Predict Aspiration Pneumonia Research Articles

Bedside evaluation of swallowing function to predict aspiration pneumonia in Duchenne muscular dystrophy

Bedside evaluation of swallowing function to predict aspiration pneumonia in Duchenne muscular dystrophy

The use of a myofunctional device in an aged care population for oral care and swallowing: A feasibility study

Purpose: Poor oral health is a known predictor of aspiration pneumonia in vulnerable populations such as the elderly and chronically ill. This study examined the feasibility of using myofunctional devices during a 5-week intervention for the management of oral care and dysphagia for residents in a residential aged-care facility. Method: Feasibility was determined through evaluation of study recruitment and retention rates, adherence to intervention, and resident and staff acceptability of the intervention. Thirteen residents, ages 74–99, participated in the intervention and 10 care staff completed feedback on post-intervention questionnaires. Results: Enrolment and retention rates were 61.9% and 92.3%, respectively. Adherence rates for use of the device were 92.6% at 3 weeks, and 89.3% at 5 weeks for the 12 participants who completed the protocol. The device was considered acceptable for ease of use, comfort, and amount of support required. Conclusion: Results indicate that further research exploring device use in an aged care population for the management of dysphagia and oral hygiene is feasible.

Myofunctional device use in oral care and swallowing: a protocol for a feasibility study in an aged care population

BackgroundPoor oral health is a known predictor of aspiration pneumonia in vulnerable populations such as the elderly and chronically ill and has been linked to systemic disease, morbidity, and mortality. Reduced oral health not only places individuals at a greater risk of aspiration pneumonia but may result in pain or poorer dentition which can impact on mastication and swallowing. Consequences of this may include reduced oral intake, malnutrition, poorer health outcomes, and reduced quality of life. Few evidence-based protocols exist to manage oral care in aged care populations, and maintenance of good oral hygiene is difficult for nursing and care staff to facilitate. However, a recent literature review found that improvements in oral hygiene, oral behaviors, and swallowing, along with breathing and speech have been found to be associated with the use of myofunctional devices due to positive changes in orofacial functions such as lip seal, mastication, swallowing, and nasal breathing patterns. The primary aim of this study is to assess the feasibility of using a myofunctional device to improve oral care and swallowing function in an aged care population.Methods/designThis project is a feasibility study that involves a 5-week intervention for oral hygiene and dysphagia for residents >65 years old in an aged care setting. Feasibility will be determined by the acceptability of the intervention, study recruitment and retention, and adherence to the intervention. Feasibility testing will also include an evaluation of clinical outcome measures, and sensitivity to detect changes in oral health and swallowing in an aged care population.DiscussionThe results of this trial will provide important information regarding the feasibility of utilizing a myofunctional device to improve oral care and dysphagia in elderly patients in an aged care facility. This knowledge will further guide and inform design of a larger trial or future research.Trial registrationThis trial was registered August 10, 2021, with the Australian New Zealand Clinical Trials Registry and allocated the ACTRN: ACTRN12621001359820.

Bedside evaluation of swallowing function to predict aspiration pneumonia in Duchenne muscular dystrophy

ObjectiveAspiration pneumonia is one of the leading causes of death in patients with muscular dystrophy; therefore, it is important to predict its occurrence in the clincal setting. We aimed to examine the usefulness of repeated saliva swallowing test (RSST), modified water swallowing test (MWST), and flexible endoscopic evaluation of swallowing (FEES) for evaluating the Hyodo score at the bedside, to predict the risk of aspiration pneumonia in patients with Duchenne muscular dystrophy (DMD). MethodsIn this retrospective cohort study involving 43 patients, we evaluated the swallowing function using the RSST, MWST, and FEES, and predicted the likelihood of aspiration pneumonia within 2 years after the assessment. The Hyodo score, a scoring system for evaluating the swallowing function determined by the FEES, was used. ResultsPneumonia was observed in 14 patients (32.6%). The RSST was not significantly useful for predicting the onset of pneumonia. The MWST was reported to have a cutoff value of < 4 points. Significantly more patients in the pneumonia group had an MWST score of < 4 points. The results revealed that the occurrence of pneumonia could be predicted based on a Hyodo cutoff score of ≥ 6. Significantly more patients in the pneumonia group had an MWST score of < 4 or a Hyodo score of ≥ 6. ConclusionsCombining MWST and FEES is useful for evaluating the bedside swallowing function and predicting the onset of pneumonia.

