Development Of Aspiration Pneumonia Research Articles

Features of nutritional support for dysphagia. The role of a speech therapist

Neurogenic oropharyngeal dysphagia remains a widespread complication of neurological diseases. Its prevalence in stroke patients reaches 50%, among patients with multiple sclerosis — 44%, with amyotrophic lateral sclerosis — 60%, after brain injury — 50%, with Parkinson’s disease — 84%. Neurogenic oropharyngeal dysphagia can lead to a decrease in food intake, development of malnutrition and dehydration, and can also be complicated by the development of aspiration pneumonia, followed by death. Currently, the detection of dysphagia in hospitalized patients is often carried out late or outside the algorithm, which significantly increases the risk of nutritional deficiency, decreased quality of life, and other complications when eating. A clinical study of the swallowing function at the earliest possible time of hospitalization avoids delays in diagnosis and timely determines the feeding tactics of a patient with neurogenic dysphagia. The assessment of the swallowing function should be carried out in the first hours of the patient’s hospitalization, and the main conclusion to be drawn from the results of a clinical study of the swallowing function is whether the patient can receive food through the mouth to satisfy nutritional needs. Despite the urgency of the problem of the development of nutritional deficiency in patients with dysphagia, there are few specific recommendations in the Russian literature on the stages of diagnosis, medical rehabilitation and nutritional support for this category of patients. This review is devoted to the analysis of the need for correct diagnosis and rehabilitation of patients with dysphagia and the impact of dysphagia on the quality of life and nutritional status of the patients.

Relationship between aspiration pneumonia and oral health assessment tool (OHAT)

This study clarified the relationship between aspiration pneumonia and the oral health status. A total of 809 users from Kounankai were targeted. The Oral Health Assessment Tool (OHAT) includes eight items: lip, tongue, gingiva/mucosa, saliva, remaining teeth, dentures, oral cleaning, and toothache. Information on aspiration pneumonia was collected from each facility. A binomial logistic regression analysis was performed, with aspiration pneumonia as the objective variable and the OHAT items as explanatory variables. The analysis was performed using the R software program, version 4.0. 2, with a significance level of < 5%. No significant association was found between the development of aspiration pneumonia and the OHAT score. The proportion of males was significantly higher in the aspiration pneumonia group than in the group without pneumonia. No association was found between the development of aspiration pneumonia and the OHAT score.

Predictors of aspiration pneumonia: developing a new matrix for speech and language therapists.

The contributing factors of aspiration pneumonia have been well documented. However, there are gaps in the literature regarding identifying the weight associated with each factor and the relationship between factors. In this study, 20 potential predictors of aspiration pneumonia (with four additional variables) have been applied to historic Speech and Language Therapy records to greater understand the significance of each contributor of aspiration pneumonia. 152 cases with an oropharyngeal dysphagia, and a Speech and Language Therapy recommendation of eating and drinking with known aspiration and the associated potential risk of developing an aspiration pneumonia, were included in the data. These were inpatients and outpatients, and had various diagnoses but all had had a videofluoroscopy. Logistic regression analysis found seven factors that were individually significant in predicting the development of aspiration pneumonia with 84.93% sensitivity and 91.03% specificity DISCUSSION: Logistic regression and random forest analyses led to the proposal of a new matrix of predictors of aspiration pneumonia with respective scoring weights for individual and cumulative contributors (a direction for future research).

Oral care reduces incidence of pneumonia after esophagectomy: systematic review and meta-analysis.

