Prevent Aspiration Pneumonia Research Articles

Pharyngeal Residues Following Swallowing of Pureed Diets Thickened with a Gelling Agent or a Xanthan Gum-Based Thickener in Elderly Patients with Dysphagia.

The ideal texture of pureed diets to prevent aspiration pneumonia remains unclear. The aim of this study was to evaluate the effectiveness of a pureed diet with either a gelling agent or a xanthan gum-based thickener to prevent pharyngeal residues in patients with dysphagia. We retrospectively analyzed a randomized, crossover trial of pureed rice with either a gelling agent or a xanthan gum-based thickener in patients with dysphagia. The enrolled patients were classified into mild and moderate-to-severe dysphagia groups. The primary outcome measure was degree of need for cyclic ingestion using test jelly for pharyngeal residuals (cyclic ingestion score). The secondary outcome was the patient's sense of material remaining in the throat following swallowing. Sixty-two patients (58% men; mean age 83 ± 9 years) with dysphagia were included. They were classified into mild dysphagia (n = 26) and moderate-to-severe dysphagia (n = 36) groups. In the moderate-to-severe dysphagia group, pharyngeal residuals were significantly less likely with pureed diets using a gelling agent than with those using a xanthan gum-based thickener, with respective median cyclic ingestion scores (range) of 1 (0-4) vs. 2.5 (0-4) (p = 0.001). There was no significant difference in pharyngeal residuals between the pureed diets in the mild dysphagia group. The multivariate analysis identified gelling agent as an important factor significantly associated with less pharyngeal residual after swallowing of pureed diet in patients with moderate-to-severe dysphagia. Pureed diets thickened by a gelling agent decrease pharyngeal residues in patients with moderate-to-severe dysphagia and may reduce risk of aspiration pneumonia.

Outcome of Guillain-Barré syndrome with bulbar palsy

BackgroundElective intubation is advocated in Guillain-Barré syndrome (GBS) with bulbar palsy to prevent aspiration pneumonia and lung collapse. We evaluate the outcome of GBS patients with bulbar palsy, and also compare the risks and benefits of intubation and MV in them. Methods187 GBS patients with bulbar palsy from a cohort of 547 GBS registry were analyzed. Detailed clinical records and peak disability on a 0-6 GBS Disability Scale (GBSDS) were noted. The patients were intubated if arterial blood gas (ABG) analysis revealed hypoxia, hypercarbia or acidosis. The patients with normal ABG parameters were fed by nasogastric tube, and nursed in lateral position. Occurrence of pneumonia, in-hospital death and outcomes at 6-months were classified as complete (GBSDS <2), partial (GBSDS 2-3) and poor (GBSDS >3). Results76/187(40.6%) patients required MV, and they had a shorter duration of illness (p = 0.007), higher peak disability (p < 0.001), autonomic dysfunction (p < 0.001) and more frequently received IVIg (p = 0.02). Pneumonia (63% vs 10.8%; p < 0.001) and in-hospital deaths (7.9% vs 1.8%; p = 0.06) were more frequent in MV group compared to nasogastric fed group. At 6-months,104 (55.6%) patients recovered completely. On multivariate analysis, the independent predictors of poor outcome were peak disability [Adjusted Odds Ratio (AOR) 9.84, 95% Confidence Interval (CI) 3.15-30.74, p < 0.0001], day of hospitalization from disease onset (AOR 1.09, 95% Cl 1.01-1.01; p=0.009) and requirement of MV (AOR 0.10; 95% 0.02-0.50; p = 0.005). ConclusionGBS patients with bulbar palsy may be managed by nasogastric feeding and nursing in lateral position without increasing the risk of pneumonia. Mechanical ventilation based on ABG does not worsen outcomes of GBS with bulbar palsy.

Impact of Cilostazol Administration on Prevention of Aspiration Pneumonia in Patients With Chronic Limb-Threatening Ischemia.