Factors associated with gravity-dependent distribution on chest CT in elderly patients with community-acquired pneumonia: a retrospective observational study

Although lung involvement in aspiration pneumonia typically has a gravity-dependent distribution on chest images, which patient’s conditions contribute to its radiological pattern has not been fully elucidated. This study was designed to determine the factors associated with the gravity-dependent distribution of community-acquired pneumonia (CAP) on chest computed tomography (CT). This retrospective study included elderly patients aged ≥ 65 years with CAP who underwent chest CT within 1 week before or after admission. The factors associated with lower lobe- and posterior-predominant distributions of ground glass opacity or airspace consolidation were determined. Of the 369 patients with CAP, 348 (94%) underwent chest CT. Multivariate analyses showed that impaired consciousness, a low Barthel index of activities of daily living, and high hemoglobin levels were associated with lower lobe-predominant distribution, while male sex and impaired consciousness were associated with posterior-predominant distribution. Cerebrovascular diseases were unrelated to these distributions. While male sex, impaired consciousness, high hemoglobin levels, low albumin levels, and the number of involved lobes were associated with in-hospital mortality, gravity-dependent distributions were not. Impaired consciousness might be the most significant predictor of aspiration pneumonia; however, the gravity-dependent distribution of this disease is unlikely to affect disease prognosis.

Incidence and Predictors of Aspiration Pneumonia Among Traumatic Brain Injury in Northwest Ethiopia.

BackgroundA significantly greater proportion of patients who die due to aspiration pneumonia were diagnosed with in-hospital aspiration pneumonia (19%). The incidence and major predictors are not known clearly, especially in Ethiopia.ObjectiveTo determine the incidence and predictors of aspiration pneumonia among adult traumatic brain injury patients at Felege Hiwot comprehensive specialized hospital, Bahir Dar, North west Ethiopia, in 2021.MethodsAn institution-based retrospective study was conducted from all admitted adult traumatic brain injury patients at Felege Hiwot comprehensive specialized hospital from January 1, 2015 to December 31, 2020 for 51 days of survival. Descriptive statistics, Kaplan–Meier survival curve log rank test, and the Cox proportional hazard regression model were used.ResultsA total of 396 adult patients diagnosed and admitted with traumatic brain injury in the past 5 years were included. Seventy patients (17.67%) developed aspiration pneumonia, providing an incidence rate of 32.39 (95% CI=25-62–40.94) per 1,000 person days of observation. Independent predictors were being referred for AHR (2.43; 95% CI=1.12–5.25), nasogastric tube insertion AHR (3.02; 95% CI=1.43–6.39), and baseline Glasgow coma scale <8 AHR (3.88; 95% CI=1.42–10.062).ConclusionHaving a nasogastric tube and low baseline Glasgow coma scale were significant predictors. This improves prehospital and hospital care during transportation and admission time.

Predictors of Aspiration Pneumonia and Mortality in Patients with Dysphagia.