Post-operative pneumonia after esophagectomy is a major contributor to morbidity and mortality. Prior studies have demonstrated a link between the presence of pathologic oral flora and the development of aspiration pneumonia. The objective of this systematic review and meta-analysis was to evaluate the effect of pre-operative oral care on the incidence of post-operative pneumonia after esophagectomy. A systematic search of the literature was performed on September 2, 2022. Screening of titles and abstracts, full-text articles, and evaluation of methodological quality was performed by two authors. Case reports, conference proceedings, and animal studies were excluded. A meta-analysis of peri-operative oral care on the odds of post-operative pneumonia after esophagectomy was performed using Revman 5.4.1 with a Mantel-Haenszel, random-effects model. A total of 736 records underwent title and abstract screening, leading to 28 full-text studies evaluated for eligibility. A total of nine studies met the inclusion criteria and underwent meta-analysis. Meta-analysis revealed a significant reduction in post-operative pneumonia among patients undergoing pre-operative oral care intervention compared to those without an oral care intervention (OR 0.57, 95% CI 0.43-0.74, p < 0.0001; I2 = 49%). Pre-operative oral care interventions have significant potential in the reduction of post-operative pneumonia after esophagectomy. North American prospective studies, as well as studies on the cost-benefit analysis, are required.

Predicting the development of aspiration pneumonia in patients with ischemic stroke and neurogenic dysphagia

To determine the prognostic aspects of the development of pneumonia in patients with ischemic stroke of various pathogenetic subtypes. The study enrolled 110 patients (64 men and 46 women), aged 44-95 years, with dysphagia during the acute period of ischemic stroke (IS). The TOAST criteria were used to diagnose the pathogenetic subtype, and the MASA scale was used to determine the presence and severity of dysphagia. To predict the probability of switching to self-feeding from the severity of dysphagia, a non-linear regression method was used using the least squares method. In patients with swallowing disorders in the acute period of IS, pneumonia often developed after 5 days from the onset of clinical manifestations of stroke. In the cardioembolic subtype of IS, the probability of pneumonia in groups with dysphagia severity from 90 to 120 points on the MASA was higher than in the atherothrombotic subtype of IS (p<0.05). Patients with cardioembolic stroke subtype are characterized by a worse prognosis for the developing pneumonia compared to patients with atherothrombotic stroke subtype.

Investigation of buccal mucosa salivary protein collection methods from salivary proteins and evaluation by proteomic analysis with the goal of detecting the development of aspiration pneumonia

Investigation of buccal mucosa salivary protein collection methods from salivary proteins and evaluation by proteomic analysis with the goal of detecting the development of aspiration pneumonia

Triage and dysphagia: Are hospitals in the South African public health sector ready?

Dysphagia screening is unequivocally beneficial for individuals who may be at risk of swallowing impairment. Benefits range from capitalising on early intervention, facilitating hydration and nutrition, reduced financial costs for the patient and prevention of dysphagia-related complications. Why then is there a need for triage? Inefficiencies and often non-existence of screening and referral processes require one to consider if triage may be a more viable option in the public healthcare context. Dysphagia triage could potentially prioritise emergency swallowing care and identify patients who need immediate swallowing attention because of the nature or severity of dysphagia. The use of a dysphagia triage checklist could have implications for patient health outcomes in terms of the safety of oral diets, development of aspiration pneumonia, malnutrition, administration of oral medication and overall patient prognosis.

Japanese clinical practice guidelines for aspiration and pharyngeal residual assessment during eating and swallowing for nursing care.

This clinical practice guideline aims to provide and recommend methods of assessing aspiration and pharyngeal residue during eating and swallowing and methods of selecting and implementing nursing care for adults to prevent the development of aspiration pneumonia through early and appropriate management of oropharyngeal dysphagia. In April 2018, the Japan Academy of Nursing Science established the Supervisory Committee in Nursing Care Development/Standardization Committee to develop clinical practice guidelines for aspiration and pharyngeal residual assessment during eating and swallowing for nursing care. This clinical practice guideline was developed according to the Minds Manual for Guideline Development 2017, with the aim of providing a specific pathway for nurses to determine the policy for selecting management for oropharyngeal dysphagia based on research evidence and multifaceted factors including the balance of benefits and harms and patients' values. Based on the 10 clinical questions related to assessment by physical assessment, the Repetitive Saliva Swallowing Test, Modified Water Swallowing Test, Food Test, cervical auscultation, observation using an ultrasound diagnostic device, and an endoscope, 10 recommendations have been developed. Eight recommendations have been evaluated as the Grading of Recommendations Assessment, Development and Evaluation (GRADE) 2C, and the other two have been evaluated as no GRADE. The first reliable clinical practice guideline has been produced from an academic nursing organization that focuses on assessment for nursing care and incorporates the latest findings.