Cilostazol has reported effectiveness for preventing aspiration pneumonia in patients with ischemic stroke, but whether it is similarly beneficial for patients with chronic limb-threatening ischemia (CLTI) is unclear. This retrospective single-center study enrolled 1,368 CLTI patients treated with endovascular therapy (EVT). In the multivariate analysis, predictors for aspiration pneumonia were age (hazard ratio [HR] 1.06 [95% confidence interval (CI) 1.03-1.10]), non-ambulatory status (HR 2.54 [95% CI 1.38-4.65]), the Geriatric Nutritional Risk Index (HR 0.97 [95% CI 0.95-0.99]), and cilostazol (HR 0.37 [95% CI 0.16-0.87]). Cilostazol administration reduced the risk of aspiration pneumonia in patients with CLTI undergoing EVT.

Factors Associated with Differences in Physicians' Attitudes toward Percutaneous Endoscopic Gastrostomy Feeding in Older Adults Receiving End-of-Life Care in Japan: A Cross-Sectional Study.

Although percutaneous endoscopic gastrostomy (PEG) placement is still widely practiced in Japan, studies from Western countries report that it is less beneficial for patients in end-of-life care with cognitive decline. Decisions regarding PEG placement are largely influenced by physician judgment. The aim of this study was to investigate the background and perceptions of Japanese physicians regarding PEG for older adults in end-of-life care and to identify the factors associated with differences in physician judgment regarding PEG. The study employed a cross-sectional design. A questionnaire on PEG for older adults in end-of-life care was sent to Japanese physicians. Logistic regression analysis was used to calculate the odds ratios (ORs) and confidence intervals (CIs) of the association between PEG recommendations and each factor. PEG placement was advised for bedridden patients and older adults with cognitive decline by 26% of the physicians who responded to the survey. Differences in physician perceptions of PEG feeding were associated with the recommendation for PEG, benefits of preventing aspiration pneumonia (OR: 4.9; 95% CI: 3.1-8.2), impact on post-discharge accommodation decisions (OR: 6.1; 95% CI: 1.9-30.9), and hesitancy to recommend a PEG placement (OR: 1.9; 95% CI: 1.3-4.5). Working in a facility with PEG placement (OR: 2.0; 95% CI: 1.2-3.5) was an associated background factor. Differences in Japanese physicians' attitudes toward using PEG feeding for older adults in end-of-life care were significantly associated with differences in their perceptions of the impact of PEG feeding and working in a facility with PEG placement.

Lack of Physician-Dentist Collaboration in Aspiration Pneumonia Prevention.

This opinion paper addresses the challenges and future directions for preventing aspiration pneumonia in Japan's rapidly aging population. It highlights the increasing proportion of elderly individuals and the associated rise in health issues like decreased swallowing function, a risk factor for aspiration pneumonia. The paper emphasizes the effectiveness of dentist-provided oral care in preventing this condition but notes the lack of collaboration between dentists and physicians in Japan's clinical practice. Key challenges identified include the scarcity of full-time hospital dentists, insufficient communication between physicians and dentists, limited patient understanding and motivation regarding oral care, and a lack of training in geriatric dentistry. The paper advocates for enhanced awareness among healthcare professionals and patients, increased hospital dentists, and improved collaboration mechanisms, particularly in light of recent positive changes in insurance reimbursement policies for elderly oral care.

Relationship Between Subjective Questionnaires and Videofluoroscopy of Dysphagia Evaluation: A Systematic Review and Meta-Analysis.