To identify risk factors for pneumonia incidence in patients with dysphagia undergoing a videofluoroscopic swallow study (VFSS) in an outpatient tertiary-care center. Historical cohort study. All individuals undergoing a VFSS between 10/02/13 and 07/30/15 were identified and followed historically for 2 years. Demographic information, medical history, and fluoroscopic data were collected. The 2-year incidence of pneumonia was obtained from the medical records and telephone interview. The incidence of pneumonia and death were calculated and risk factors for pneumonia and mortality were ascertained. 689 patients were followed for 2 years. The mean age (±standard deviation) of the cohort was 65 (±15.5) years. 49% (338/689) were female. The most common causes of dysphagia were cricopharyngeus muscle dysfunction (270/689), head and neck cancer (175/689), and neurodegenerative disease (56/689). The incidence of pneumonia was 22% (153/689). The incidence of death was 11%. Multivariable logistic regression revealed that chronic obstructive pulmonary disorder [COPD] (odds ratio [OR]=2.36, 95% confidence interval [CI]: 1.33-4.19), hypertension (OR=1.82, 95% CI: 1.23-2.73), tracheotomy status (OR=2.96, 95% CI: 1.09-7.99), and vallecular residue (OR=1.88, 95% CI: 1.24-2.85) were all significantly associated with an elevated risk of pneumonia. Kidney disease (OR=1.27, 95% CI: 1.02-9.9), COPD (OR=3.27, 95% CI: 1.65-6.49), vallecular residue (OR=2.35, 95% CI: 1.35-4.1), male gender (OR=2.21, 95% CI: 1.25-3.92), and low body mass index (OR: 1.12, 95% CI: 1.06-1.19) were independent adjusted risk factors for death. The incidence of aspiration pneumonia (22%) and death (11%) within 2-years of a VFSS was high. The greatest adjusted risk factors for incident pneumonia were tracheotomy (OR=3.0), COPD (OR=2.4) and vallecular residue (OR=1.9). The greatest adjusted risk factors for death were COPD (OR=3.3), vallecular residue (OR=2.3), and male gender (OR=2.2). 4 Laryngoscope, 132:1172-1176, 2022.

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.

The Modified Volume-Viscosity Swallow Test as a Predictor of Aspiration Pneumonia after Acute Ischemic Stroke

Objectives: Dysphagia is common in patients with acute ischemic stroke patients (AIS) and it increases the risk of aspiration pneumonia after AIS. The volume-viscosity swallow test (V-VST) is a useful dysphagia screening tool. Therefore, we aim to explore the association between dysphagia (using the modified V-VST) and aspiration pneumonia in acute ischemic stroke patients.Patients and methods: All patients with acute ischemic stroke (AIS) admitted during 1 January 2018 and 31 December 2018 were screened in this study by completing the modified V-VST within 24 hours after admission. The information of aspiration pneumonia was obtained from electronic medical system (EMS) and discharge notes. Results: Among 624 AIS patient, there were 152(24.36%) patients who suffered from aspiration pneumonia (95% CI, 20.65% - 27.35%) during hospitalization. Among all of them, patients with both impaired safety and impaired efficacy (HR, 7.53, 95%CI, 3.42-16.58, P < 0.001)) had a higher risk of aspiration pneumonia than those with only safety impaired (HR, 2.38, 95%CI, 1.40-4.04, P < 0.001) or only efficacy impaired (HR, 2.47, 95%CI, 1.33-4.57, P = 0.004). The risk of aspiration pneumonia was also associated with their completed volume at each viscosity. The patients with all impairment of three viscosities were also found to be related to the higher risk of developing aspiration pneumonia (P = 0.029).Conclusions: The Modified V-VST is an easy-hand on, reliable screening tool for dysphagia among patients with AIS. Patient subgroup analyses based on the modified V-VST might be able to predict the risk of aspiration pneumonia during hospitalization.

Neutrophil-to-lymphocyte Ratio as A Predictor of Aspiration Pneumonia in Drug Intoxication Patients