Effect of weekend hospitalization on the duration of fasting in patients with aspiration pneumonia.

BackgroundDecreased swallowing function is an important risk factor for the development of aspiration pneumonia. A previous study reported that a long duration of fasting decreased swallowing function and increased mortality. The purpose of this study is to clarify the relationship between weekend hospitalization and fasting duration in older patients with aspiration pneumonia.MethodsIn this retrospective cohort study using hospital claims data and electronic medical record data between April 1, 2018, and March 31, 2020, 238 patients hospitalized for aspiration pneumonia were enrolled. Patients admitted from Monday to Friday were defined as the weekday admission group, and patients admitted on Saturday, Sunday, and holidays were defined as the weekend admission group. The primary endpoint was the duration of fasting. Multiple regression analysis was performed with age, gender, place of living, Functional Oral Intake Scale before admission, severity of pneumonia, and weekend admission as the independent variables.ResultsThere were 41 patients in the weekend admission group and 103 patients in the weekday admission group. The baseline characteristics of the two groups were similar. There was a median difference in the fasting duration of 23.3 h; the fasting duration in the weekend admission group was significantly longer than the weekday admission group by 20.03 h (95% confidence interval: 2.81–37.25) in the multiple regression analysis.ConclusionsWeekend hospitalization was significantly associated with a longer fasting duration in patients hospitalized for aspiration pneumonia. There is a need to establish a system to enable early meal initiation for patients admitted on weekends.

Effects of Cough Training and Inspiratory Muscle Training on Cough Strength in Older Adults: A Randomized Controlled Trial.

While the need for preventive strategies to reduce the incidence of aspiration pneumonia has been indicated, it is also important to investigate effective training methods to improve cough function, which is associated with the development of aspiration pneumonia. This study aimed to investigate whether a 4-week home-based unsupervised cough training (CT) or inspiratory muscle training (IMT) program was effective in improving cough strength in older adults. Fifty-three ambulatory older adults without airflow limitations were randomly assigned to one of three groups: a CT group (n = 18), an IMT group (n = 18), or a control group (n = 17). The CT and IMT groups performed home-based unsupervised training with a device for 4weeks. Cough strength (cough peak flow), forced vital capacity, and respiratory muscle strength were assessed at the 4-week and 16-week follow-up. Intention-to-treat analyses were performed to investigate differences between the three groups using linear mixed models. At the 4-week follow-up, the CT group showed significant increases in cough peak flow and forced vital capacity compared with the control group, while the IMT group showed significant increases in inspiratory muscle strength compared with the cough training and control groups. At the 16-week follow-up, the CT group showed a significant increase in cough peak flow compared with the IMT group. These preliminary results suggest that a 4-week home-based CT program may have short-term effectiveness in improving cough peak flow in ambulatory older adults. This trial was registered on UMIN-CTR on 01/05/2018 (UMIN000031656).

Risk Factors for Aspiration Pneumonia among Elderly Patients in a Community-Based Integrated Care Unit: A Retrospective Cohort Study

We aimed to clarify the physical factors associated with the incidence of aspiration pneumonia in a community-based integrated care unit. This retrospective cohort study included 412 patients aged 65 years or older admitted to a community-based integrated care unit. A new diagnosis of aspiration pneumonia made by the attending physician based on physical examination, imaging findings, and blood test data after 48 h of admission was considered as an incidence of aspiration pneumonia. Basic patient information, activities of daily living, swallowing function, nutritional status, cognitive function, oral health-related factors, and energy intake were retrospectively investigated. We classified the patients into a pneumonia group and a non-pneumonia group, and examined the factors associated with the development of aspiration pneumonia. The mean age was 86.9 ± 8.1 years, and the pneumonia group comprised 49 participants. Comparison between the groups showed significant differences in oral environment, denture use, cognitive functional independence measure, and discharge to home. In multivariate logistic regression analysis, oral environment (odds ratio (OR) = 0.229, 95% confidence interval (CI): 0.070–0.753, p = 0.015) and use of dentures (OR = 0.360, 95% CI: 0.172–0.754, p = 0.007) were independently associated with aspiration pneumonia. Oral care and the use of dentures may be effective in preventing aspiration pneumonia.

