Top

European Archives of Oto-Rhino-Laryngology

Published in:

06-08-2023 | Aspiration Pneumonia | Miscellaneous

Predictors of aspiration pneumonia: developing a new matrix for speech and language therapists

Authors: Laura Ball, Lotte Meteyard, Roy J. Powell

Published in: European Archives of Oto-Rhino-Laryngology | Issue 11/2023

Abstract

Introduction

The contributing factors of aspiration pneumonia have been well documented. However, there are gaps in the literature regarding identifying the weight associated with each factor and the relationship between factors.

Method

In this study, 20 potential predictors of aspiration pneumonia (with four additional variables) have been applied to historic Speech and Language Therapy records to greater understand the significance of each contributor of aspiration pneumonia. 152 cases with an oropharyngeal dysphagia, and a Speech and Language Therapy recommendation of eating and drinking with known aspiration and the associated potential risk of developing an aspiration pneumonia, were included in the data. These were inpatients and outpatients, and had various diagnoses but all had had a videofluoroscopy.

Results

Logistic regression analysis found seven factors that were individually significant in predicting the development of aspiration pneumonia with 84.93% sensitivity and 91.03% specificity

Discussion

Logistic regression and random forest analyses led to the proposal of a new matrix of predictors of aspiration pneumonia with respective scoring weights for individual and cumulative contributors (a direction for future research).

Available only for authorised users

The Royal College of Speech and Language Therapists (2006) Communicating Quality 3: RCSLT’s guidance on best practice in service organisation and provision, 2nd edn. The Royal College of Speech and Language Therapists, London

Morgan S, McRae J (2016) Successfully transitioning a ventilator dependent spinal cord injured patient to eating 14 months post injury—a case presentation. [Online poster]. https://www.researchgate.net/publication/293173782_Successfully_Transitioning_a_Ventilator_Dependent_Spinal_Cord_Injured_Patient_to_Eating_14_Months_Post_Injury_-_A_Case_Presentation. Accessed 18 Jan 2023

Sura L, Madhavan A, Carnaby G, Crary MA (2012) Dysphagia in the elderly: management and nutritional considerations. Clin Interv Aging 7:287–298. https://doi.org/10.2147/CIA.S23404CrossRefPubMedPubMedCentral

O’Keeffe ST, Murray A, Leslie P, Collins L, Lazenby-Paterson T, McCurtin A, Mulkerrin S, Smith A (2021) Aspiration, risk and risk feeding: a critique of the Royal College of Physicians guidance on care of people with eating and drinking difficulties. Adv Commun Swallow 24:63–72. https://doi.org/10.3233/ACS-210031CrossRef

Royal College of Physicians (2021) Supporting people who have eating and drinking difficulties. A guide to practical care and clinical assistance, particularly towards the end of life. Report of a working party. London: Royal College of Physicians.

Murray A, Mulkerrin S, O’Keeffe ST (2019) The perils of ‘risk feeding.’ Age Ageing 48(4):478–481. https://doi.org/10.1093/ageing/afz027CrossRefPubMed

Royal College of Physicians (2010) Oral feeding difficulties and dilemmas: a guide to practical care, particularly towards the end of life. Report of a Working Party. London: Royal College of Physicians.

Langmore SE, Terpenning MS, Schork A, Chen Y, Murray JT, Lopatin D, Loesche WJ (1998) Predictors of aspiration pneumonia: How important is dysphagia? Dysphagia 13(2):69–81. https://doi.org/10.1007/PL00009559CrossRefPubMed

Mandell LA, Niederman MS (2019) Aspiration pneumonia. N Engl J Med 380:651–663. https://doi.org/10.1056/NEJMc1903636CrossRefPubMed

10.

Hibberd J, Fraser J, Chapman C, McQueen H, Wilson A (2013) Can we use influencing factors to predict aspiration pneumonia in the United Kingdom? Multidiscipl Respir Med 8:39–46. https://doi.org/10.1186/2049-6958-8-39CrossRef

11.

Ashford JR (2005) Pneumonia: factors beyond aspiration. Swallow Swallow Disord 14(1):10–16. https://doi.org/10.1044/sasd14.1.10CrossRef

12.

Marik PE (2001) Aspiration pneumonitis and aspiration pneumonia. N Engl J Med 344(9):665–671. https://doi.org/10.1056/NEJM200103013440908CrossRefPubMed

13.

Palmer PM, Padilla AH (2022) Risk of an adverse event in individuals who aspirate: a review of current literature on host defenses and individual differences. Am J Speech Lang Pathol 31:148–162. https://doi.org/10.1044/2021_AJSLP-20-00375CrossRefPubMed

14.

