Preventing Aspiration Pneumonia



Preventing Aspiration Pneumonia

February, 2013

“Aspiration pneumonia is caused by inhaling foreign material (usually food, liquids, vomit, or secretions from the mouth) into the lungs. This may lead to an inflammatory reaction, a lung infection (pneumonia), or a collection of pus in the lungs,” ().

What are the signs and symptoms of aspiration pneumonia? There are overt signs and symptoms of aspiration pneumonia such as coughing or choking while eating and drinking. If the patient develops a wet or “gurgly” vocal quality when eating or drinking something this could indicate food or liquid on the vocal cords. Chronically throat clearing while eating and drinking can also be a sign of aspiration pneumonia. Often times a patients respiration rate will increase and their oxygen saturation levels will decrease during a meal if they are aspirating. There are also some non-overt signs and symptoms to watch for when monitoring for aspiration pneumonia. A patient with low grade temperature spikes, lung congestion or infiltrates in the right lower lobe or an increased white blood cell count could have aspiration pneumonia.

The elderly population as well as victims of stroke are both high risk populations for aspiration pneumonia. Although the elderly and victims of stroke appear to be our populations at highest risk for aspiration pneumonia, there are several other risk factors to be considered. The following are the top three risk factors for aspiration pneumonia:

1. Dependent on someone else for feeding (41%) – Patients who are dependent on someone else to feed them are at a loss for the biofeedback signals received when feeding themselves such as holding utensils, hand to mouth coordination, control of bolus placement and bolus size. This includes a lot of our stroke patients who have lost the ability to use their dominant hand and need someone to feed them.

2. Dependent on someone else for oral care (40%) – When oral care is neglected there is an overgrowth of oropharyngeal bacteria as well as a potential growth of thrush for patients on large doses of antibiotics. If the patient has poor oral care and is aspirating, each time they swallow they are ingesting large amounts of bacteria and fungi into their lungs which can quickly develop into an infection. Bacteria carried in saliva have been linked to pathogens involved in pneumonia (Abe, 2005). Good oral care is also important in preventing aspiration pneumonia in tube fed patients. One study suggests that effective oral care can decrease mortality due to pneumonia by half (Yoneyama, 2002).

3. Number of missing teeth (34%) – Just like patients who have to be fed, patients with missing teeth are missing the biofeedback signals given to their brain by their teeth when chewing and swallowing.

What are some ways we can prevent aspiration pneumonia? Here are some general precautions you can take to help prevent aspiration pneumonia.

1. Optimal positioning – the best way for a patient to eat is sitting up at 90 degrees, preferably in a chair, with their tray table at an easily accessible height. The patient should also remain upright for at least 20 to 30 minutes after their meal to prevent post meal aspiration.

2. Adequate alertness – a patient needs to be fully alert and awake to eat. If the patient cannot stay awake for more than 20 minutes at a time, the patient needs to wait to eat.

3. Thorough oral care – Oral care should be offered before breakfast, after each meal and at bedtime. Brushes are key, not oral swabs. Brushing should last approximately two minutes.

4. Follow all recommendations given by the speech pathologist – Patients should be reminded to use all swallow precautions given by the speech pathologist including thickened liquids, special diet modifications as well as specific swallowing techniques.

Xerostomia, or dry mouth, can also cause complications for patients with swallowing difficulties. Studies have shown that people produce less saliva as they grow older. Antidepressants, antihistamines and diuretics often compound this problem as dry mouth is a known side effect for each of these groups of medications.

Taking medications can often be a difficulty for patients with dysphagia. Here are some tips to help prevent medication-induced injury:

1. Have patients take medication sitting at a 90 degree angle.

2. Take medications with at least 100 mL of water if safe to do so

3. Take sips of water before and after taking medicatons

4. Take “bedtime” medicines at least 30 minutes before sleeping or 10 minutes before reclining.

5. Take one pill at a time.

6. If needed ask pharmacist if medications can be crushed.

7. If needed, request medication in a liquid form.

All of these are important keys to protecting our patients from aspiration pneumonia. When these suggestions are followed carefully we can greatly reduce incidence of aspiration pneumonia in our patient population.

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