Risk Factors for Aspiration Pneumonia After Receiving Liquid-Thickening Recommendations.

ObjectiveWe examined the influence of liquid thickness levels on the frequency of liquid penetration-aspiration in patients with dysphagia and evaluated the clinical risk factors for penetration-aspiration and aspiration pneumonia development.Study DesignA case series.SettingSingle-institution academic center.MethodsWe reviewed medical charts from 2018 to 2019. First, we evaluated whether liquid thickness levels influence the frequency of liquid penetration-aspiration in patients with dysphagia. Penetration-aspiration occurrence in a videofluoroscopic swallowing study was defined as Penetration-Aspiration Scale (PAS) scores ≥3. Second, the association between liquid thickness level and penetration-aspiration was analyzed, and clinical risk factors were identified. Moreover, clinical risk factors for aspiration pneumonia development within 6 months were investigated.ResultsOf 483 patients, 159 showed penetration-aspiration. The thickening of liquids significantly decreased the incidence of penetration-aspiration (P < .001). Clinical risk factors for penetration-aspiration were vocal fold paralysis (odds ratio [OR], 1.99), impaired laryngeal sensation (OR, 5.01), and a history of pneumonia (OR, 2.90). Twenty-three patients developed aspiration pneumonia while undertaking advised dietary changes, including liquid thickening. Significant risk factors for aspiration pneumonia development were poor performance status (OR, 1.85), PAS score ≥3 (OR, 4.03), and a history of aspiration pneumonia (OR, 7.00).ConclusionThickening of liquids can reduce the incidence of penetration-aspiration. Vocal fold paralysis, impaired laryngeal sensation, and history of aspiration pneumonia are significant risk factors of penetration-aspiration. Poor performance status, PAS score ≥3, and history of aspiration pneumonia are significantly associated with aspiration pneumonia development following recommendations on thickening liquids.Level of Evidence3.

Pathogenic oral bacteria in hospitalised patients with dysphagia: The silent epidemic.

BackgroundAspiration pneumonia is a serious and fatal complication of dysphagia, secondary to the ingestion of bacteria-laden secretions. However, no studies have documented the oral hygiene features present in patients who present with dysphagia.ObjectivesThe purpose of this study was to describe the oral hygiene problems of adults admitted to a sub-acute rehabilitation hospital and who presented with dysphagia.MethodsA descriptive, cross-sectional survey was conducted, during which 40 participants – 57.5% (n = 23) male and 42.5% (n = 17) female – underwent a clinical swallow evaluation using the Mann Assessment of Swallowing Ability (MASA) augmented with cervical auscultation (CA) and pulse oximetry (PO), an oral hygiene assessment using an adapted version of the Oral Health Assessment Tool (OHAT), followed by microbiology laboratory analysis of buccal swab samples to detect bacteria not considered part of the normal oral flora.ResultsResults indicated that poor oral hygiene status was a common feature amongst all participants who presented with dysphagia. The most prevalent oral hygiene issues were related to abnormalities concerning saliva (60%), oral cleanliness (82.5%), the tongue (80%) and the use of dentures (71.4%). A high prevalence, 62.5% (n = 25), of opportunistic bacteria was found. The most commonly occurring bacteria groups were: (1) Candida albicans (47.5%) and (2) respiratory pathogens (37.5%) such as Klebsiella pneumoniae and Staphylococcus aureus.ConclusionPersons with dysphagia have poor oral hygiene which creates favourable environments for bacteria to flourish and increases the prevalence of pathogenic oral bacteria associated with the development of aspiration pneumonia. The management of oral health issues for persons with dysphagia should receive greater attention during hospitalisation.

