A Randomized Controlled Trial to Investigate the Effectiveness of the Prevention of Aspiration Pneumonia Using Recommendations for Swallowing Care Guided by Ultrasound Examination

Abstract

Prevention for aspiration pneumonia requires assessment of aspiration and adequate swallowing care. This randomized controlled trial aimed to investigate the effectiveness of ultrasound examination and recommendations for swallowing care for the reduction of aspiration and pharyngeal post-swallow residue as compared with standard swallowing care. Twenty-three participants were randomized to the intervention group and 23 to the control group. The intervention consisted of four ultrasound examinations during mealtimes and recommendations for swallowing care every 2 weeks during an 8 week period. No recommendations concerning swallowing care based on ultrasound examinations were provided to the control group. The frequency of aspiration or residue was defined as x/y × 100% when aspiration or residue were detected x times from y times concerning the total ultrasound measurements. The proportion of the residents with reduced frequency of aspiration which was detected by ultrasonography at eight weeks were 4.3% in the intervention group and 0% in the control group. The median reduction in the frequency of aspiration and residue in the intervention group was 31%, and that in the control group was 11%. In conclusion, swallowing care guided by frequent ultrasound examinations during mealtimes had a trend of reducing the frequency of aspiration and residue during an 8-week period in individuals relative to standard swallowing care alone.

Diagnostic accuracy of ultrasound examination in detecting aspiration and pharyngeal residue in patients with dysphagia: A systematic review and meta‐analysis

“…In the specific RCT, the intervention group that introduced the cough reflex test did not show any significant difference in the incidence rate of pneumonia compared to the control group. This result is in agreement with the findings from another RCT that evaluated the effectiveness of ultrasound examinations (Miura et al, 2018). In the RCT, the odds ratios of the frequency of aspiration, the frequency of pharyngeal residue, and the incidence of aspiration pneumonia were 0.30 (95% CI: 0.03–3.15), 0.63 (95% CI: 0.10–4.21), and 2.09 (95% CI: 0.18–24.87), respectively.…”

“…If clinical professionals suspect individual aspiration or pharyngeal residue from their symptoms, such as coughing, wet voice, and delayed swallowing, they can perform ultrasound examination to visualize the aspirated bolus and pharyngeal residue. Moreover, a randomized controlled trial (RCT) that applied recommendation of swallowing care based on ultrasound examinations during mealtimes showed a trend of reducing the frequency of aspiration and residue in the intervention group (Miura et al, 2018). This clearly suggests that ultrasound assessments can serve to detect aspiration and pharyngeal residue and contribute to the prevention of aspiration pneumonia; however, this method requires skill to obtain and to evaluate the images.…”

Assessment of swallowing function and muscle using ultrasonography in general and family medicine

“…The sensitivity of detecting pharyngeal residue in the epiglottic vallecula was 86.7%, and the specificity was 63.6% . Moreover, swallowing care guided by frequent ultrasound examinations during mealtimes had a trend of reducing the frequency of aspiration and residue in a randomized controlled trial . Therefore, ultrasonography should be used to assess swallowing function in clinical practice.…”

Effectiveness of Swallowing Care on Safe Oral Intake Using Ultrasound-Based Observation of Residues in the Epiglottis Valley: A Pragmatic, Quasi-Experimental Study

“…Although ultrasound observation is not a diagnostic measure, it is useful to screen out risk of aspiration and residue and to guide swallowing care for preventing these outcomes. Our previous study [13] demonstrated the efficacy of recommendations for swallowing care utilizing the guide by ultrasound observation. Nevertheless, this study has some shortcomings.…”

“…Also, patients often refuse to receive VFSS because of pain and discomfort due to the insertion of an endoscope in the patient's nose. Therefore, nurses have some difficulties providing swallowing care because correct information is lacking about the patient's swallowing function more than 1 month until physicians perform VESS or VFSS [13].…”