Brice E, Van Sickle,A (2020) Aspiration pneumonia: the more we learn the less we know. Dysphagia Café. https://dysphagiacafe.com/2020/09/17/aspiration-pneumonia-the-more-we-learn-the-less-we-know. Accessed 18 Jan 2023

15.

Komiya K, Ishii H, Umeki K, Kawamura T, Okada F, Okabe E, Murakami J, Kato Y, Matsumoto B, Teramoto S, Johkoh T, Kadota J (2013) Computed tomography findings of aspiration pneumonia in 53 patients. Geriatr Gerontol Int 13(3):580–585. https://doi.org/10.1111/j.1447-0594.2012.00940.xCrossRefPubMed

16.

Langmore SE, Skarupski KA, Park PS, Fries BE (2002) Predictors of aspiration pneumonia in nursing home residents. Dysphagia 17(4):298–307. https://doi.org/10.1007/s00455-002-0072-5CrossRefPubMed

17.

van der Maarel-Wierink CD, Vanobbergen JN, Bronkhorst EM, Schols JM, de Baat C (2011) Risk factors for aspiration pneumonia in frail older people: a systematic literature review. J Am Med Dir Assoc 12(5):344–354. https://doi.org/10.1016/j.jamda.2010.12.099CrossRefPubMed

18.

Loeb M, McGeer A, McArthur M, Walter S, Simor AE (1999) Risk factors for pneumonia and other lower respiratory tract infections in elderly residents of long-term care facilities. Arch Intern Med 159:2058–2064. https://doi.org/10.1001/archinte.159.17.2058CrossRefPubMed

19.

Kozlow JH, Berenholtz SM, Garrett E, Dorman T, Pronovost PJ (2003) Epidemiology and impact of aspiration pneumonia in patients undergoing surgery in Maryland, 1999–2000. Crit Care Med 31:1930–1937. https://doi.org/10.1097/01.CCM.0000069738.73602.5FCrossRefPubMed

20.

The Health Research Authority (2022) HRA and HCRW Approval. https://www.myresearchproject.org.uk/help/hlphraapproval.aspx#Which-projects-apply-for-HRA-Approval. Accessed 14 June 2022

21.

Skerrett SJ (1994) Host defenses against respiratory infection. Med Clin North Am 78(5):941–966. https://doi.org/10.1016/S0025-7125(16)30113-4CrossRefPubMed

22.

Cole RB, Mackay AD (1990) Essentials of respiratory disease, 3rd edn. Churchill Livingstone, Edinburgh

23.

Tobin MJ, Grenvik A (1984) Nosocomial lung infection and its diagnosis. Crit Care Med 12:191–199. https://doi.org/10.1097/00003246-198403000-00008CrossRefPubMed

24.

Pierce AK, Sanford JP (1974) Aerobic gram-negative bacillary pneumonias. Am Rev Respir Dis 110(5):647–658. https://doi.org/10.1164/arrd.1974.110.5.647CrossRefPubMed

25.

StatsDirect Ltd. (2013). StatsDirect statistical software (version 3). [Software]. http://www.statsdirect.com. Accessed 27 Oct 2022

26.

Liaw A, Wiener M (2002) Classification and regression by randomForest. R News 2(3): 18–22. https://CRAN.R-project.org/doc/Rnews/. Accessed 28 Apr 2023

27.

R Core Team (2012) R: a language and environment for statistical computing. R Foundation for Statistical Computing; Vienna, Austria. https://www.R-project.org/

28.

O’Keeffe ST (2018) Use of modified diets to prevent aspiration in oropharyngeal dysphagia: Is current practice justified? BMC Geriatr 18(1):167. https://doi.org/10.1186/s12877-018-0839-7CrossRefPubMedPubMedCentral

29.

Beck AM, Kjaersgaard A, Hansen T, Poulsen I (2017) Systematic review and evidence based recommendations on texture modified foods and thickened liquids for adults (above 17 years) with oropharyngeal dysphagia—an updated clinical guideline. Clin Nutr 37(6):1980–1991. https://doi.org/10.1016/j.clnu.2017.09.002CrossRefPubMed

30.

Gillman A, Winkler R, Taylor NF (2017) Implementing the free water protocol does not result in aspiration pneumonia in carefully selected patients with dysphagia: a systematic review. Dysphagia 32(3):345–361. https://doi.org/10.1007/s00455-016-9761-3CrossRefPubMed

31.

