A systematic review and meta-analysis of pneumonia associated with thin liquid vs. thickened liquid intake in patients who aspirate

Kaneoka, Asako; Pisegna, Jessica M.; Saito, Hiroki; Lo, Melody; Katey, Felling; Haga, Nobuhiko; LaValley, Michael P.; Langmore, Susan E.

doi:10.1177/0269215516677739

Cited by 44 publications

(43 citation statements)

References 32 publications

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“…() and Kaneoka et al . () also report that the evidence in favour of TL is not strong. In this arena of less‐than‐robust empirical evidence and embedded use of TL, there also exists limited evidence from people who have had strokes as to the lived experience and acceptability of using thickeners.…”

Section: Introductionmentioning

confidence: 94%

“…On a positive note, recent systematic reviews carried out by Newman et al (2016) and Steele et al (2015) conclude that there is some evidence for thicker liquids reducing the risk of airway invasion. However, Steele et al along with other reviewers including Andersen et al (2016) and Kaneoka et al (2016) also report that the evidence in favour of TL is not strong. In this arena of less-than-robust empirical evidence and embedded use of TL, there also exists limited evidence from people who have had strokes as to the lived experience and acceptability of using thickeners.…”

Section: Introductionmentioning

confidence: 98%

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Plugging the patient evidence gap: what patients with swallowing disorders post‐stroke say about thickened liquids*

McCurtin

Healy

Kelly

et al. 2017

Intl J Lang & Comm Disor

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Background: Oropharyngeal dysphagia post-stroke is well known, with its presence increasing the risk of poor outcomes in particular aspiration and aspiration pneumonia. Management to minimize the risk of aspiration and improve swallow safety post-stroke includes the treatment of thickened liquids (TL), an established bolus modification intervention. Despite widespread use, there is a lack of robust empirical evidence and minimal patient evidence as to the experience and acceptability of using thickeners by people who experience dysphagia after a stroke. Aims: To explore people with swallowing disorders post-stroke experiences of and acceptability regarding the bolus modification treatment of thickened liquids. Methods & Procedures:A qualitative, descriptive study exploring the experiences of individuals given TL after their stroke. A purposive sample of 14 adults was obtained with data collection and generation through the medium of individual semi-structured interviews. Inductive thematic analysis was used to analyse the data. Outcomes & Results: Three overarching themes of 'uncertainty', 'an unpleasant experience' and 'a trade-off' were identified. These themes highlight that participants disliked TL and this dislike may have impacted clinically in terms of adherence, hydration and quality of life. Lack of sensory appeal was important in framing patient dislike. Participants' involvement in and understanding of reasons for prescription of TL was poor leading to uncertainty regarding the treatment. Notwithstanding, some participants felt it was necessary for their stroke recovery. Conclusions & Implications: TL can be considered a burdensome treatment from multiple perspectives including product palatability, treatment uncertainty and treatment adherence issues. Despite intensely disliking this treatment, some patients ultimately understand why the treatment is prescribed. Improvements in product palatability are required in order to improve adherence and patient quality of life. Consideration of other treatment options and newer products to manage aspiration post-stroke is also warranted.

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Section: Introductionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 98%

Plugging the patient evidence gap: what patients with swallowing disorders post‐stroke say about thickened liquids*

McCurtin

Healy

Kelly

et al. 2017

Intl J Lang & Comm Disor

View full text Add to dashboard Cite

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“…Gillman et al, Kaneoka et al, and Loeb et al found no statistical difference in the risk of developing aspiration pneumonia in patients granted access to free water when compared to those with thickened liquids. 1,9,12,15 In the meta-analysis of Gillman et al of 206 patients, there was no significant increase in the odds of having lung complications when allowing patients access to free water in comparison to thickened liquids (odds ratio 1.51, 95% confidence interval 0.2-100.03). 1 The meta-analysis of Kaneoka et al showed no significant difference in the odds of developing pneumonia in patients with access to free water compared with thickened liquids in a sample of 135 patients (odds ratio 0.82, 95% confidence interval 0.05-13.42).…”

