are none that I know of that are greater than aspiration of the patient's own saliva.
two chose
to continue, even with severe coughing as they aspirated water."
*** Exactly what I mean when I say that one must determine whether or not it is a problem for the patient.
Claire
----- Original Message -----
From: "Francesca Swift"
To:
; ; ;
Sent: Thursday, January 27, 2005 7:49 AM
Subject: Re: [Dysphagia] thickened liquids
> I agree with this when it does not cause them distress. What are you
> guys' feelings when ingestion of water causes explosive choking (with a
> weak, non-productive cough), gurgling, discomfort and face turning red
> etc. each sip. It can be quite uncomfortable for them and disruptive to
> the meal process. (We've obviously all seen this regularly).
>
> >>> "Chris and Claire Langdon" 1/25/2005
> 9:50:13 PM >>>
> Are people on the listserv familiar with the study by Garon et. al.
> from 1997?
> Garon BR, Engle M and Ormiston C (1997) A randomized control study to
> determine the effects of unlimited oral intake of water in patients with
> identified aspiration. J. Neuro Rehab 11(3):139-148
>
> They conducted a study where acute stroke patients (mean 12.8 days
> post) with documented aspiration on thin fluids were randomised to
> receive (a) thickened liquids only (b) thickened liquids plus access to
> water. The (b) group weren't allowed water with or within an hour of
> meals and were required to rinse their mouths prior to any water intake
> in order to minimise ingestion of bacteria or food stasis. Participants
> in the group allowed access to water reported greater satisfaction as
> thickened liquids were reportedly "not thirst quenching and were lacking
> in taste and enjoyment". A significant difference in fluid intake per
> day was found between the groups for the amount of thickened fluids
> ingested; with participants in the (b) group ingesting less thickened
> fluids.
>
> Participants in group (b) had a mean intake of 1318cc fluid, of which
> water comprised an average 463cc. Group (a) participants averaged
> 1210cc thickened liquids daily. The research team reported that
> participants in the study group consumed considerably less water than
> expected, but water was placed out of the patients' reach for control
> purposes. Study participants reported they drank water for oral dryness
> and to alleviate thirst. Being able to take small sips of cold water
> during the day reportedly made a big difference to participants in terms
> of thirst.
>
> No patients in either group developed pneumonia or dehydration during a
> 30-day follow up period. Limitations - The study was of a small
> population (10 participants in each group). Patients unable to "rinse
> and spit" prior to a swallow and patients unable to hold a cup or self
> feed were excluded, so probably the more severe strokes were excluded.
> Impulsive patients were excluded, as were patients with a severe cough
> reaction to aspiration of thin fluids.
>
> Garon reported since completing the study that approximately 100
> patients with thin liquid aspiration had been allowed access to water
> and ice chips for hydration or thirst following the protocol of a
> pre-ingestion rinse and spit and not allowing water with or within a
> hour of meals. No patient had developed pneumonia.
>
> I'm not sure if this study pre-dates the Frazier Free Water Protocol
> (Kathy Panther).
>
> Wishing you all a Happy Australia Day!
>
> Claire
>
>
> ----- Original Message -----
> From: "Irene Campbell-Taylor"
> To:
;
> Sent: Tuesday, January 25, 2005 10:15 PM
> Subject: Re: [Dysphagia] thickened liquids
>
>
> > Increasingly, physicians are realizing that thickened liquids tend to
> produce not only dehydration but malnutririon as the recent literature
> indicates. It is not possible to get enough water on thickened liquids
> without compromising other intake. Also, there is NO evidence whatever
> that thickeners achieve any positive result. Hydration requires adequate
> intake of water, nit just any fluid : See
> >
> > ASHA SID 13 Newsletter, Perspectives on Swallowing and Swallowing
> Disorders, 11(2): 16-19, 2002
> >
> > Defining Physical Properties of Fluids for Dysphagia Evaluation and
> Treatment JoAnne Robbins; Wm. S. Middleton ;Mark Nicosia;Jacqueline A.
> Hind; Gary D. Gill; Roberto Blanco, EZ-EM, Inc;Jed Logemann,
> Northwestern University.
> >
> >
> > Thickening liquids has been and continues to be one of the most
> frequently used compensatory interventions in hospitals and long term
> care facilities, the latter because liquid aspiration is most common in
> elderly patients (Feinberg, Knebl, Tully, Segall, 1990; La Croix,
> Lipson, Miles, White, 1989). Nonetheless, there are little (sic) extant
> data that convincingly demonstrate that drinking thickened liquids has a
> significant positive effect on health outcomes such as pneumonia,
> hydration, nutrition, or quality of life. Bolus flow outcomes have long
> served as surrogate indicators of health outcomes. They include
> direction (aspiration or penetration), duration (transit times), and
> clearance (residue). The generally accepted clinical notion that
> manipulation of thicker (more viscous) substances reduces occurrence of
> aspiration, or modifies other bolus flow characteristics in dysphagic
> persons that produce an "improved swallow", has little support other
> than anecdotal, in the li!
> > terature.
> > And
> > Whelan K. Inadequate fluid intakes in dysphagic acute stroke. Clin
> Nutr 2001 Oct;20(5):423-8 Patients not on specialist stroke units who
> received pre-thickened fluids drank almost 100% more than those on
> powder-thickened fluids (Note: This was still only approximately 900ml
> fluid/day.Fluid intakes in this patient group are insufficient to
> achieve requirements. Hospital staff must ensure adequate fluid intakes
> in patients at risk of dehydration, which should include both an
> adequate prescription and provision of supplementary fluids
> >
> > Finestone HM, Foley NC, Woodbury MG, Greene-Finestone L.. Quantifying
> fluid intake in dysphagic stroke patients: a preliminary comparison of
> oral and nonoral strategies. Arch Phys Med Rehabil 82:1744-6. 2001.
> > The authors examined thirteen dysphagic patients with acute strokes
> for 21 days postadmission. Seven patients (group 1) were started on
> enteral feeding and later progressed to oral diets and 6 patients (group
> 2) received oral dysphagia diets. Fluid intake of patients in group 1
> significantly declined over the 21 days . Mean fluid intake of patients
> in group 2 was approximately 33% of requirements. This volume was
> significantly lower than the fluid intake of patients who received
> nonoral feeding. The patients who received thickened-fluid dysphagia
> diets failed to meet their fluid requirements whereas patients on
> enteral feeding and intravenous fluid regimens received sufficient
> fluid. It is not clear how much the intravenous fluid contributed to the
> overall fluid intake and whether or not fluid intake would have been
> sufficient without it.
> >
> >
> > This practice requires significant reconsideration, at best.
> > What is the general consensus out there: Do thickened liquids provide
> as
> > much hydration as regular thin liquids? I work with a doctor who
> feels that
> > anyone on thickened liquids is at risk for dehydration (even if they
> take adequate
> > amounts).
> > Thank you, Patti Banick, SLP
> > Maryland
> > _______________________________________________
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> > Dysphagia@b9.com
> > http://lists.b9.com/mailman/listinfo/dysphagia
> >
> >
> > Dr I Campbell-Taylor
> > Clinical Neuroscientist
> > Exclusive Distributor:
> > www.interactivetherapy.com
> > _______________________________________________
> > Dysphagia mailing list
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> > _______________________________________________
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>
Dr I Campbell-Taylor
Clinical Neuroscientist
Exclusive Distributor:
www.interactivetherapy.com
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