Early detection of dysphagia is important for preventing aspiration pneumonia. Although videofluoroscopy is currently the primary diagnostic tool for dysphagia, access to this tool may be limited because of radiation exposure risk, high cost, and other factors. In this study, a meta-analysis was used to determine the strength of the correlation between dysphagia detection outcomes obtained using subjective questionnaires and videofluoroscopy. The PubMed and Embase databases were searched for original articles up to December 2022. Studies published in English that used cross-sectional designs to assess the correlation between subjective questionnaires and videofluoroscopy were considered eligible for inclusion. The search terms used included "dysphagia," "questionnaire," and "videofluoroscopy." Two reviewers critically appraised and extracted the correlation coefficient r values. In addition, a random-effects meta-analysis was conducted. The Q statistic was used to assess the heterogeneity among the included studies. Publication bias was checked using the funnel plot and Egger's tests. Multilevel analysis was used to determine sensitivity to consider within-study correlations. In addition, subgroup analyses were conducted based on type of questionnaire, head and neck cancer, and English-speaking regions. The meta-analysis included five studies and 856 patients using the Eating Assessment Tool-10 and one study and 27 patients using the Sydney Swallow Questionnaire. The results of the random-effects meta-analysis showed a moderate relationship between the subjective questionnaires and videofluoroscopy ( r = .35, 95% CI [0.20, 0.48]). Similar results were also obtained using multilevel analysis ( r = .34, 95% CI [0.25, 0.42]). No publication bias was found for any of the studies ( p = .88). In the subgroup analyses, a moderate relationship between Eating Assessment Tool-10 and videofluoroscopy ( r = .31, 95% CI [0.19, 0.42]) and an ultrahigh relationship between Sydney Swallow Questionnaire and video-fluoroscopy ( r = .74, 95% CI [0.50, 0.87]) were found. Furthermore, moderate associations were observed within each head and neck cancer and English-speaking regions subgroup. However, no significant differences were found between these two subgroups. These results indicate the subjective questionnaires considered in this study share a moderate relationship with videofluoroscopy. Subjective questionnaires may be used as an auxiliary tool by nurses and homecare givers for the early assessment of dysphagia risk in patients.

Dysphagia in patients with severe COVID-19: a retrospective study

To investigate dysphagia after extubation in patients with severe coronavirus disease 2019 (COVID-19). We retrospectively examined patients with severe COVID-19 treated in our hospital between August 2021 and March 2022. Feeding outcomes were categorized into two groups—(1) total oral intake, and (2) difficulty in oral intake. To assess the feeding outcome, we used modified water-swallowing test (MWST) for all patients. However, in cases where aspiration or recurrent laryngeal nerve palsy was suspected, we conducted the fiberoptic endoscopic evaluation of swallowing after MWST. Patient data were collected from medical records. Forty-six patients with severe COVID-19 were included. Among the 46 patients, 14 (30.4%) experienced difficulties with oral intake. Older age, longer length of hospitalization, duration of mechanical ventilation, tracheostomy, diabetes, and higher serum levels of C-reactive protein (CRP) and procalcitonin (PCT) at the time of intubation were associated with difficulty in oral intake. The rate of difficulty with oral intake in patients with severe COVID-19 was 30.4%, which is not as high as reported in previous studies. Older age, longer duration of mechanical ventilation, tracheostomy, diabetes, and higher levels of CRP and PCT were associated with the prevalence of oral intake difficulty, suggesting that early attention should be paid to high-risk patients who have preexisting deterioration of swallowing function due to aging and comorbidities, or who have prolonged intubation or tracheostomy to prevent aspiration pneumonia.

Rhododendron poisoning in alpacas (Vicugna pacos) in Northern Germany

Poisoning is often suspected to be the origin of disease in South American camelids (SACs) by owners, but only in a few cases this assumption can be confirmed. In small ruminants, rhododendron poisoning is a common emergency for livestock veterinarians. However, this condition has rarely been reported in SACs so far. This paper provides information regarding clinical findings, hematology, clinical chemistry, and treatment of four alpacas after presumed intake of rhododendron leaves including pathological findings of one of the animals. Rhododendron leaves contain grayanatoxins that lead to hyperpolarization of excitable cells. Clinical signs that were observed in the presented alpacas comprised: salivation, dehydration, decreased motility of compartment 1, uncoordinated regurgitation, and cardiac arrhythmia. Clinical chemistry revealed that rhododendron poisoning was associated with metabolic acidosis and azotaemia, hyponatremia and hyperkalemia. Most striking macroscopic and histopathological findings included gastric ulceration, and renal infarcts along with inflammatory changes. Leaves of Rhododendron spp. were identified in the forestomach content of this animal. Affected animals were treated symptomatically as there is no specific antidote in rhododendron poisoning. This included parenteral rehydration, treatment of metabolic acidosis (infusion of sodium bicarbonate solution), and oral administration of activated charcoal to bind potential toxins. In addition, antibiotic treatment might be necessary to prevent aspiration pneumonia in case of uncoordinated regurgitation. Of the four animals, the worst affected alpaca was euthanized, one had minimal signs and two responded to supportive care and recovered. In conclusion, rhododendron poisoning might be fatal for alpacas in individual cases and therefore rhododendron bushes should not be placed in the habitat of SACs.

