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[Dysphagia] Dehydration and thickened liquids
I enjoy learning from the many opinions on the board, and appreciate the
information and viewpoints. In trying to avoid thickened liquids, I do have
a question.
What can you do about someone who, regardless of aspiration and pneumonia
risk, coughs severely on thin liquids (the video showed aspiration with
thin), even with every strategy she's able to do, after every intervention I
could think of had been tried, yet doesn't cough with nectar. I varied
amounts of thickener to have the smallest amount added without coughing, and
used that measurement with my educating on how to thicken. She wouldn't
drink thin liquid because of the coughing. She's an outpatient who is no
longer on caseload, so I can't do much about it now, but so I can learn for
the future, any recommendations?
Thank you
Beth Dolar
-----Original Message-----
From: dysphagia-bounces at dysphagia.com
[mailto:dysphagia-bounces at dysphagia.com] On Behalf Of lobsterpam at aol.com
Sent: Wednesday, August 22, 2007 7:32 AM
To: dysphagia at b9.com
Subject: Re: [Dysphagia] Dehydration and falls 2
I'm not ready tho throw out the baby however as
less thick alternatives can reduce aspiration as clearly seen on videos and
reduce pneumonias as clearly seen during the few cases that pt.s who are
doing
fine on nectar get pneumonia when upgraded to thin without a repeat video.
We need to be careful about drawing conclusions from incomplete data. I'm
not sure anything can be "clearly seen" from a "few cases." There are just
as many cases that would show the opposite. What about all the videos we've
done where the person has no respiratory sx, but a video is done and they're
aspirating thins - and have been for ages? Or the ones who are placed on
thickened liquids or tubes, steal water, and still do fine? And the ones who
get pneumonia repeatedly when they are made NPO?
No one is suggesting that aspiration is a GOOD thing, but the development of
pneumonis is a far more complicated relationship than just aspirating thin
liquids.?
Feinberg, M., Knebl, J., and Tully, J. (1996) Prandial Aspiration and
Pneumonia in an Elderly Population Followed? Over 3 Years. Dysphagia
11:104-10 Abstract.? The purpose of our study was to prospectively?
determine pneumonia frequency and correlate it with? prandial liquid
aspiration and feeding status in frail elderly nursing home residents.
Initially, 152 patients had? video swallowing examinations (81?
oropharyngeal dys-? phagia,? 19 thoracic dysphagia, 52 without dysphagia).?
Those diagnosed with oropharyngeal impairment were? subsequently managed
with swallowing therapy or artifi-? cial feeding modalities. Patients were
followed for 3 years? (unless they expired earlier) and clinical courses
were? categorized according to the degree of prandial aspiration? and
feeding (PAF) status. Subjects with new lung infil-? trates persisting for
at least 5 days with appropriate clini-? cal findings were diagnosed as
having pneumonia and? were classified according to the PAF status months in?
which these findings occurred. Fifty-six pneumonias were? diagnosed during
4,280 months with the following fre-? quencies: no aspiration!
months 0.6%; minor aspiration? months 0.9%; major aspiration/oral feeding
months 1.3%;? major? aspiration/artificial? feeding? months? 4.4%,? p? <?
0.001. Our results indicate that there is not a simple and? obvious relation
between prandial liquid aspiration and? pneumonia. Artificial feeding does
not seem to be a satis-? factory solution for preventing pneumonia in
elderly prandial aspirators.
?
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