Effects of Early Dysphagia Rehabilitation by Speech-language-hearing Therapists on Patients with Severe Aspiration Pneumonia

Nakamura, Tomoyuki; Kurosaki, Shuhei

doi:10.2490/prm.20200020

Cited by 11 publications

(10 citation statements)

References 21 publications

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“…When aspiration is suspected, early SLT assessment and intervention has been known to improve patient outcomes [ 52 ]. SLTs were only referred in 17.8% of patients diagnosed with non-AP.…”

Section: Discussionmentioning

confidence: 99%

A Paradigm Shift in the Diagnosis of Aspiration Pneumonia in Older Adults

Yoshimatsu

Smithard²

2022

JCM

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In older adults, community-acquired pneumonia (CAP) is often aspiration-related. However, as aspiration pneumonia (AP) lacks clear diagnostic criteria, the reported prevalence and clinical management vary greatly. We investigated what clinical factors appeared to influence the diagnosis of AP and non-AP in a clinical setting and reconsidered a more clinically relevant approach. Medical records of patients aged ≥75 years admitted with CAP were reviewed retrospectively. A total of 803 patients (134 APs and 669 non-APs) were included. The AP group had significantly higher rates of frailty, had higher SARC-F scores, resided in institutions, had neurologic conditions, previous pneumonia diagnoses, known dysphagia, and were more likely to present with vomiting or coughing on food. Nil by mouth orders, speech therapist referrals, and broad-spectrum antibiotics were significantly more common, while computed tomography scans and blood cultures were rarely performed; alternative diagnoses, such as cancer and pulmonary embolism, were detected significantly less. AP is diagnosed more commonly in frail patients, while aspiration is the underlying aetiology in most types of pneumonia. A presumptive diagnosis of AP may deny patients necessary investigation and management. We suggest a paradigm shift in the way we approach older patients with CAP; rather than trying to differentiate AP and non-AP, it would be more clinically relevant to recognise all pneumonia as just pneumonia, and assess their swallowing functions, causative organisms, and investigate alternative diagnoses or underlying causes of dysphagia. This will enable appropriate clinical management.

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“…When aspiration is suspected, early SLT assessment and intervention has been known to improve patient outcomes [ 52 ]. SLTs were only referred in 17.8% of patients diagnosed with non-AP.…”

Section: Discussionmentioning

confidence: 99%

A Paradigm Shift in the Diagnosis of Aspiration Pneumonia in Older Adults

Yoshimatsu

Smithard²

2022

JCM

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“…Contracting infectious complications, e.g., aspiration pneumonia under bedridden status, catheter-associated urinary tract infection, and central line-associated bloodstream infection, can be dependent on clinical settings [43][44][45][46][47][48]. These infections can be preventable or be eased with dysphagia rehabilitation, avoidance of both physical restraint and inappropriate catheter use, appropriate positionings such as the semi-recumbent position, proper aseptic techniques, surveillance, and management strategies [43][44][45][46][47][48][49].…”

Section: Discussionmentioning

confidence: 99%

Restrictive type and infectious complications might predict nadir hematological values among individuals with anorexia nervosa during the refeeding period: a retrospective study

et al. 2022

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Background Although hematological abnormalities in patients with anorexia nervosa have been documented, the mechanisms involved have not been fully clarified, especially during the refeeding period when hematological values further decrease after admission prior to improving. Here we address potential mechanisms underlying the hematological abnormalities of inpatients with anorexia nervosa during the refeeding period. Methods We recruited patients from 101 admissions corresponding to 55 individual patients with anorexia nervosa with severe malnutrition (body mass index, 13.4 ± 3.4) from the neuropsychiatry unit in Ashikaga Red Cross Hospital during the period from October 1999 to March 2018. We analyzed three hematological cell measures, i.e., hemoglobin, white cell count, and platelet count, to determine their levels at admission and their lowest levels during the refeeding period and calculated the percent decrease in those values from admission to the nadir levels. We analyzed each measure using a general mixed model with explanatory variables, including data upon admission and a treatment-related indicator, i.e., energy intake. Results The initial hemoglobin value of 12.1 ± 2.7 g/dl decreased by 22.3% to 9.4 ± 2.5 g/dl; the initial white cell count was 5387 ± 3474/μl, which decreased by 33.6% to 3576 ± 1440/μl; the initial platelet count of 226 ± 101 × 103/μl decreased by 24.3% to 171 ± 80 × 103/μl. All nadir levels were observed during the refeeding period from the fifth to tenth day of hospitalization. Significant correlations among the three hematological cell measures, particularly at the nadir levels, were found. Of note, 41.7% of our patients who received red blood cell transfusion during hospitalization showed normal hemoglobin levels upon admission. The anorexia nervosa restrictive type was associated with a lower nadir level of white blood cell count. Infectious complications were related to a lower nadir level of hemoglobin and a greater percent decrease in hemoglobin level as well as to the need for red blood cell transfusion. Conclusions Nadir hematological cell measures of inpatients with anorexia nervosa might be predicted by the restrictive type and infectious complications. The anorexia nervosa restrictive type was associated with further decrease in hematological values during the refeeding period.

