Abstract
Management of oropharyngeal dysphagia (OD) is mainly based on modifying liquid viscosity and solid consistency in order to preserve oral feeding while avoiding unsafe swallowing. Adding thickening powders (TP) to water is the most common practice in patients suffering from OD to liquids, but ready-to-use gelled waters (RGW) can also be proposed. The main objective of this study was to assess the efficacy of a RGW and a TP on swallowing in hospitalized patients with different OD etiologies. This open, crossover, multicenter trial recruited thirty hospitalized patients with OD to liquids, confirmed by positive 3-ounce water test or positive Practical Aspiration Screening Scheme test. The patient’s ability to swallow 120 g of a RGW (IDDSI level 4) and a drink prepared with TP (nectar viscosity; NTP, 291 cP, IDDSI level 2; or if necessary, honey; HTP, 769 cP, IDDSI level 3) was evaluated in a random order at 1- to 3-day intervals. The main criterion was the efficacy of each product, defined as the proportion of patients who successfully swallowed without immediate reflexive cough. The RGW and TP were successfully swallowed in respectively 93.3% (95% CI: 77.9–99.2) and 82.8% (95% CI: 64.2–94.2) of patients with different dysphagia etiologies (stroke, neurodegenerative diseases, or aging) and unable to swallow thin water. Taste and texture of both study products were well appreciated by patients, with a preference for the RGW over TP. Therefore, the use of these thickened products could be part of the therapeutic strategy for patients with OD to liquids.
Highlights
Oropharyngeal dysphagia (OD), a prevalent condition recognized by the World Health Organization (WHO) in the International Classification of Diseases [1], is characterized by difficulties in swallowing liquids and/or solids that may lead to aspiration
Different viscosity levels were defined for liquids in 2002 by the National Dysphagia Diet (NDD) task force [7] according to their rheological properties: nectar thick liquid (51–350 cP), honey thick liquid (351–1750 cP), and spoon/pudding thick liquid (>1750 cP)
Clinical Predictive Scale of Aspiration (CPSA) was evaluated for 28 patients, and 86% of them were at potential risk of aspiration
Summary
Oropharyngeal dysphagia (OD), a prevalent condition recognized by the World Health Organization (WHO) in the International Classification of Diseases [1], is characterized by difficulties in swallowing liquids and/or solids that may lead to aspiration. Management of OD is mainly based on modifying liquid viscosity and solid texture/consistency in order to preserve oral feeding while avoiding unsafe swallowing [3]. A well-established intervention in hospitals for patients with OD is to thicken liquids by adding thickeners in water as described in previous studies [4,5,6]. More recently in 2017, the International Dysphagia Diet Standardization Initiative (IDDSI) proposed new definitions for texture-modified foods and thickened liquids for OD [8]. A five-level scale of drink thickness has been established from thin (level 0) to extremely thick liquids (level 4) [8]
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