Placement of Nasogastric Tubes in Pancreaticoduodenectomy Patients: Switching from Immediate Intraoperative Removal to Avoiding Unnecessary Perioperative Use

BackgroundThe placement of nasogastric tubes (NGTs) in abdominal surgery has been adopted for decades to attenuate ileus and prevent aspiration pneumonia. In the recent era, the guidelines recommend not using NGT routinely, and even in pancreaticoduodenectomy (PD), immediate removal of NGT in operating rooms (ORs) was suggested. However, the clinical outcome and safety of abandoning NGT during the pre-PD and intra-PD periods remain unknown. MethodsWe conducted a single-center retrospective review on adult PD patients aged between 20 and 75 years from 2013 to 2022. The study population was grouped into the NGT group (NGT was placed before PD and immediately removed in the ORs) and the non-NGT group (NGT was not placed preoperatively). Safety was evaluated by the number of adverse events. The primary aim of this study is to evaluate the need of NGT insertion in ORs among PD patients. ResultsThe case numbers in the NGT and non-NGT groups were 391 and 578, respectively. No case in the non-NGT group needed the intraoperative insertion of NGT. The rate of pulmonary complications was 2.3% in the NGT group compared to 1.6% in the non-NGT group (P = 0.400). Furthermore, there were no significant differences in terms of rates of major complications (12.8% vs. 9.3%, P = 0.089) or mortality (1.0% vs. 1.0%, P =0.980) between the two groups. The rates of the postoperative insertion of NGT in the NGT and non-NGT groups were 2.6% and 2.8% (P = 0.840), respectively. ConclusionFor selected PD patients, the placement of NGT during pre-PD and intra-PD periods may be safely omitted. This primary study is considered the first foundation stone in the extension of the element of no NGT in PD.

Tracheostomy tube changes in patients with tracheostomy: A quality improvement project.

Tracheostomy tube changes are a considerable part of the management of patients with tracheostomy and are necessary for preventing aspiration pneumonia, especially in patients with long-term tracheostomy. The process of tracheostomy tube changes in many patients may not be timely, safe or efficient. The objectives were to implement a quality improvement intervention that reduces the incidence of aspiration pneumonia in patients with tracheostomy, improve staff knowledge about tracheostomy tube changes and improve staff adherence to documentation. A pre-post intervention design was used in this quality improvement project. We created a change strategy bundle that included identification of the need for and observation determination of the timing of tube changes timing, change assessments, identification of the person and location, preparation, co-operation and maintenance. A tracheostomy tube change workflow was also created. Then, the intervention was implemented in the clinic after staff training. The incidence of aspiration pneumonia, staff knowledge and staff adherence were compared before and after the intervention. Two hundred and 20 patients were enrolled (105 in the preintervention group; 115 in the postintervention group) with 88 tracheostomy tube change episodes (23 in the preintervention group; 65 in the postintervention group). Thirty-five staff members completed the training and surveys. The incidence of pneumonia decreased from 43.8% to 27.8% after the intervention (p = .013). The knowledge score of staff increased from 46.57 ± 11.10 to 88.14 ± 6.76, and the implementation rate of the audit increased to 67.32%-100%. This quality improvement project regarding tracheostomy changes reduced the incidence of pneumonia, increased staff knowledge about tracheostomy tube changes and improved staff adherence. A standardized tracheostomy tube change bundle, education, interprofessional collaboration and culture changes were important to ensure the best outcomes in this quality improvement project. These factors improved the timeliness, efficiency and safety of tracheostomy tube changes.

