Promoting safe swallowing when puree is swallowed without aspiration but thin liquid is aspirated: nectar is enough.
The use of thickened liquids is a common compensatory strategy to improve swallow safety. The purpose of this study was to determine the optimal liquid viscosity to use to promote successful swallowing in a specific subset of dysphagic patients who swallow puree without aspiration but thin liquid with aspiration. A referral-based sample of 84 consecutive inpatients from a large, urban, tertiary-care teaching hospital who met the study criteria was analyzed prospectively. Inclusion criteria were no preexisting dysphagia, a successful pharyngeal swallow without aspiration with puree consistency but pharyngeal dysphagia with aspiration of thin liquid consistency, and stable medical, surgical, and neurological status at the time of transnasal fiberoptic swallow testing and up to 24 h after recommendations for oral alimentation with a modified diet consisting of nectar-like and honey-like thickened liquids. Success with ingesting both nectar-like and honey-like thickened liquids and clinically evident aspiration events were recorded. Care providers were blinded to the study's purpose. All 84 patients were successfully ingesting nectar-like and honey-like thickened liquids at the time of swallow testing and up to 24 h after testing. A specific subset of dysphagic patients who swallowed puree without aspiration but aspirated thin liquid demonstrated 100 % successful swallowing of both nectar-like and honey-like thickened liquids. Therefore, a nectar-like thickened liquid appears to be adequate to promote safe swallowing in these patients and, because of patient preference for the least thick liquid, may enhance compliance and potentially contribute to maintenance of adequate hydration requirements.
Section of Otolaryngology, Department of Surgery, Yale University School of Medicine, P.O. Box 208041, New Haven, CT 06520-8041, USA. steven.leder@yale.edu
Steven B
SB
Leder
Benjamin L
BL
Judson
Edward
E
Sliwinski
Lindsay
L
Madson
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003680:Deglutition Disorders / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005526:Food, Formulated; D006801:Humans; D008297:Male; D008875:Middle Aged; D019875:One-Carbon Group Transferases; D011446:Prospective Studies; D053120:Respiratory Aspiration / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome; D014783:Viscosity
D019875:One-Carbon Group Transferases