Videofluoroscopic evidence of aspiration predicts pneumonia and death but not dehydration following stroke

Abstract

In order to assess the risk of pneumonia, dehydration, and death associated with videofluoroscopic evidence of aspiration following stroke, the clinical records of 26 patients with aspiration and 33 randomly selected, case-matched, dysphagic controls without videofluoroscopic evidence of aspiration were reviewed. The videofluoroscopic modified barium swallow technique included 5 ml-thin and thick liquid barium, 5 ml barium pudding, and 1/4 cookie coated with barium, plus additional 20 and 30 ml of thin liquid barium. Patients were assessed a mean of 2 +/- 1 SD months poststroke and were followed for a mean of 16 +/- 8 SD months poststroke. The odds ratio for developing pneumonia was 7.6 times greater for those who aspirated any amount of barium irrespective of its consistency (p = 0.05). The odds ratio for developing pneumonia was 5.6 times greater for those who aspirated thickened liquids or more solid consistencies compared with those who did not aspirate, or who aspirated thin liquids only (p = 0.06). Dehydration was unrelated to the presence or absence of aspiration. The odds ratio for death was 9.2 times greater for those aspirating thickened liquids or more solid consistencies compared with those who did not aspirate or who aspirated thin liquids only (p = 0.01). Aspiration documented by modified videofluoroscopic barium swallow technique is associated with a significant increase in risk of pneumonia and death but not dehydration following stroke.

Tracheobronchial aspiration of gastric contents in critically ill tube-fed patients: Frequency, outcomes, and risk factors

“…This finding clearly indicates the significant impact of aspiration on pneumonia. A connection between aspiration and pneumonia has also been reported by other investigators (10,26,27). Among other risk factors for pneumonia identified in our study were a high sedation level, a low backrest elevation, and use of paralytics.…”

Nosocomial Pneumonia After Acute Stroke

“…Both are often associated with impaired consciousness and are believed to have a cumulative effect on the deterioration of swallowing with a high frequency of aspiration. 33 Several studies have shown that swallowing difficulties and aspiration are common within 2 weeks after stroke 34,35 and are of pathogenetic relevance for the development of pneumonia in these patients. 36 However, it should be noted that dysphagia and aspiration are not limited to vertebrobasilar or bilateral hemispheric stroke but may also be present after unilateral hemispheric infarction.…”

Does a Water Protocol Improve the Hydration and Health Status of Individuals with Thin Liquid Aspiration Following Stroke? A Randomized Controlled Trial

“…There has been growing concern, however, about the blanket prescription of thickened liquids for a number of reasons: (i) not all who aspirate thin liquids will develop pneumonia and prescription of modified diets can be unnecessarily restrictive [9,10]; (ii) patients may not like drinking thickened liquids and are, therefore, frequently non-compliant [11][12][13]; (iii) there is a potential for increased aspiration risk of thickened liquids postswallow due to pharyngeal residue [14][15][16]; (iv) there is an increased risk of developing pneumonia or of dying if an individual aspirates thickened fluids or more solid substances as compared with thin fluids making the diagnostic process even more critical [17] and (v) there is limited empirical evidence of the medical effectiveness of fluid viscosity modification in terms of chest infection, nutritional status, hydration and mortality [14,18,19]. By far the greatest concern about thickened liquid prescription is that individuals with dysphagia do not consume enough fluids.…”