Safe initiation of oral diets in hospitalized patients based on passing a 3-ounce (90 cc) water swallow challenge protocol

Abstract

A 3-ounce water swallow challenge protocol successfully identified patients who can be safely advanced to an oral diet without subsequent identification of overt signs of aspiration within 12-24 h of testing. Importantly, when a clinical 3-ounce challenge protocol administered by a trained provider is passed, specific diet recommendations, including drinking thin liquids, can be made safely and without the need for additional instrumental dysphagia testing.

8 Otorhinolaryngology and Principles of Neurotology in Skull Base Surgery

“…The presence of a unilateral vocal fold paralysis from a vagus neuropathy causes a 2.5 increased risk of aspiration over that in similar patients without a vocal fold paralysis. 28 The mortality rate from a hospital-acquired aspiration pneumonia is reported to be between 20% and 60%. 27 • Dysphagia due to cranial nerve deficits can be quite complex.…”

“…The presence of a vocal fold paralysis was found to have a 2.5 times higher change of aspiration on fluoroscopic evaluation. 28 • The arytenoid tips anteroinferiorly with a lowering of vocal fold height, and the vocal fold will atrophy if paralysis persists. Voice quality can be very breathy and weak, with a poor cough.…”

Silent Aspiration Risk is Volume-Dependent: Reply to Letter to the Editor

“…The same wording applies to the 110 participants not given puree consistency on FEES. Our study design and methodology remained the same [2,3,5,9], and the validity of the 3-ounce water swallow challenge protocol to both determine aspiration risk and make safe and successful diet recommendations has not been compromised [6][7][8].…”

“…The same wording applies to the 110 participants not given puree consistency on FEES. Our study design and methodology remained the same [2,3,5,9], and the validity of the 3-ounce water swallow challenge protocol to both determine aspiration risk and make safe and successful diet recommendations has not been compromised [6][7][8].We are continuing our programmatic line of research in order to corroborate our results with blinded testing, correlating oral mechanism findings with aspiration risk, and collecting longitudinal data regarding success of diet recommendations all based on the 3-ounce water swallow challenge protocol. We are confident that our research and recommendations to improve patient care by fostering safer swallowing will stand the test of time.…”

“…We have, however, increased the population sample from the original 44 stroke patients to 3,000 participants with a wide variety of diagnoses found in the acute care setting, thereby fostering generalization and more widespread use. Further research incorporated a basic cognitive assessment [5] and oral mechanism evaluation resulting in a 3-ounce water swallow challenge protocol that has the additional advantages of reliably and safely identifying patients with aspiration risk and successfully recommending specific oral diets for different patient populations, i.e., trauma patients [6], general acute care inpatients [7], and patients with acute stroke [8]. The protocol's strengths include prospective, consecutive, and referral-based population samples that span the age range [9].…”