Association Between the Swallowing Reflex and the Incidence of Aspiration Pneumonia in Patients With Dysphagia Admitted to Long-term Care Wards: A Prospective Cohort Study of 60 Days

ObjectiveTo investigate the association between the Simple Swallowing Provocation Test (SSPT) and the incidence of aspiration pneumonia in patients with dysphagia in long-term care (LTC) wards. DesignThe study design was a prospective cohort study. Participants were followed for 60 days from admission. SettingLTC wards. ParticipantsStudy participants were patients with dysphagia aged ≥65 years who were admitted to LTC wards between August 2018 and August 2019. In total, 39 participants were included in the analysis (N=39; 20 male, 19 female; mean age, 83.8±8.5y). Participants were divided into 2 groups based on SSPT results: normal swallowing reflex (SSPT normal group) and abnormal swallowing reflex (SSPT abnormal group). The covariates were age and sex, primary disease, history of cerebrovascular disease, Glasgow Coma Scale, body mass index, Geriatric Nutritional Risk Index, the Mann Assessment of Swallowing Ability, Food Intake Level Scale, FIM, and Oral Health Assessment Tool. InterventionsNot applicable. Main Outcome MeasuresThe outcome was the incidence of aspiration pneumonia during the first 60 days of hospitalization, and the predictive factor was SSPT: 0.4 mL. ResultsThe incidence of aspiration pneumonia was 33.3% in the SSPT normal group and 76.2% in the SSPT abnormal group. The φ coefficient (a measure of association for 2 binary variables) was 0.43, the risk ratio (the ratio of the probability of an outcome in an exposed group to the probability of an outcome in an unexposed group) was 2.29, and the 95% confidence interval was 1.14-4.58 for the SSPT abnormal group. ConclusionsOur findings suggest that the SSPT provides a valid index for the development of aspiration pneumonia in older patients with dysphagia admitted to LTC wards.

The Cough Reflex: The Janus of Respiratory Medicine.

In clinical practice, we commonly face adversity when encountering dysfunction of the cough reflex. Similar to ancient Roman deity Janus, it often presents with one of two opposing “faces”. Continual aberrant activation of the cough reflex, also known as chronic cough, can cause great detriment to quality of life and many of these patients are left misdiagnosed and undertreated. In contrast, loss of normal functioning of the cough reflex is the cause of a significant proportion of mortality in the elderly, primarily through the development of aspiration pneumonia. In this review we discuss both hyper- and hypo-activation of the cough reflex and how airway reflux and chronic aspiration may be involved in the aetiology and sequalae of both disease states. We detail the physiological and pharmacological mechanisms involved in cough, and how the recent development of P2X3 receptor antagonists may lead to the first pharmaceutical agent licensed for chronic cough. The treatment and prevention of loss of the cough reflex, which has been largely neglected, is also discussed as novel low-cost interventions could help prevent a number of hospital and domiciliary deaths from both acute and chronic aspiration.

Laboratory study on bacteriological aspects of beverages and thickeners for dysphagia patients : Growth survey of Escherichia coli on thickeners and beverages

Currently, there is little evidence-based guidance on bacteriological aspects of thickeners or beverages for dysphagia patients in Germany that can be recommended to prevent aspiration pneumonia. Therefore, the aim of this study was to evaluate the lowest cell amount of E.coli on M9 agar media with beverages and thickeners. In the laboratory experiment 1 · 107 cells of E.coli were plated on adefined minimal medium (M9 agar plates) with different carbon sources and incubated at 37 °C for 2 days. The increase in cell number was determined using aphotometer. Carbon sources were water, beer, orange juice, thickened beer, maltodextrin-xanthan gum-based thickeners, corn starch-based thickeners and potato starch-based thickeners. The lowest E.coli cell amount was measured on water compared to beer, orange juice and all thickeners. A higher E.coli cell count was measured on maltodextrin-based thickeners than on potato starch-based and corn starch-based thickeners. In the present laboratory experiment, no individual risk factors for the development of aspiration pneumonia in humans were considered; however, initial bacteriological evidence for dysphagia patients could be collected. Due to the high growth of E.coli on maltodextrin, yeast, fructose and glucose, these ingredients should be used with caution by dysphagia patients. Further research on thickeners and beverages is needed to make acomprehensive recommendation for action in this aspect.

