Evidence-Based Measures for Preventing Aspiration Pneumonia in Patients with Dysphagia

Abstract

Dysphagia increases the risk of aspiration pneumonia with resultant morbidity and recurrent hospital admissions. With a rapidly ageing population and an increasing complex chronic disease burden, the prevalence of patients with dysphagia will increase. Family physicians will encounter more patients with dysphagia in various practice settings of primary, intermediate long term care and tertiary settings. We conducted a comprehensive literature review on the latest established evidence on measures to prevent aspiration pneumonia in patients with dysphagia. We found that many studies involved only small numbers of patients and lacked the methodological quality of well-conducted randomised contolled trials. Interventions that showed strongest evidence in preventing aspiration pneumonia were good oral health and the use of Angiotensin Converting Enzyme (ACE) inhibitor. We have provided a summary of key recommendations for family physicians, based on the Scottish Intercollegiate Guidelines Network (SIGN) framework in order to reflect the latest evidence-based strategies on measures to prevent aspiration pneumonia in patients with dysphagia.

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“…Current evidence‐based literature has shown that tube feeding has not been proven to reduce aspiration; in fact, the decision to perform tube feeding placement should aim to improve patients' nutritional status, rather than to reduce aspiration risk (Tay et al . ). Furthermore, a Cochrane review did not show different aspiration risk when comparing nasogastric tube vs. percutaneous endoscopic gastrostomy (Tay et al .…”

“…Furthermore, a Cochrane review did not show different aspiration risk when comparing nasogastric tube vs. percutaneous endoscopic gastrostomy (Tay et al . ). The pros and cons of gastrostomy tube placement therefore should be discussed thoroughly with the patients' family members or caretakers: although the procedure may improve the patient's quality of life, there may be unintended complications.…”

“…Good oral hygiene and the use of angiotensin‐inhibiting enzyme inhibitors showed the strongest supporting evidence to prevent aspiration pneumonia (Tay et al . ). We recommend treating physicians to have a low threshold to obtain speech pathology consultation when patients are hospitalised.…”

“…Contrary to a common belief, two large studies in general patients with severe ID indicated that the presence of tube feeding increased mortality (Eyman et al 1993;Kastner et al 1994;Strauss et al 1997). Current evidence-based literature has shown that tube feeding has not been proven to reduce aspiration; in fact, the decision to perform tube feeding placement should aim to improve patients' nutritional status, rather than to reduce aspiration risk (Tay et al 2014). Furthermore, a Cochrane review did not show different aspiration risk when comparing nasogastric tube vs. percutaneous endoscopic gastrostomy (Tay et al 2014).…”

“…Current evidence-based literature has shown that tube feeding has not been proven to reduce aspiration; in fact, the decision to perform tube feeding placement should aim to improve patients' nutritional status, rather than to reduce aspiration risk (Tay et al 2014). Furthermore, a Cochrane review did not show different aspiration risk when comparing nasogastric tube vs. percutaneous endoscopic gastrostomy (Tay et al 2014). The pros and cons of gastrostomy tube placement therefore should be discussed thoroughly with the patients' family members or caretakers: although the procedure may improve the patient's quality of life, there may be unintended complications.…”