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Dysphagia

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23.11.2016 | Original Article

Implementing the Free Water Protocol does not Result in Aspiration Pneumonia in Carefully Selected Patients with Dysphagia: A Systematic Review

verfasst von: Anna Gillman, Renata Winkler, Nicholas F. Taylor

Erschienen in: Dysphagia | Ausgabe 3/2017

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Abstract

The Frazier Free Water Protocol was developed with the aim of providing patients with dysphagia an option to consume thin (i.e. unthickened) water in-between mealtimes. A systematic review was conducted of research published in peer-reviewed journals. An electronic search of the EMBASE, CINAHL and MEDLINE databases was completed up to July 2016. A total of 8 studies were identified for inclusion: 5 randomised controlled trials, 2 cohort studies with matched cases and 1 single group pre-post intervention prospective study. A total of 215 rehabilitation inpatients and 30 acute patients with oropharyngeal dysphagia who required thickened fluids or were to remain ‘nil by mouth’, as determined by bedside swallow assessment and/or videofluoroscopy/fiberoptic endoscopic evaluation of swallowing, were included. Meta-analyses of the data from the rehabilitation studies revealed (1) low-quality evidence that implementing the protocol did not result in increased odds of having lung complications and (2) low-quality evidence that fluid intake may increase. Patients’ perceptions of swallow-related quality of life appeared to improve. This review has found that when the protocol is closely adhered to and patients are carefully selected using strict exclusion criteria, including an evaluation of their cognition and mobility, adult rehabilitation inpatients with dysphagia to thin fluids can be offered the choice of implementing the Free Water Protocol. Further research is required to determine if the Free Water Protocol can be implemented in settings other than inpatient rehabilitation.

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Snyder NA, Feigal DW, Arieff AL. Hypernatremia in elderly patients. A heterogeneous, morbid, and iatrogenic entity. Ann Intern Med. 1987;107:309–19.CrossRefPubMed

Shireffs SM, Merson SJ, Fraser SM, Archer DT. The effects of fluid restriction on hydration status and subjective feelings in man. Br J Nutr. 2004;91(6):951–8.CrossRef

Kelly J, Hunt BJ, Lewis RR, Swaminathan R, Moody A, Seed PT, Rudd A. Dehydration and venous thromboembolism after acute stroke. QJM. 2004;97(5):293–6.CrossRefPubMed

Warren JL, Bacon WE, Harris T, McBean AM, Foley DJ, Phillips C. The burden and outcomes associated with dehydration among US elderly. Am J Public Health. 1991;84:1265–9.CrossRef

Altman KW, Gou-Peri Y, Schaefer S. Consequence of dysphagia in the hospitalised patient. Arch Otolaryngol Head Neck Surg. 2010;136(8):784–9.CrossRefPubMed

Marik PE. Aspiration pneumonitis and pneumonia: a clinical review. N Engl J Med. 2001;344:665–72.CrossRefPubMed

Langmore SE, Terpenning MS, Schork A, Chen Y, Murray JT, Lopatin D, Loesche WJ. Predictors of aspiration pneumonia: how important is dysphagia? Dysphagia. 1998;13(2):69–81.CrossRefPubMed

Hibberd J, Fraser J, Chapman C, McQueen H, Wilson A. Can we use influencing factors to predict aspiration pneumonia in the United Kingdom? Multidiscip Respir Med. 2013;8(1):39.CrossRefPubMedPubMedCentral

Vivanti AP, Campbell KL, Suter MS, Hannan-Jones MT, Hulcombe JA. Contribution of thickened drinks, food and enteral parenteral fluids of fluid intake in hospitalized patients with dysphagia. J Hum Nutr Diet. 2009;22:148–55.CrossRefPubMed

10.

Kuhlemeier KV, Palmer JB, Rosenberg D. Effect of liquid bolus consistency and delivery method on aspiration and pharyngeal retention in dysphagia patients. Dysphagia. 2001;16(2):119–22.CrossRefPubMed

11.

Logemann J. Evaluation and treatment of swallowing disorders/edition 2. Austin: PRO-ED; 1998.

12.

Dantas RO, Kern MK, Massey BT, Dodds WJ, Kahrilas PJ, Brasseur JG, Cook IJ, Lang IM. Effect of swallowed bolus variables on oral and pharyngeal phases of swallowing. Am J Physiol. 1990;258(5):G675–81.PubMed

13.

Low J, Wyles C, Wilkinson T, Sainsbury R. The effect of compliance on clinical outcome for patients with dysphagia on videofluoroscopy. Dysphagia. 2001;16(2):123–7.CrossRefPubMed

14.