Purpose: To evaluate the association between neutrophil-to-lymphocyte ratio (NLR) and occurrence of aspiration pneumonia in drug intoxication (DI) patients in the emergency department (ED) and to evaluate the relationship between NLR and length of hospital admission/intensive care unit (ICU) admission Methods: A total of 466 patients diagnosed with DI in the ED from January 2016 to December 2017 were included in the analysis. The clinical and laboratory results, including NLR, were evaluated as variables. NLR was calculated as the absolute neutrophil count/absolute lymphocyte count. To evaluate the prognosis of DI, data on the development of aspiration pneumonia were obtained. Also, we evaluated the relationship between NLR and length of hospital admission and between NLR and length of ICU admission. Statistically, multivariate logistic regression analyses, receiver-operating characteristic (ROC) curve analysis, and Pearson's correlation (${ho}$) were performed. Results: Among the 466 DI patients, 86 (18.5%) developed aspiration pneumonia. Multivariate logistic regression analysis revealed NLR as an independent factor in predicting aspiration pneumonia (odds ratio, 1.7; p=0.001). NLR showed excellent predictive performance for aspiration pneumonia (areas under the ROC curves, 0.815; cut-off value, 3.47; p&lt;0.001) with a sensitivity of 86.0% and a specificity of 72.6%. No correlations between NLR and length of hospital admission (${ho}=0.195$) and between NLR and length of ICU admission (${ho}=0.092$) were observed. Conclusion: The NLR is a simple and effective marker for predicting the occurrence of aspiration pneumonia in DI patients. Emergency physicians should be alert for aspiration pneumonia in DI patients with high NLR value (&gt;3.47).

Different clinical predictors of aspiration pneumonia in dysphagic stroke patients related to stroke lesion: A STROBE-complaint retrospective study.

Although stroke is one of the most common causes of dysphagia, no studies have investigated the radionuclide salivagram as a predictor of aspiration pneumonia in patients with stroke. In addition, few researches on the risk factors of aspiration pneumonia in patients with subacute and chronic stroke undergoing rehabilitation in the rehabilitation unit have been rarely conducted. In this study, therefore, we investigated whether a radionuclide salivagram could predict aspiration pneumonia, and tried to find other clinical factors that may be helpful in predicting aspiration pneumonia in stroke patients undergoing rehabilitation in the rehabilitation department.From March 2013 and January 2018, a retrospective review of the medical records of 1182 subacute and chronic stroke patients who were admitted to rehabilitation department (South Korea) was carried out. We included 117 stroke patients with swallowing difficulties who were admitted to our rehabilitation department and satisfied our criteria retrospectively. Stroke lesion, the degree of paralysis, sex, age, onset duration, feeding methods, the Mini-Mental State Examination (MMSE), the Global Deterioration Scale (GDS), the presence of aspiration in VFSS or salivagram, the penetration-aspiration scale (PAS), and the total score of the Modified Barthel Index (MBI) were investigated by reviewing medical records.To evaluate the predictor of aspiration pneumonia for patients with stroke, multivariate logistic regression analysis with forward stepwise was performed. In the results of this study, only MMSE was significant as a clinical predictor, but not aspiration in VFSS or salivagram in multivariate analysis of supratentorial stroke patients (OR, 0.895) (95% CI, 0.830–964). In multivariate analysis of infratentorial stroke patients, combined results of salivagram and VFSS (aspiration in a salivagram or VFSS) (OR, 0.956) (95% CI, 0.919–995), and total MBI scores were significant as clinical predictors (OR, 24.882) (95% CI, 1.298–477.143).In conclusion, MMSE can be a clinical predictor of the occurrence of aspiration pneumonia in patients with supratentorial stroke. In contrast, total MBI score and combined results of a salivagram and VFSS can be clinical predictors of the occurrence of aspiration pneumonia in patients with infratentorial stroke.

Determining Peak Cough Flow Cutoff Values to Predict Aspiration Pneumonia Among Patients With Dysphagia Using the Citric Acid Reflexive Cough Test

ObjectiveTo investigate the clinical usefulness of the peak cough flow generated during the citric acid reflexive cough test (0.28 mol/L) by determining the appropriate cutoff values that could accurately predict aspiration pneumonia within the first 6 months after onset. DesignRetrospective analysis of a prospectively maintained database. SettingUniversity-affiliated hospital. ParticipantsPatients (N=163) with first-ever diagnosed dysphagia attributable to cerebrovascular disease, who had undergone the citric acid reflexive cough test on the same day they underwent the instrumental assessment of swallowing, such as videofluoroscopy or the functional endoscopic swallowing test. InterventionsNot applicable. Main Outcome MeasuresPeak cough flow (L/min) from the citric acid reflexive cough test. ResultsA final 163 patients had full medical records with 6-month follow-up. Receiver operating curve analysis showed that peak cough flow cutoff values set at 59 L/min were significantly associated with aspiration pneumonia (area under the curve [AUC] 95% confidence interval =0.88 [0.83-0.93]). This cutoff value significantly (P<.001) predicted the risk of aspiration pneumonia with an odds ratio of 21.56 (9.62-48.28). A multivariate regression logistic regression analysis model including initial dysphagia severity, low body mass index, and decreased level of cognition showed that inclusion of the peak cough flow from the citric acid reflexive cough test significantly improved the predictive model of aspiration pneumonia within the first 6 months after onset (AUC=0.91 vs 0.79). ConclusionsThose with reflexive cough strength less than 59 L/min may be at high risk of respiratory infections within the first 6 months after dysphagia onset. Objective measurement of reflexive cough strength may help to predict those at risk of aspiration pneumonia.

Using oral health assessment to predict aspiration pneumonia in older adults.

To investigate the significance of comprehensive assessment of oral health using the revised oral assessment guide (ROAG) in older adults with pneumonia. Oral health plays a major role in the eating-swallowing process. The role of comprehensive assessment of oral health in older adults with aspiration pneumonia has not been evaluated in detail. The ROAG is a screening tool for comprehensive assessment and has been shown to have a high sensitivity and specificity for the assessment of oral health. We retrospectively studied 238 adults with pneumonia, aged 65years and above, in whom the ROAG score had been assessed between December 2014 and June 2016. Participants were divided into two groups based on aspiration risk, as defined by Marik etal; correlation between the ROAG score and the risk of aspiration was evaluated. Two hundred and fifteen adults (90.3%) were found to be at aspiration risk. According to the ROAG score, mild-to-moderate and severe oral problems were noted in 38 (16.0%) and 200 (84.0%) adults, respectively. Aspiration risk was noted in 68.4% and 94.5% of adults with mild-to-moderate and severe oral problems, respectively (P<.0001). The area under the receiver operating characteristics curve for ROAG to predict aspiration risk was 0.72 (95% confidence interval: 0.60-0.84). Furthermore, a high ROAG score was an independent predictor of aspiration risk in our study population. In clinical practice, oral health assessment using ROAG can help predict aspiration risk in older adults with pneumonia.

Abstract WP315: Neutrophil-to-lymphocyte Ratio is a Useful Predictor of Aspiration Pneumonia in Patients With Acute Ischemic Stroke

Introduction: Aspiration pneumonia is a common complication in the acute phase after ischemic stroke. Inflammation is associated with the initiation and progression of pneumonia after stroke. The neutrophil-to-lymphocyte ratio (NLR) has recently been described as a predictor of clinical outcomes in stroke. However, impact of NLR on the aspiration pneumonia in patients with ischemic stroke remains unclear. Hypothesis: Therefore, we investigated that NLR on admission was related to the risk of aspiration pneumonia after ischemic stroke. Methods: A consecutive 1,200 patients who were admitted within 7 days after ischemic stroke onset between March 2010 and March 2015 were included for analysis. The NLR was calculated as the ratio of neutrophils to lymphocytes. The patients were categorized into tertile groups based on the NLR. We evaluated aspiration pneumonia complication during hospitalization. We compared the clinical characteristics and NLR according to the presence of aspiration pneumonia. Results: Among the included patients (mean age, 67.7 years; men, 59.7%), 97 (8.1%) patients experienced aspiration pneumonia during hospitalization following ischemic stroke. The patients with aspiration pneumonia were older and more likely to have atrial fibrillation, and diabetes mellitus. In addition, patients with aspiration pneumonia tended to have lower body mass index and higher initial NIHSS. The proportion of the NLR tertile 3 were significantly higher in the aspiration pneumonia group (30.7% vs. 64.9%, P &lt; 0.001). Moreover, higher NLR patients were more likely to be admitted to the intensive care unit (1.0% vs. 1.3% vs. 5.0%, P &lt; 0.001), and were more likely to have sepsis (defined by quick Sepsis-related Organ Failure Assessment score of ≥ 2; 0.5% vs. 1.8% vs. 4.2%, P = 0.001) After adjustment for covariates, the highest NLR tertile groups had an exaggerated risk for aspiration pneumonia [Odds ratio (95% confidence interval); tertile 3, 2.39 (1.20 – 4.77), P = 0.014]. Conclusions: This study demonstrated that higher NLR predicted aspiration pneumonia and severe infection following acute ischemic stroke. This suggests that NLR could be a useful and reliable prognostic biomarker for severe aspiration pneumonia after ischemic stroke.

