Pilot study of 12-month outcomes of nursing home patients with aspiration on videofluoroscopy

Croghan, John E.; Burke, Elizabeth; Caplan, Sharon; Denman, Susan

doi:10.1007/bf00341256

Cited by 140 publications

(73 citation statements)

References 8 publications

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“…Tube feeding is generally implemented for patients who are severely dysphagic, debilitated, or malnourished and are unable to sustain their caloric and nutritional needs on an oral diet. In our study, tube feeding was significantly associated with aspiration pneumonia, which is consistent with the findings of others [19,28,[31][32][33][34]38,40]. Because our patients were usually not taking any food or liquid by mouth, aspiration presumably occurred with secretions.…”

Section: Variables Significantly Associated With Aspiration Pneumoniasupporting

confidence: 92%

“…Since dysphagia predisposes to aspiration, the relationship between dysphagia and aspiration pneumonia might appear obvious, but evidence for this has not always been found [31][32][33]. In fact, several studies of tube-fed patients who are taking no food or liquid by mouth have shown that tube feeding is associated with a higher rate of pneumonia than in patients who are eating [19,23,28,30,31,33,34]. A large body of literature has focused on the association between gastroesophageal reflux and aspiration [18,[35][36][37][38][39][40][41][42].…”

mentioning

confidence: 99%

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Predictors of Aspiration Pneumonia: How Important Is Dysphagia?

et al. 1998

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Aspiration pneumonia is a major cause of morbidity and mortality among the elderly who are hospitalized or in nursing homes. Multiple risk factors for pneumonia have been identified, but no study has effectively compared the relative risk of factors in several different categories, including dysphagia. In this prospective outcomes study, 189 elderly subjects were recruited from the outpatient clinics, inpatient acute care wards, and the nursing home care center at the VA Medical Center in Ann Arbor, Michigan. They were given a variety of assessments to determine oropharyngeal and esophageal swallowing and feeding status, functional status, medical status, and oral/dental status. The subjects were followed for up to 4 years for an outcome of verified aspiration pneumonia. Bivariate analyses identified several factors as significantly associated with pneumonia. Logistic regression analyses then identified the significant predictors of aspiration pneumonia. The best predictors, in one or more groups of subjects, were dependent for feeding, dependent for oral care, number of decayed teeth, tube feeding, more than one medical diagnosis, number of medications, and smoking. The role that each of the significant predictors might play was described in relation to the pathogenesis of aspiration pneumonia. Dysphagia was concluded to be an important risk for aspiration pneumonia, but generally not sufficient to cause pneumonia unless other risk factors are present as well. A dependency upon others for feeding emerged as the dominant risk factor, with an odds ratio of 19.98 in a logistic regression model that excluded tube-fed patients.

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Section: Variables Significantly Associated With Aspiration Pneumoniasupporting

confidence: 92%

mentioning

confidence: 99%

Predictors of Aspiration Pneumonia: How Important Is Dysphagia?

et al. 1998

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“…Although feeding recommendations based on VSS have been shown to decrease lower respiratory tract infections in acutely brain-injured adults with dysphagia [30], findings in other studies have suggested that VSS may have an unacceptable false-negative rate in predicting those who will progress to have aspiration pneumonia [32,33]. The reliability of VSS is also variable.…”

Section: Diagnostic Proceduresmentioning

confidence: 99%

Advances in the diagnosis and management of chronic pulmonary aspiration in children

Boesch

Daines

Willging

et al. 2006

European Respiratory Journal

158

141

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Chronic pulmonary aspiration (CPA) in children is an important cause of recurrent pneumonia, progressive lung injury, respiratory disability and death. It is sporadic, intermittent and variable, and often occurs in children with complicated underlying medical conditions and syndromes that produce symptoms indistinguishable from CPA. For most types of aspiration there is no gold-standard diagnostic test. The diagnosis of CPA is currently made clinically with some supporting diagnostic evaluations, but often not until significant lung injury has been sustained. Despite multiple diagnostic techniques, the diagnosis or exclusion of CPA in children is challenging. This is of particular concern given the outcome of unrecognised progressive lung injury and the invasiveness of definitive therapies.Although new techniques have been introduced since the 1990s and significant advances in the understanding of dysphagia and gastro-oesophageal reflux have been made, characterisation of the aspirating child remains elusive.

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“…2 The clinical setting in which pneumonia develops largely distinguishes aspiration pneumonia from other forms of pneumonia.…”

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confidence: 99%