Section: Why You Might Think Thickened Liquids Are Helpful For Adult mentioning

confidence: 95%

“…9 These results, although mostly based on imaging findings and in only narrow populations, have been widely extrapolated to routine clinical practice. 1,9,12 WHY THICKENED LIQUIDS ARE NOT HELPFUL FOR ADULT PATIENTS WITH DYSPHAGIA Evidence against thickened liquids dates back to 1994, when a comparative effectiveness trial of stroke patients found that family instruction on appropriate compensatory swallowing techniques without the use of thickened liquids carried no increased risk of pneumonia, dehydration, malnutrition, or death when compared with thickened liquids. 13 Recent evidence has established the risk for harm with thickened liquids.…”

Section: Why You Might Think Thickened Liquids Are Helpful For Adult mentioning

confidence: 99%

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Things We Do for No Reason: The Use of Thickened Liquids in Treating Hospitalized Adult Patients with Dysphagia

Lippert

Chadha

Sweigart

2019

Journal of Hospital Medicine

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The "Things We Do for No Reason" (TWDFNR) series reviews practices that have become common parts of hospital care but may provide little value to our patients. Practices reviewed in the TWDFNR series do not represent "black and white" conclusions or clinical practice standards but are meant as a starting place for research and active discussions among hospitalists and patients. We invite you to be part of that discussion. CLINICAL SCENARIOA 74-year-old man with Alzheimer's dementia and chronic dysphagia with a history of aspiration pneumonia presents with urinary tract infection, hypovolemia, and hypernatremia. He has been on thickened liquids at home for the past several months. As his overall condition improves with intravenous fluids and antibiotics, he requests to drink thin liquids.

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Inflammatory Effects of Thickened Water on the Lungs in a Murine Model of Recurrent Aspiration

et al. 2020

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Objective: Liquid thickeners are commonly recommended in individuals with dysphagia and recurrent aspiration as a strategy for pneumonia prevention. The goal of this study was to examine the effects of small amounts of aspirated liquid thickener on the lungs. Study design: Animal model. Prospective small animal clinical trial. Methods: Adult Sprague Dawley rats (n = 19) were divided into two groups and underwent three intratracheal instillations of either xanthan gum-based nectar-thick water (0.1-0.25 mL/kg) or water-only control over the course of 8 days. Blood was collected from a peripheral vein on days 1 and 8 and submitted for complete blood count (CBC) analysis. Rats were euthanized 10 days after the last instillation, and the lungs were harvested. Histopathology was conducted on lung specimens by a blinded licensed veterinary pathologist and scored for evidence of lung injury and pneumonia. Results: Fifteen animals (8 nectar-thickener group, 7 control group) survived until the endpoint of the study (day 18). Serum CBC did not show abnormalities at any timepoint in either group. Histological evidence of lung inflammation and edema were significantly greater in the nectar-thick group compared to controls (P < .05). Signs of inflammation included aggregates of foamy macrophages, expansion of bronchiolar lymphoid tissue, and large numbers of eosinophilic intraalveolar crystals. Histiocytic and neutrophilic pneumonia was noted in one animal that received thickened liquids. Conclusion: Recurrent aspiration of small amounts of thickened water resulted in significant pulmonary inflammation in a murine model of aspiration. Results of this study support the need for further investigation of liquid thickener safety and its efficacy in reducing the pulmonary complications of swallowing disorders.

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A systematic review and meta-analysis of pneumonia associated with thin liquid vs. thickened liquid intake in patients who aspirate

Abstract: There was no significant difference in the risk of pneumonia in aspirating patients who took thin liquids with safety strategies compared with those who took thickened liquids only. This result, however, is generalizable only for patients with low risk of pneumonia.

Cited by 44 publications

References 32 publications

Plugging the patient evidence gap: what patients with swallowing disorders post‐stroke say about thickened liquids*

Plugging the patient evidence gap: what patients with swallowing disorders post‐stroke say about thickened liquids*

Things We Do for No Reason: The Use of Thickened Liquids in Treating Hospitalized Adult Patients with Dysphagia

Inflammatory Effects of Thickened Water on the Lungs in a Murine Model of Recurrent Aspiration

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