Accuracy of Admission Glasgow Coma Scale to Predict Aspiration Pneumonia in Poisoned Patients

Glasgow Coma Scale (GCS) assesses the need and guides tracheal intubation in trauma patients. GCS provides a practical method for assessment of impairment of conscious level in response to defined stimuli. GCS is the sum of 3 sub-scores for eye opening (1 to 4), verbal (1 to 5), and best motor (1 to 6) response to stimulations. Low scores indicate poor level of consciousness from 3 (deep unconsciousness) to 15.

Ability of High-Resolution Manometry to Determine Feeding Method and to Predict Aspiration Pneumonia in Patients With Dysphagia.

The introduction of high-resolution manometry (HRM) offered an improved method to objectively analyze the status of pharynx and esophagus. At present, HRM for patients with oropharyngeal dysphagia has been poorly studied. We aimed to determine feeding method and predict the development of aspiration pneumonia in patients with oropharyngeal dysphagia using HRM. We recruited 120 patients with dysphagia who underwent both HRM and videofluoroscopic swallow study. HRM was used to estimate pressure events from velopharynx (VP) to upper esophageal sphincter (UES). Feeding methods were determined to non-oral or oral feeding according to dysphagia severity. We prospectively followed patients to assess the development of aspiration pneumonia. VP maximal pressure and UES relaxation duration were independently associated with non-oral feeding. Non-oral feeding was determined based on optimal cutoff value of 105.0 mm Hg for VP maximal pressure (95.0% sensitivity and 70.0% specificity) and 0.45 s for UES relaxation duration (76.3% sensitivity and 57.5% specificity), respectively. During a mean follow-up of 18.8 months, 15.8% of patients developed aspiration pneumonia. On multivariate Cox regression analysis, VP maximal pressure (P<0.01) and UES relaxation duration (P<0.05) independently predicted the development of aspiration pneumonia. Cumulative incidence of aspiration pneumonia was significantly increased in patients with readings below optimal cutoff values for VP maximal pressure (P<0.01) and UES relaxation duration (P<0.01), individually. We first established the optimal thresholds for HRM parameters to determine feeding method and predict the development of aspiration pneumonia in patients with oropharyngeal dysphagia.

Incidence and predictors of aspiration pneumonia in endoscopic sedation

Incidence and predictors of aspiration pneumonia in endoscopic sedation

Can we use influencing factors to predict aspiration pneumonia in the United Kingdom?