Groher ME (1987) Bolus management and aspiration pneumonia in patients with pseudobulbar dysphagia. Dysphagia 1:215–216. https://doi.org/10.1007/BF02406920CrossRef

32.

Mizock BA (2007) Risk of aspiration in patients on enteral nutrition: Frequency, relevance, relation to pneumonia, risk factors, and strategies for risk reduction. Curr Gastroenterol Rep 9:338–344. https://doi.org/10.1007/S11894-007-0039-7CrossRefPubMed

33.

Blomberg B, Sharda N (2022) Aspiration pneumonia. In: Sinclair AJM, Morley JE, Vellas B, Cesari M, Munshi M (eds) Pathy’s principles and practice of geriatric medicine, 6th edn. Wiley-Blackwell, New Jersey, pp 522–529. https://doi.org/10.1002/9781119484288.ch40CrossRef

34.

Lee AS, Ryu JH (2018) Aspiration pneumonia and related syndromes. Mayo Clin Proc 93(6):752–762. https://doi.org/10.1016/j.mayocp.2018.03.011CrossRefPubMed

35.

Satou Y, Oguro H, Murakami Y, Onoda K, Mitaki S, Hamada C, Mizuhara R, Yamaguchi S (2013) Gastroesophageal reflux during enteral feeding in stroke patients: a 24-hour esophageal ph-monitoring study. J Stroke Cerebrovasc Dis 22(3):185–189. https://doi.org/10.1016/j.jstrokecerebrovasdis.2011.07.008CrossRefPubMed

36.

Langdon PC, Lee AH, Binns CW (2009) High incidence of respiratory infections in ‘nil by mouth’ tube-fed acute ischemic stroke patients. Neuroepidemiology 32(2):107–113. https://doi.org/10.1159/000177036CrossRefPubMed

37.

Ong BY, Palahniuk RJ, Cumming M (1978) Gastric volume and pH in out-patients. Can Anaesth Soc 25(1):36–39. https://doi.org/10.1007/BF03006781CrossRef

38.

Cameron JL, Anderson RP, Zuidema GD (1967) Aspiration pneumonia: a clinical and experimental review. J Surg Res 7(1):44–53. https://doi.org/10.1016/0022-4804(67)90009-1CrossRefPubMed

39.

Phung DT, Wang Z, Rutherford S, Huang C, Chu C (2013) Body mass index and risk of pneumonia: a systematic review and meta-analysis. Obes Rev 14(10):839–857. https://doi.org/10.1111/obr.12055CrossRefPubMed

40.

Bouchard J, Presse N, Ferland G (2009) Association between aspiration pneumonia and malnutrition in patients from active geriatric units. Can J Diet Pract Res Publ Diet Can 70(3):152–154. https://doi.org/10.3148/70.3.2009.152CrossRef

41.

Schindler A, Ginocchio D, Ruoppolo G (2008) What we don’t know about dysphagia complication? Rev Laryngol Otol Rhinol 129(2):75–78

42.

Dickson RP, Erb-Downward JR, Martinez FJ, Huffnagle GB (2016) The microbiome and the respiratory tract. Annu Rev Physiol 78(1):481–504. https://doi.org/10.1146/annurev-physiol-021115-105238CrossRefPubMed

43.

Naruishi K, Nichikawa Y, Kido J, Fukunaga A, Nagata T (2018) Relationship of aspiration pneumonia to cognitive impairment and oral condition: a cross-sectional study. Clin Oral Invest 22:2575–2580. https://doi.org/10.1007/s00784-018-2356-7CrossRef

44.

Carlaw C, Finlayson H, Beggs K, Vesser T, Marcoux C, Coney D, Steele CM (2012) Outcomes of a pilot water protocol project in a rehabilitation setting. Dysphagia 27(3):207–306. https://doi.org/10.1007/s00455-011-9366-9CrossRef

45.

Siebens H, Trupe E, Siebens A, Cook F, Anshen S, Hanauer R, Oster G (1986) Correlates and consequences of eating dependency in institutionalized elderly. J Am Geriatr Soc 34(3):192–198. https://doi.org/10.1111/j.1532-5415.1986.tb04202.xCrossRefPubMed

46.

Takeda H, Yamashina Y, Tabira K (2021) Relationship between kyphosis and cough strength and respiratory function of communication-dwelling elderly. Physiother Theory Pract 38(13):3100–3107. https://doi.org/10.1080/09593985.2021.1989731CrossRefPubMed

47.

Neill S, Dean N (2019) Aspiration pneumonia and pneumonitis: a spectrum of infectious/noninfectious diseases affecting the lung. Curr Opin Infect Dis 32(2):152–157. https://doi.org/10.1097/QCO.0000000000000524CrossRefPubMed

48.

