Aspiration pneumonia primary prevention: Difference between revisions
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==Primary Prevention== | ==Primary Prevention== | ||
A number of interventions (eg, positioning, dietary changes, drugs, oral hygiene, tube feeding) have been proposed to prevent aspiration, especially in older adult patients and stroke patients: | |||
●Percutaneous endoscopic gastrostomy tubes and nasogastric tubes are more efficient for delivering nutrition and oral medications in patients with dysphagia but have not been shown to reduce the incidence of aspiration pneumonia [14-16]. | |||
●In a small study of mechanically ventilated patients, aspiration into the bronchi was less likely in patients in the semi-recumbent (45 degree) position compared with those who were supine [17]. Nevertheless, a subsequent systematic review of randomized controlled trials of such measures found insufficient data to assess effectiveness [18]. | |||
●A subsequent randomized trial compared chin-down position and oral feedings of two consistencies (nectar thickened or honey thickened) on the incidence of aspiration as assessed by videofluorography in 711 patients with dementia or Parkinson disease [19]. Significantly more patients aspirated on thin liquids using the chin-down posture (68 percent) than when using nectar-thickened liquids (63 percent) or honey-thickened liquids (53 percent). However, a separate report evaluating the incidence of pneumonia at three months in a subset of 515 patients found no significant difference between the two groups (9.8 versus 11.6 percent) [20]. There was no control group, so one cannot determine if the interventions were effective. | |||
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A randomized trial sought to determine whether a multicomponent strategy (including manual tooth/gum brushing plus 0.12% chlorhexidine oral rinse twice daily plus upright positioning during feeding) could reduce the incidence of pneumonia in nursing home residents compared with usual care, but the trial was terminated for futility [21]. It might have been difficult to detect a difference between the groups since upright positioning during feeding is practiced routinely in nursing homes [22], and oral hygiene is also a common part of usual nursing home care. | |||
Revision as of 14:34, 23 March 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
There are no established measures for the primary prevention of [disease name].
OR
There are no available vaccines against [disease name].
OR
Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].
OR
[Vaccine name] vaccine is recommended for [patient population] to prevent [disease name]. Other primary prevention strategies include [strategy 1], [strategy 2], and [strategy 3].
Primary Prevention
A number of interventions (eg, positioning, dietary changes, drugs, oral hygiene, tube feeding) have been proposed to prevent aspiration, especially in older adult patients and stroke patients:
●Percutaneous endoscopic gastrostomy tubes and nasogastric tubes are more efficient for delivering nutrition and oral medications in patients with dysphagia but have not been shown to reduce the incidence of aspiration pneumonia [14-16].
●In a small study of mechanically ventilated patients, aspiration into the bronchi was less likely in patients in the semi-recumbent (45 degree) position compared with those who were supine [17]. Nevertheless, a subsequent systematic review of randomized controlled trials of such measures found insufficient data to assess effectiveness [18].
●A subsequent randomized trial compared chin-down position and oral feedings of two consistencies (nectar thickened or honey thickened) on the incidence of aspiration as assessed by videofluorography in 711 patients with dementia or Parkinson disease [19]. Significantly more patients aspirated on thin liquids using the chin-down posture (68 percent) than when using nectar-thickened liquids (63 percent) or honey-thickened liquids (53 percent). However, a separate report evaluating the incidence of pneumonia at three months in a subset of 515 patients found no significant difference between the two groups (9.8 versus 11.6 percent) [20]. There was no control group, so one cannot determine if the interventions were effective.
●
A randomized trial sought to determine whether a multicomponent strategy (including manual tooth/gum brushing plus 0.12% chlorhexidine oral rinse twice daily plus upright positioning during feeding) could reduce the incidence of pneumonia in nursing home residents compared with usual care, but the trial was terminated for futility [21]. It might have been difficult to detect a difference between the groups since upright positioning during feeding is practiced routinely in nursing homes [22], and oral hygiene is also a common part of usual nursing home care.