Use of Early Bronchoscopy in Mechanically Ventilated Patients with Aspiration Pneumonitis

Background and objectivesAspiration-induced lung injury accounts for a significant proportion of acute pulmonary dysfunction. Few studies were conducted to study the use of early bronchoscopy in mechanically ventilated patients with aspiration pneumonitis. This study aimed at assessing the clinical impact of early bronchoscopy for removal of gastric fluid and solid particles in the first 24 hours of mechanical ventilation (MV) on the progression of aspiration, MV days, intensive care unit (ICU) stay, development of pneumonia, and ICU mortality.Materials and methodsThe study was an open-label randomized control trial and included 76 adult subjects mechanically ventilated due to aspiration pneumonitis, half the subjects received early bronchoscopy in the first 24 hours after aspiration for removal of aspirated material and bronchoalveolar lavage sampling, the other half received standard treatment.ResultsThe intervention group had a significant reduction in the rate of development of pneumonia at 60.5 vs 81.6%, p = 0.043 through the first week of admission, the intervention group has a significantly better hypoxic index (HI), white blood count, clinical pulmonary infection score, lung injury score, and sepsis-related organ failure assessment (SOFA) score compared to the control group. Although there was a reduction in mechanical ventilation days and ICU mortality in the intervention group vs control group that difference did not reach statistical significance.ConclusionsEarly bronchoscopy in mechanically ventilated patients with aspiration pneumonitis can be beneficial in improving respiratory functions and decreasing the incidence of development of aspiration pneumonia and may guide the de-escalation of antibiotic therapy.How to cite this articleMegahed MM, El-Menshawy AM, Ibrahim AM. Use of Early Bronchoscopy in Mechanically Ventilated Patients with Aspiration Pneumonitis. Indian J Crit Care Med 2021;25(2):146–152.

Aspiration during Rapid Sequence Induction: Prevalence and Risk Factors.

BackgroundSecuring definitive airway with minimal complications is a challenging task for high-volume emergency departments (ED) that deal with patients with compromised airway.Materials and methodsWe conducted a prospective observational study between September 2019 and March 2020. Cohort of adults presenting to the ED requiring rapid sequence induction (RSI) were recruited to determine the prevalence and risk factors for the development of aspiration pneumonia(AP) in patients intubated in the ED.ResultsDuring the study period, a total of 154 patients with a mean age of 44.5 years required RSI in the ED. Male (61%) predominance was noted among the study cohorts. We did not find any association between RSI performed in the ED and the risk of developing AP. The first attempt success rate of RSI was 76.7%, and 33(21.4%) patients had immediate adverse events following RSI. Rescue intubation was required for 11(7.1%) patients. The prevalence of AP following RSI in the ED was 13.4%. Endotracheal tube (ET) aspirate pepsin was positive in 45(29.2%) samples collected. The ET aspirate pepsin assay had low sensitivity (44.44%), specificity (73.53%), positive predictive value (18%), and negative predictive value (91%) in predicting the occurrence of AP. On multivariate logistic regression analysis, male gender (AOR: 7.29, 95%CI: 1.51−35.03, p = 0.013) and diabetes mellitus (AOR: 3.75, 95%CI: 1.23-11.51, p = 0.02) were found to be independent risk factors for developing AP.ConclusionWe identified male gender and diabetes mellitus to be independent predictors of risk of developing AP after RSI in the ED. ET aspirate pepsin levels proved to be neither sensitive nor specific in the diagnosis of AP.How to cite this articleRoshan R, Sudhakar GD, Vijay J, Mamta M, Amirtharaj J, Priya G, et al. Aspiration during Rapid Sequence Induction: Prevalence and Risk Factors. Indian J Crit Care Med 2021;25(2):140–145.