A caregiver based educational intervention study to prevent aspiration pneumonia in stroke patients at a tertiary hospital in Lusaka, Zambia

A caregiver based educational intervention study to prevent aspiration pneumonia in stroke patients at a tertiary hospital in Lusaka, Zambia

Factors affecting the number of bacteria in saliva and oral care methods for the recovery of bacteria in contaminated saliva after brushing: a randomized controlled trial

BackgroundOral care is important in preventing aspiration pneumonia in older adults. However, it is not clear what kind of oral care can reduce the number of bacteria in saliva. The purposes of this study are to clarify whether there is a relationship between plaque amounts and salivary bacterial counts, and how bacteria dispersed into the oral cavity by brushing can be reduced.MethodsFirst, saliva samples were collected from 10 healthy adult volunteers after 30 h of unbrushing and after thorough brushing, and the total bacterial count was determined by real-time PCR. Next, 40 older adults attending an outpatient dental clinic were randomly assigned into two groups: a wiping group (20 patients) and a mouthwashing group (20 patients). Saliva was collected before and after brushing, and after wiping in the wiping group and after mouthwashing in the mouthwashing group, and the total bacterial count was quantified by real-time PCR.ResultsIn a study of volunteers, there was no association between plaque amounts and salivary bacterial counts. In a study of older adult patients, salivary bacterial counts were significantly higher in patients with higher oral hygiene index and fewer remaining teeth. Brushing increased salivary bacterial counts. Wiping did not significantly reduce the number of bacteria, while mouthwash returned the increased number of bacteria after brushing to the pre-brushing level.ConclusionsThere is no direct relationship between the amount of plaque and the number of bacteria in saliva. Brushing disperses bacteria into the oral cavity, resulting in a marked increase in the number of bacteria in saliva. Wiping does not collect the dispersed bacteria, and it seems essential to rinse the mouth after brushing.Trial registrationUMIN000045854.

Recommendations of good practice to prevent aspiration pneumonia in older adults at risk of oropharyngeal dysphagia living in nursing homes: A modified e-Delphi study protocol.

Aspiration pneumonia (AP) is a subset of pneumonia caused by the aspiration of food and fluids to the lungs and is highly prevalent in the older population. Oropharyngeal dysphagia (OD) is one of the risk factors for AP and it is also associated with malnutrition, dehydration and poor functional outcomes. As pneumonia is the second most common infection in nursing homes (NHs) and OD represents a major concern to NH staff, good practices for the prevention of AP in older adults at risk of OD are needed. The aim of this modified e-Delphi study is to build consensus among a panel of experts regarding a set of recommendations for NH staff on good practices to prevent AP in older adults at risk of OD living in NHs. The objective of this paper is to establish the methodology inherent to the Delphi study. An online modified Delphi study will be developed in three rounds. Criteria for the Delphi panel participants include holding a master's or doctoral degree in OD or speech and language therapy; or having 10 or more years of experience in OD; or having at least one scientific publication related to OD. A previously described modified Delphi methodology will be used to achieve consensus (75% agreement). An additional round will be performed to collect the experts' perspectives regarding the priority for application of each recommendation previously validated. This protocol aimed to describe the methodology of a future Delphi study on the prevention of AP, seeking to fulfil the gap in the literature regarding this topic. The modified Delphi technique is a widely used method for collecting experts' opinion in health sciences, but the absence of standardised guidelines allows some heterogeneity between studies with the same aim. What is already known on the subject Aspiration pneumonia (AP) is related to three main risk factors: impaired safety of swallow, impaired nutritional status and poor oral health. It is known that being dependent for feeding is one of the main risk factors for AP and around 50% of nursing home (NH) residents need feeding assistance. Thus, it is important to promote specialised intervention and care by the NH staff for preventing AP. What this paper adds to existing knowledge It is hypothesised that increasing the knowledge of NH staff regarding the best practices for preventing AP in older adults at risk of oropharyngeal dysphagia (OD) will improve outcomes such as quality of life, incidence of AP and mortality. What are the potential or actual clinical implications of this work? The recommendations resulting from this study will address a current gap in healthcare practice of NH staff regarding older adults at increased risk for OD and, consequently, for AP.