Garcia J, Chambers E, Molander M. Thickened liquids: practice patters of speech-language pathologists. Am J Speech Lang Pathol. 2005;14(1):4–13.CrossRefPubMed

15.

Colodny N. Dysphagic independent feeders’ justifications for noncompliance with recommendations by a speech-language pathologist. Am J Speech Lang Pathol. 2005;14:61–70.CrossRefPubMed

16.

Leiter AE, Windsor J. Compliance of geriatric dysphagic patients with safe-swallowing instructions. J Med Speech Lang Pathol. 1996;4:289–99.

17.

Langmore SE. Why I like the free water protocol. SIG 13 perspectives on swallowing and swallowing disorders. Dysphagia. 2011;20:116–20.

18.

Holas MA, DePippo KL, Reding MJ. Aspiration and relative risk of medical complications following stroke. Arch Neurol. 1994;51(10):1051–3.CrossRefPubMed

19.

Effros RM, Jacobs ER, Schapira RM, Biller J. Response of the lungs to aspiration. Am J Med. 2000;108(Suppl 4a):15S–9S.CrossRefPubMed

20.

Panther K. The Frazier free water protocol. SIG 13 perspectives on swallowing and swallowing disorders. Dysphagia. 2005;14:4–9.

21.

Terpenning M, Bretz W, Lopatin D, Langmore S, Dominguez B, Loesche W. Bacterial colonization of saliva and plaque in the elderly. Clin Infect Dis. 1993;16(Suppl 4):S314–6.CrossRefPubMed

22.

Van der Maarel-Wierink CD, Vanobbergen JN, Bronkhorst EM, Schols JM, de Baat C. Oral health care and aspiration pneumonia in frail older people: a systematic literature review. Gerodontology. 2013;30(1):3–9.CrossRefPubMed

23.

Adachi M, Ishihara K, Abe S, Okuda K, Ishikawa T. Effect of professional oral health care on the elderly living in nursing homes. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002;94(2):191–5.CrossRefPubMed

24.

Azarpazhooh A, Leake L. Systematic review of the association between respiratory diseases and oral health. J Periodontol. 2006;77(9):1465–82.CrossRefPubMed

25.

Roberts N, Moule P. Chlorhexidine and tooth-brushing as prevention strategies in reducing ventilator-associated pneumonia rates. Nurs Crit Care. 2011;16:295–302.CrossRefPubMed

26.

Sato M, Yoshihara A, Miyazaki H. Preliminary study on the effect of oral care on recovery from surgery in elderly patients. J Oral Rehabil. 2006;33:820–6.CrossRefPubMed

27.

Bronson-Lowe C, Leising K, Bronson-Lowe D, Lanham S. Effects of a free water protocol for patients with dysphagia. Dysphagia. 2008;23:423–36.CrossRef

28.

Stewart RJ, Mehta SA, Veltman LE, Oleszek MR, Brady SL, Escobar NG. Water access for individuals with dysphagia who aspirate: research challenges. Brain Inj. 2012;26(4–5):309–792.

29.

Kenedi H, Foreman M, Graybeal D, Reynolds J, Campbell JB, Santos TO, Gibson M, Burgardt M. Positive and negative clinical indicators of the free water protocol in an acute care setting: two pilot studies North American brain injury society’s eleventh annual conference on brain injury. J Head Trauma Rehabil. 2013;28(5):31–65.CrossRef

30.

Pooyania S, Galimova L, Buchel C, Daun R, Lenton L. Effects of a free water protocol on inpatients in a neurological rehabilitation setting. Stroke. 2013;44:174–228.CrossRef

31.

Karagiannis C. Quality of life for patients with dysphagia: what really matters? Dysphagia. 2013;25:354–62.

32.

Carlaw, et al. Implementation of a water protocol in a rehabilitation setting for clients with thin liquid dysphagia: preliminary results of a randomized trial. Dysphagia. 2010;25:354–98.CrossRef

33.

Carlaw C, Finlayson H, Kathleen B, Tiffany V, Caroline M, Coney D, Steele C. A randomized controlled trial of a water protocol for clients with thin liquid dysphagia. Dysphagia. 2009;24:461–84.CrossRef

34.

Karagiannis M. Quality of life for patients with dysphagia: what really matters? Dysphagia. 2010;25:354–98.CrossRef

35.

Becker A, Tews L, Lemke J. ‘An oral water protocol in rehabilitation patients with dysphagia for liquids’. Paper presented at the American Speech-Language Hearing Association Convention, Chicago. 2008. http://www.asha.org/Events/convention/handouts/2008/1877_Tews_Lisa.htm.

36.