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“…Contracting infectious complications, e.g., aspiration pneumonia under bedridden status, catheter-associated urinary tract infection, and central line-associated bloodstream infection, can be dependent on clinical settings [38][39][40][41][42][43]. These infections can be preventable or be eased with dysphagia rehabilitation, avoidance of both physical restraint and inappropriate catheter use, appropriate positionings such as the semi-recumbent position, proper aseptic techniques, surveillance, and management strategies [38][39][40][41][42][43][44].…”

Section: Discussionmentioning

confidence: 99%

The restrictive type and infectious complications might predict nadir hematological values among individuals with anorexia nervosa during the refeeding period: a retrospective study

Funayama

Koreki

Mimura

et al. 2022

Preprint

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Background: Although hematological abnormalities in patients with anorexia nervosa have been documented, the mechanisms involved have not been fully clarified, especially during the refeeding period, when hematological values further decrease after admission prior to improving. Here we address potential mechanisms underlying the hematological abnormalities of inpatients with anorexia nervosa during the refeeding period.Methods: We recruited patients from 101 admissions corresponding to 55 individual patients with anorexia nervosa with severe malnutrition (body mass index, 13.4 ± 3.4) from the neuropsychiatry unit in Ashikaga Red Cross Hospital during the period from October 1999 to March 2018. We analyzed three hematological cell measures to determine their levels at admission and their lowest levels during the refeeding period and calculated the rate of decrease in those values from admission to the nadir levels. We analyzed each measure using a general mixed model with explanatory variables, including data upon admission and a treatment-related indicator. Results: The initial hemoglobin value of 12.1 ± 2.7 g/dl decreased by 22.3% to 9.4 ± 2.5 g/dl; the initial white cell count was 5387 ± 3474/μl, which decreased by 33.6% to 3576 ± 1440/μl; the initial platelet count of 226 ± 101 ×103/μl decreased by 24.3% to 171 ± 80 ×103/μl. All nadir levels were observed during the refeeding period from the fifth to tenth day of hospitalization. Significant correlations among the three hematological cell measures, particularly at the nadir levels, were found. Of note, 41.7% of our patients who received red blood cell transfusion during hospitalization showed normal hemoglobin levels upon admission. The anorexia nervosa restrictive type was associated with a lower nadir level of white blood cell count. Infectious complications were related to a lower nadir level of hemoglobin and a greater rate of decrease in hemoglobin level as well as to the need for red blood cell transfusion. Conclusions: Nadir hematological cell measures of inpatients with anorexia nervosa might be predicted by the restrictive type and infectious complications. The anorexia nervosa restrictive type is considered to cause further decrease in hematological values during the refeeding period, which might be prevented by controlling infectious complications.

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Effects of Early Dysphagia Rehabilitation by Speech-language-hearing Therapists on Patients with Severe Aspiration Pneumonia

Cited by 11 publications

References 21 publications

A Paradigm Shift in the Diagnosis of Aspiration Pneumonia in Older Adults

A Paradigm Shift in the Diagnosis of Aspiration Pneumonia in Older Adults

Restrictive type and infectious complications might predict nadir hematological values among individuals with anorexia nervosa during the refeeding period: a retrospective study

The restrictive type and infectious complications might predict nadir hematological values among individuals with anorexia nervosa during the refeeding period: a retrospective study

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