Systematic review on the prevention of aspiration pneumonia in the elderly

Systematic review on the prevention of aspiration pneumonia in the elderly

Antibacterial Effect of Alcohol-free Oral Rinses on Aspiration Pneumonia-inducing Microorganisms

Objectives: This study aimed to evaluate the antimicrobial effects of several commercial alcohol-free oral rinses on aspiration pneumonia‑inducing microorganisms. Methods: The experimental products of three commercial oral rinses (Caregargle, Listerine [coolmint mild], and Garglin [zero]) were selected for the evaluation of antimicrobial effect. Hexamedine and sterile distilled water were used as positive and negative controls, respectively. Four pneumonia‑causing microorganisms and Streptococcus mutans were treated with the experimental oral rinses for one minute, and the live cells were counted as colony-forming units (CFUs). For statistical analysis, one-way ANOVA and Tukey’s hoc test were performed using SPSS version 26.0. Results: Hexamedine and Listerine (coolmint mild) exhibited the highest antibacterial effects against all microorganisms. Caregargle and Garglin (zero) showed comparatively lower antibacterial effects than did Listerine (coolmint mild) and Hexamedine. Conclusions: Hexamedine and Listerine (coolmint mild) displayed significant antimicrobial effects on aspiration pneumonia‑inducing microorganisms. These findings suggest that Hexamedine and Listerine (coolmint mild) products for oral care in hospitalized patients or older adults may be effective in preventing aspiration pneumonia.

797 Short-Term Review of the Presentations and Outcomes of Vocal Fold Palsy Cases Identified at a Large DGH

Abstract Aim Due to the convoluted course of the recurrent laryngeal nerves, vocal cord palsy can be a manifestation of pathologies that cross multiple surgical and medical specialties. The primary role of the vocal folds is that of airway protection. Therefore, it is important that all relevant clinicians understand this clinical scenario in order to prevent aspiration pneumonia in their patients. Method We reviewed eight months of referrals and diagnoses of patients with vocal cord paresis or palsy. This was in the setting of a tertiary Head &amp; Neck service within a large DGH. We assessed the aetiology, management, and outcome of these cases. Results Eleven new cases were identified over the course of eight months. One was due to intrathoracic vascular pathology; one breast cancer; two from head &amp; neck cancer; one bilateral palsy due to upper-GI cancer surgery; four from thyroid-related pathology; one lung cancer; and one idiopathic. To date, ten of eleven cases appear permanent in nature. One patient underwent in-clinic injection laryngoplasty. Two patients (18%) died within six months of diagnosis, both predictable deaths based on baseline pathology. Conclusions Our experience demonstrated the relevance of ENT (Head &amp; Neck), Vascular, Breast, Upper-GI and Thoracic surgeons as well as medical colleagues in Endocrinology, Respiratory Medicine, and Rheumatology. We present diagnostic and management strategies to help surgical trainees across the specialties identify, manage, and refer patients to prevent complication, improve quality of life and provide access to relatively novel procedures such as awake (local anaesthetic) injection laryngoplasty.

Swallowing sound evaluation using an electronic stethoscope and artificial intelligence analysis for patients with amyotrophic lateral sclerosis.