Risk factors for aspiration pneumonia in geriatric patients with dementia and prolonged dysphagia

Background: Dysphagia is an obvious risk factor for aspiration pneumonia in old age patients, especially those who are having dementia. The study aimed to determine the risk factors responsible for the development of aspiration pneumonia in geriatric patients with dementia and dysphagia in order to enable the development of a particular preventive program accordingly. Patients and Methods: The study recruited 98 patients diagnosed with dementia and dysphagia classified into patient and control groups according to the presence of aspiration pneumonia. Data collected included demographic and medical assessment data. Dementia severity was assessed with the clinical dementia rating (CDR) scale. According to the results of bedside clinical swallowing assessment and the Fiberoptic endoscopic evaluation of swallowing (FEES) results, the severity of swallowing impairment was determined by using the functional oral intake scale (FOIS), oropharyngeal secretion collection, penetration aspiration scale (PAS), and pharyngeal stasis scale. Results: Patients with aspiration pneumonia were of longer hospital stay duration, with more percentage of malnutrition, recent stroke, and comorbidities with RR (risk ratio) of 3.22, 1.59 and 3.8 respectively. FEES outcome revealed significant differences between the two groups in all measures of dysphagia severity. The risk factors of aspiration pneumonia were severe penetration aspiration, combined tube, and oral feeding, malnutrition, comorbidities, and severe dementia. Conclusion: The predictive risk factors for the development of aspiration pneumonia in dementia patients with dysphagia were malnutrition, comorbidities, severe dementia, and severe aspiration scale and tube feeding. These findings should be integrated into clinical practice to prevent aspiration pneumonia.

Risk factors for aspiration pneumonia in patients with dysphagia undergoing videofluoroscopic swallowing studies

Prediction of aspiration pneumonia development in at-risk patients is vital for implementation of appropriate interventions to reduce morbidity and mortality. Unfortunately, studies utilizing a comprehensive approach to risk assessment are still lacking. The objective of this study was to analyze the clinical features and videofluoroscopic swallowing study (VFSS) findings that predict aspiration pneumonia in patients with suspected dysphagia.Medical records of 916 patients who underwent VFSS between September 2014 and June 2018 were retrospectively analyzed. Patients were divided into either a pneumonia group or a non-pneumonia group based on diagnosis of aspiration pneumonia. Clinical information and VFSS findings were evaluated.One hundred seven patients (11.7%) were classified as having pneumonia. Multivariate analysis indicated that aspiration during the 2- cubic centimeter thick-liquid trial of VFSS (odds ratio [OR] = 3.23, 95% confidence interval [CI]: 1.93–5.41), smoking history (OR = 2.63, 95% CI: 1.53–4.53), underweight status (OR = 2.27, 95% CI: 1.31–3.94), abnormal pharyngeal delay time (OR = 1.60, 95% CI: 1.01–2.53), and a Penetration-Aspiration Scale level of 8 (OR = 3.73, 95% CI: 2.11–6.59) were significantly associated with aspiration pneumonia development. Integrated together, these factors were used to develop a predictive model for development of aspiration pneumonia (DAP), with a sensitivity of 82%, specificity of 56%, and an area under the receiver operating characteristic curve of 0.73.The best predictors for DAP included videofluoroscopic findings of aspiration during a 2-cubic centimeter thick-liquid trial, prolonged pharyngeal delay time, a Penetration-Aspiration Scale level of 8, history of smoking, and underweight status. These 5 proposed determinants and the associated DAP score are relatively simple to assess and may constitute a clinical screening tool that can readily identify and improve the management of patients at risk for aspiration pneumonia.