BackgroundThe current study builds upon the work of others in looking at influencing factors of aspiration pneumonia in people with a swallowing problem. This study differs from previous researches on this topic, focusing on the United Kingdom (UK) population and involving more recently defined influencing factors of aspiration pneumonia. The study aims to explore the multifactorial nature of aspiration pneumonia in a UKdysphagic client group, as well as different disease specific variables.MethodsSpeech and Language Therapists collected data on 33 influencing factors over a period of 6 months during routine bedside swallowing assessment of 687 patients. All subjects were adults referred with suspected dysphagia and included acute inpatients, head and neck cancer patients and adults with learning disabilities. The study population included 400 males and 287 females and ages ranged from 17 to 102 giving a mean age of 72.9 years. The influence of the different variables included in the study was evaluated using multivariate logistic regression analysis.ResultsThe results show that 13 statistically significant influencing factors were implicated in the development of aspiration pneumonia for this group. Out of these, nine correlate with the previous work undertaken in the United States. These were poor mobility, nil by mouth status, age, dependency for feeding, number of medications, Chronic Obstructive Pulmonary Disease (COPD), number of medical conditions, stroke and alcohol abuse. Four further influencing factors were shown to be significant in the UK population, these were dysphagia, only oral intake, bedfast, and male gender.ConclusionsThis study confirms that in the UK there are influencing factors in the development of an aspiration pneumonia. It would be prudent to remember that a direct link is yet to be established when applying this knowledge to inform clinical management.

Can we use influencing factors to predict aspiration pneumonia in the United Kingdom?

Background: The current study builds upon the work of others in looking at influencing factors of aspiration pneumonia in people with a swallowing problem. This study differs from previous researches on this topic, focusing on the United Kingdom (UK) population and involving more recently defined influencing factors of aspiration pneumonia. The study aims to explore the multifactorial nature of aspiration pneumonia in a UKdysphagic client group, as well as different disease specific variables. Methods: Speech and Language Therapists collected data on 33 influencing factors over a period of 6 months during routine bedside swallowing assessment of 687 patients. All subjects were adults referred with suspected dysphagia and included acute inpatients, head and neck cancer patients and adults with learning disabilities. The study population included 400 males and 287 females and ages ranged from 17 to 102 giving a mean age of 72.9 years. The influence of the different variables included in the study was evaluated using multivariate logistic regression analysis. Results: The results show that 13 statistically significant influencing factors were implicated in the development of aspiration pneumonia for this group. Out of these, nine correlate with the previous work undertaken in the United States. These were poor mobility, nil by mouth status, age, dependency for feeding, number of medications, Chronic Obstructive Pulmonary Disease (COPD), number of medical conditions, stroke and alcohol abuse. Four further influencing factors were shown to be significant in the UK population, these were dysphagia, only oral intake, bedfast, and male gender. Conclusions: This study confirms that in the UK there are influencing factors in the development of an aspiration pneumonia. It would be prudent to remember that a direct link is yet to be established when applying this knowledge to inform clinical management.

Evaluation of Salivary Aspiration in Brain-Injured Patients With Tracheostomy

ObjectiveTo determine the useful tool for evaluating salivary aspiration in brain-injured patients with tracheostomy.MethodsRadionuclide salivagram and laryngoscopy was done in 27 brain-injured patients with tracheostomy. During salivagram, 99mTc sulfur colloid was placed sublingually in the supine position, and 50-minute dynamic images and 2-hour delayed images were obtained. Salivary aspiration was detected when the tracer was entered into the major airways or lung parenchyma. Laryngoscopy was done by otolaryngologists, and saliva aspiration, saliva pooling, and vocal cord palsy were evaluated. Videofluoroscopic swallowing study was done in patients who were able to undergo the test.ResultsThe detection rate of salivary aspiration was 44.4% with salivagram, and 29.6% with laryngoscopy. The correlation of the two tests was 70.4%. Of the laryngoscopy findings, salivary pooling had significant correlation with positive salivagram results (p=0.04). Frequent need of suction correlated with salivary aspiration in both salivagram (p=0.01) and laryngoscopy (p=0.01). Patients with negative results in salivagram or laryngoscopy had higher rates of progressing to oral feeding or tapering tracheostomy. Two patients developed aspiration pneumonia, and both patients only showed aspiration in salivagram.ConclusionBrain-injured patients with tracheostomy have a high risk of salivary aspiration. Evaluation of salivary aspiration is important, as it may predict aspiration pneumonia and aids in clinical decisions of oral feeding or tracheostomy removal. Salivagram is more sensitive than laryngoscopy, but laryngoscopy may be useful for evaluating structural abnormalities or for follow-up examinations to assess the changes.