Non-invasive, simple, and repetitive swallowing evaluation is required to prevent aspiration pneumonia in neurological care. We investigated the usefulness of swallowing sound evaluation in patients with amyotrophic lateral sclerosis (ALS) using our new electronic stethoscope artificial intelligence (AI) analysis tool. We studied patients with ALS who provided written informed consent. We used an electronic stethoscope, placed a Bluetooth-enabled electronic stethoscope on the upper end of the sternum, performed a 3-mL water swallow three times, and remotely identified the intermittent sound components of the water flow caused at that time by AI, with the maximum value as the swallowing sound index. We examined the correlation between the swallowing sound index and patient background, including swallowing-related parameters. We evaluated 24 patients with ALS (age 64.0 ± 11.8 years, 13 women, median duration of illness 17.5 months). The median ALS Functional Rating Scale-Revised (ALSFRS-R) score was 41 (minimum 18, maximum 47). In all cases, the mean swallowing sound index was 0.209 ± 0.088. A multivariate analysis showed that a decrease in the swallowing sound index was significantly associated with a low ALSFRS-R score, an ALSFRS-R bulbar symptom score, % vital capacity, tongue pressure, a Mann Assessment of Swallowing Ability (MASA) score, and a MASA pharyngeal phase-related score. Swallowing sound evaluation using an electronic stethoscope AI analysis showed a correlation with existing indicators in swallowing evaluation in ALS and suggested its usefulness as a new method. This is expected to be a useful examination method in home and remote medical care.

Viscosity Measurement Results of a Commercially Available Universal Design Food (UDF: Can be Crushed with the Longue) using the Line Spread Test (LST)

In Japan, which is a super-aged society, people need the nursingcare foods in recent years.For the prevention of aspiration pneumonia, there is a demand for safe and delicious nursing care foodfor not only patients but also senior citizen. To create food for swallowing that can be easily prepared even at ordinary homes, among the previous studies that have already been reported, using a type of universal design food,but that can be crushed with the tongue, for which the results have not yet been shown, is suitable or not for nursing care food is not sure. To obtain theviscosity, we investigated using eight types of thickeners and reported them.After adding 1 g, 2 g, and 3 g of each of the eight types of thickeners to commercially available shrimp gratin, a line spread test (LST) was performed using a superficial thickness measuring plate (manufactured by Saraya Co., Ltd.). As a result, by adding 1 g, it was possible to obtain a thick viscosity of 30 mm or more and less than 32 mm, which is thought to promote safe swallowing. Eight kinds of thickeners are commercially available products containing xanthan gum, among which the thickener containing xanthan gum, calcium lactate, and trisodium citrate showed the highest viscosity. In the future, it will be necessary to investigate the effects of thickeners on universal design foods (UDF) that can be crushed with the tongue and have different nutritional values.

Association between Anterior Surgical Approach and Dysphagia Severity in Patients with Cervical Spinal Cord Injury.

Early detection and management of dysphagia are essential for preventing aspiration pneumonia and reducing mortality in patients with cervical spinal cord injury (C-SCI). In this study, we identified risk factors for dysphagia in patients with C-SCI by analyzing the correlation between the clinical factors and the severity of dysphagia, not the presence or absence of dysphagia. Combined with the analysis results of previous studies, we thought that this additional analysis method could more accurately reveal the risk factors for dysphagia in patients with C-SCI. The presence and severity of dysphagia in patients with C-SCI was evaluated using a modified videofluoroscopic dysphagia scale (mVDS) and penetration-aspiration scale (PAS). All included patients with C-SCI performed a video fluoroscopic swallowing study (VFSS). Clinical factors such as age, sex, the presence of tracheostomy, spinal cord independence measure (SCIM), pulmonary function test (PFT), including forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FVC/FEV1, maximal inspiratory pressure (MIP), and maximal expiratory pressure (MEP), American Spinal Cord Injury Association (ASIA) score, Berg Balance Scale (BBS), and operation method were investigated. In the multivariate regression analysis, the anterior surgical approach was the only clinical factor that had a significant correlation in both mVDS and PAS, which represents the severity of dysphagia in C-SCI patients (p < 0.05). The anterior surgical approach was correlated with the severity of dysphagia in patients with C-SCI. Considering this, as one of the risk factors affecting dysphagia in patients with C-SCI, surgical method may also need to be considered. Additionally, we recommend that clinicians should pay particular attention to the potential for development of dysphagia in patients who received anterior cervical surgery. However, further prospective studies with larger sample sizes are needed for more accurate generalization.

Intervention to Prevent Aspiration Pneumonia in the Elderly

Intervention to Prevent Aspiration Pneumonia in the Elderly