Kim SK, Mo SJ, Moon WS, Jun PS, Kim CR (2016) Effects of cervical kyphosis on recovery from dysphagia after stroke. Ann Rehabil Med 40(5):816–825. https://doi.org/10.5535/arm.2016.40.5.816CrossRefPubMedPubMedCentral

49.

Oda K, Montayre J, Parsons J, Boyd M (2021) Oral care in hospital setting: breaking the vicious circle of older adult deconditioning. J Gerontol Nurs 47(6):7–12. https://doi.org/10.3928/00989134-20210507-01CrossRefPubMed

50.

van der Maarel-Wierink C, Vanobbergen JNO, Bronkhorst EM, Schols JMGA, de Baat C (2012) Oral health care and aspiration pneumonia in frail older people: a systematic literature review. Gerodontology 30(1):3–9. https://doi.org/10.1111/j.1741-2358.2012.00637.xCrossRefPubMed

51.

Pace C, McCullough G (2010) The association between oral microorganisms and aspiration pneumonia in the institutionalized elderly: review and recommendations. Dysphagia 25(4):307–322. https://doi.org/10.1007/s00455-010-9298-9CrossRefPubMed

52.

Terpenning MS, Taylor GW, Lopatin DE, Kerr CK, Dominiquez L, Loesche WJ (2001) Aspiration pneumonia: dental and oral risk factors in an older veteran population. J Am Geriatr Soc 49(5):557–563. https://doi.org/10.1046/j.1532-5415.2001.49113.xCrossRefPubMed

53.

Burkhead LM (2017) Exercise-based dysphagia rehabilitation: past, present, and future. SIG-13 Swallow Swallow Disord (Dysphagia) 2(13):36–43. https://doi.org/10.1044/persp2CrossRef

54.

Burkhead LM (2009) Applications of exercise science in dysphagia rehabilitation. Perspect Swallow Swallow Disord (Dysphagia) 18(2):43–48. https://doi.org/10.1044/sasd18.2.43CrossRef

55.

Burkhead LM, Sapienza CM, Rosenbek JC (2007) Strength-training exercises in dysphagia rehabilitation: principles, procedures and directions for future research. Dysphagia 22(3):251–265. https://doi.org/10.1007/s00455-006-9074-zCrossRefPubMed

56.

Maeda K, Akagi J (2017) Muscle mass loss is a potential predictor of 90-day mortality in older adults with aspiration pneumonia. J Am Geriatr Soc 65(1):18–22. https://doi.org/10.1111/jgs.14543CrossRef

57.

Ferguson J, Ravert B, Gailey M (2018) Aspiration: /asp e ’raSH( e )n/: Noun: an ambiguous term used for a diagnosis of uncertainty. Clin Pulm Med 25(5):177–183. https://doi.org/10.1097/cpm.0000000000000277CrossRef

58.

Marik PE, Kaplan D (2003) Aspiration pneumonia and dysphagia in the elderly. Chest 124(1):328–336. https://doi.org/10.1378/chest.124.1.328CrossRefPubMed

59.

Stover DE, Kaner RJ (1996) Pulmonary complications in cancer patients. CA A Cancer J Clin 46(5):303–320. https://doi.org/10.3322/canjclin.46.5.303CrossRef

60.

DiBardino DM, Wunderink RG (2015) Aspiration pneumonia: a review of modern trends. J Crit Care 30(1):40–48. https://doi.org/10.1016/j.jcrc.2014.07.011CrossRefPubMed

61.

Yoneyama T, Yoshida M, Ohrui T, Mukaiyama H, Okamoto H, Hoshiba K, Ihara S, Yanagisawa S, Ariumi S, Morita T, Mizuno Y, Ohsawa T, Akagawa Y, Hasimoto K, Sasaki H (2002) Oral care reduces pneumonia in older patients in nursing homes. J Am Geriatr Soc 50(3):430–433. https://doi.org/10.1046/j.1532-5415.2002.50106.xCrossRefPubMed

62.

Teramoto A, Fukuchi Y, Sasaki H, Sato K, Sekizawa K, Matsuse T (2008) High incidence of aspiration pneumonia in community and hospital-acquired pneumonia in hospitalized patients: a multicenter, prospective study in Japan. J Am Geriatr Soc 56(3):577–579. https://doi.org/10.1111/j.1532-5415.2008.01597.xCrossRefPubMed

63.

Nakashima T, Maeda K, Tahira K, Taniguchi K, Mori K, