Preventing Aspiration Pnemonia in Patients with Dysphasia Jess A. BS-SL, Yen D., Brando G., John K.

Background Dysphagia is a significant problem in patients in the United States today and poses a distinct risk for causing aspiration pneumonia (AHRQ, 2009).  Two methods that have been researched to prevent aspiration include using the chin- down method and the use of liquid thickeners (AHRQ, 2009).

Purpose The purpose of our literature review is to compare the effectiveness of the chin down and liquid thickener feeding methods in avoiding the development of aspiration pneumonia in patients with dysphagia. 

Methods of search Database searched: EBSCOhost Article research: Retrieved: 32  Read: 19 Used: 9 Key words: dysphagia, aspiration pneumonia, chin-down, liquid thickener Elimination & selection techniques: Time period, scanning, quan. vs qual., peer- reviewed, research relevance

Method of organization How did you categorize your L.R. articles? Treatment options (chin-down vs liquid thickeners) Liquid viscosity

Findings: Compare & Contrast of Chin-down method Logemann et al. (2008), found the chin-down method less effective. Terre & Mearin (2012)  found that only about 55% of patients were successful when using the chin-down method. Robbins et al. (2008) also assessed the effectiveness of the chin-down method, but the results were not conclusive. Sakuma & Kida (2010) found that the chin- down position widens the vallecula epiglottica and narrows the laryngeal vestibule, resulting in a reduction in laryngeal penetration and aspiration.

Findings: Compare & Contrast of Liquid Thickener Logemann et al. (2008), Leder et al. (2012). & Diniz et al. (2009) found the liquid thickeners to be more effective in preventing aspiration . Leder et al. (2012) determined that the nectar-like thickened liquids would be the best option, since they are less thick and still produce a pass rate of 100%. Diniz et al. (2009) Aspiration occurred in only 3 patients (4.9%) with the spoon-thick consistency vs 24 patients (39.3%) with the liquid consistency.

Findings: Gaps The study discovered that numerous healthcare providers were not preparing the liquids according to the instructions (Garcia et al., 2010). Further education was needed on how to prepare the liquids correctly. Having too thick or too thin of a liquid could be detrimental.

Findings: Summary Overall, while the chin-down method appears to be somewhat helpful in preventing aspiration pneumonia, it is not the most effective way. Liquid thickeners were found to be most effective in preventing aspiration.

References DeFabrizio, M.E. & Rajappa, A. (2010). Contemporary approaches to dysphagia management. The Journal for Nurse Practitioners (6) 8, 622–630. Diniz, P., Vanin, G., Xavier, R., & Parente, M. (2009). Reduced incidence of aspiration with spoon-thick consistency in stroke patients. Nutrition In Clinical Practice, 24(3), 414-418. doi:10.1177/0884533608329440 Garcia, J.M., Chambers IV, E., Clark, M., Helverson, J., & Matta, Z. (2010). Quality of care issues for dysphagia: Modifications involving oral fluids. Journal of Clinical Nursing, 19, 1618-1624. doi: 10.1111/j.1365- 2702.2009.03009.x. Leder, S.B., Judson, B.L., Sliwinski, E., & Madson, L. (2012). Promoting safe swallowing when puree is swallowed without aspiration but thin liquid is aspirated: Nectar is enough. Dysphagia, 28, 58-62. doi: 10.1007/s00455- 012-9412-2. Logemann, J.A., Gensler, G., Robbins, J., Lindblad, A.S., Hind, J.A., Kosek, S.,  … Gardner, P.J. M. (2008). A randomized study of three interventions for aspiration of thin liquids in patients with Dementia or Parkinson’s disease. Journal of Speech, Language, and Hearing Research, 51, 173-183. doi: 10.1044/1092-4388. Nicholson, T. M., Torley, P. J., & Cichero, J. Y. (2008). The measurement of thickened liquids used for the management of dysphagia. American Institute of Physics. Conference Proceedings, 1027(1), 627-629. doi:10.1063/1.2964788 Robbins, J., Gensler, G., Hind, J., Logemann, J.A., Lindblad, A.S., Brandt, D., … Gardner, P.J.M. (2008). Comparison of 2 interventions for liquid aspiration on pneumonia incidence. Annals of Internal Medicine, 148, 509-518. Sakuma, T., & Kida, I. (2010). Relationship between ease of swallowing and deglutition-related muscle activity in various postures. Journal of Oral Rehabilitation, 37(8), 583-589. doi:10.1111/j.1365-2842.2010.02084.x Terre, R., & Mearin, F. (2012). Effectiveness of chin-down posture to prevent tracheal aspiration in dysphagia secondary to acquired brain injury: A videofluoroscopy study. Neurogastroenterol Motility, 24, 414-e206. doi:10.1111/j.1365-2982.2011.01869.x.