Clinical factors predicting risk for aspiration and respiratory aspiration among patients with Stroke

Abstract

Objective: to investigate the association of risk factors with the Risk for aspiration nursing diagnosis and respiratory aspiration. Method: cross-sectional study assessing 105 patients with stroke. The instrument used to collect data addressing sociodemographic information, clinical variables and risk factors for Risk for aspiration. The clinical judgments of three expert RNs were used to establish the diagnosis. The relationship between variables and strength of association using Odds Ratio (OR) was verified both in regard to Risk for aspiration and respiratory aspiration. Results: risk for aspiration was present in 34.3% of the patients and aspiration in 30.5%. The following stood out among the risk factors: Dysphagia, Impaired or absent gag reflex, Neurological disorders, and Impaired physical mobility, all of which were statistically associated with Risk for aspiration. Note that patients who develop such a diagnosis were seven times more likely to develop respiratory aspiration. Conclusion: dysphagia, Impaired or absent gag reflex were the best predictors both for Risk for aspiration and respiratory aspiration.

Associação entre escalas de avaliação de funcionalidade e severidade da disfagia pós-acidente vascular cerebral

“…In the present study, the incidence of dysphagia found, considering the factor of VCA presence, was of 94%, according to the classification of the DOSS (7) scale, corroborating the incidence studies. The predominance regarding age above 70 years and occurrence of VCA in individuals of male gender found in this study is pertinent to the one found in literature (12)(13)(14)(15)(16) . The speech-language pathologist follow up on the dysphagia patient requires the discussion with the multi professional team regarding the indication of indirect therapies (without food introduction) or direct (with the use of food), related to the releasing moment of the oral intake in a systematic way, the indication of full oral intake diet, with the possibility of weaning of the alternative feeding intake.…”

“…Among the neurologic diseases, VCA is the one with the highest incidence of dysphagia, with a profile of incidence between 30% and 96%, depending on the study method for this variation. The factors considered are injury time, location and range of the cerebral injury, type of VCA and the diagnostic method of the deglutition disorder (11)(12)(13) . In the present study, the incidence of dysphagia found, considering the factor of VCA presence, was of 94%, according to the classification of the DOSS (7) scale, corroborating the incidence studies.…”

“…The lack or presence of aspiration has been one of the video fluoroscopic signals of higher relevance, being this signal essential for decision making at the management of oral food intake and for the indication of the most adequate consistency in each case (9)(10)(11)(12)(13)(14)(15)(16)(17) . The aspiration incidence in VCA neurogenic dysphagia framework is described in studies between 155 and 50% (18,19) .…”

Diagnósticos de enfermagem em pós-operatório de neurocirurgia

“…It is noteworthy that, in the study, an association was found between the risk factor Neurological disorders and the nursing diagnosis Aspiration risk, however, these ND behaved as a protective factor. 30 The diagnoses related to impaired physical mobility and risk of constipation, mentioned in this study, were related to the prescribed restriction of movement, considering, specifically in the case of aneurysm, that the patient should remain at absolute rest in order to avoid rebleeding and, consequently, , rest can make peristalsis difficult, leading to constipation.…”

Poor consistency in evaluating South African adults with neurogenic dysphagia

“…As many as 50% of participants never or seldom utilised gag reflex testing, and only 18.4% of participants assessed it frequently. There is varying clinical usefulness of this clinical component in the literature, and thus it seems speech-language therapists are using it as they see fit (McCullough et al, 2005 ; Oliveira et al, 2015 ). Other reasons for poor use were that it was uncomfortable for the patient and that the doctor assessed it.…”