Carlaw C, Steele C. Implementation of a water protocol in a rehabilitation setting. Paper presented at the American Speech-Language Hearing Association Convention, New Orleans, Louisiana. 2009. http://www.asha.org/Events/convention/handouts/2009/1977_Carlaw_Caren.

37.

Schwartzentruber. A The effects of a free-fluid protocol on individuals with thin-liquid dysphagia. University of Western Ontario. 2011. https://www.uwo.ca/fhs/csd/ebp/reviews/2010-11/Schwartzentruber.pdf. Accessed 30 June 2015.

38.

Weber V. The challenges of initiating the Frazier Water Protocol on an acute care stroke unit. Inst Nurs Newsl. 2009;5(3):10.

39.

Mosheim, J. Frazier Water Protocol 16:24:6. 2006. http://speech-language-pathology-audiology.advanceweb.com/Article/Frazier-Water-Protocol-1.aspx Accessed 30 June 2015.

40.

Coyle JL. Water, water everywhere, but why? Argument against free water protocols. SIG 13 perspectives on swallowing and swallowing disorders. Dysphagia. 2011;20:109–15.

41.

Moher D, Liberati A, Tetzlaff J, Altman DG. The PRISMA group preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097.CrossRefPubMedPubMedCentral

42.

Downs SH, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomized and non-randomized studies of health care interventions. J Epidemiol Community Health. 1998;52:377–84.CrossRefPubMedPubMedCentral

43.

Speed L, Harding KE. Tracheostomy teams reduce total tracheostomy time and increase speaking valve use: a systematic review and meta-analysis. J Crit Care. 2013;28(2):216.CrossRefPubMed

44.

Kennelly J. Methodological approach to assessing the evidence. In: Handler A, Kennelly J, Peacock N, editors. Reducing racial/ethnic disparities in reproductive and perinatal outcomes: the evidence from population-based interventions. Springer: Chicago; 2011. p. 7–19.CrossRef

45.

Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions. Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. http://www.handbook.cochraneorg.

46.

Karagiannis MJ, Chivers L, Karagiannis TC. Effects of oral intake of water in patients with oropharyngeal dysphagia. BMC Geriatr. 2011;1(11):9.CrossRef

47.

Karagiannis M, Karagiannis TC. Oropharyngeal dysphagia, free water protocol and quality of life: an update from a prospective clinical trial. Hellenic J Nucl Med. 2014;17:26–9.

48.

GRADE Working Group. Grading quality of evidence and strength of recommendations. BMJ. 2004;328:1490.CrossRefPubMedCentral

49.

Garon BR, Engle M, Ormiston C. A randomized control study to determine the effects of unlimited oral intake of water in patients with identified aspiration. Journal of Neurol Rehabil. 1997;11(3):139–48.

50.

Carlaw C, Finlayson H, Beggs K, Visser T, Marcoux C, Coney D, Steele CM. Outcomes of a pilot water protocol project in a rehabilitation setting. Dysphagia. 2012;27(3):297–306.CrossRefPubMed

51.

Murray J, Doeltgen S, Miller M, Scholten I. Does a water protocol improve the hydration and health status of individuals with thin liquid aspiration following stroke? A randomized controlled trial. Dysphagia. 2016;31:424–33.CrossRefPubMed

52.

Pooyania S, Vandurme L, Daun R, Buchel C. Effects of a Free Water Protocol on inpatients in a neuro-rehabilitation setting. Open J Ther Rehabil. 2015;2015(3):132–8.CrossRef

53.

Frey KL, Ramsberger G. Comparison of outcomes before and after implementation of a water protocol for patients with cerebrovascular accident and dysphagia. J Neurosci Nurs. 2011;43(3):165–71.CrossRefPubMed

54.

Bernard S, Loeslie V, Rabatin J. Brief report—use of a modified Frazier Water Protocol in critical illness survivors with pulmonary compromise and dysphagia: a pilot study. Am J Occup Ther. 2016;70(1):1–5.

Titel: Implementing the Free Water Protocol does not Result in Aspiration Pneumonia in Carefully Selected Patients with Dysphagia: A Systematic Review
verfasst von: Anna Gillman
Renata Winkler
Nicholas F. Taylor
Publikationsdatum: 23.11.2016
Verlag: Springer US
Erschienen in: Dysphagia / Ausgabe 3/2017
Print ISSN: 0179-051X
Elektronische ISSN: 1432-0460
DOI: https://doi.org/10.1007/s00455-016-9761-3

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Implementing the Free Water Protocol does not Result in Aspiration Pneumonia in Carefully Selected Patients with Dysphagia: A Systematic Review

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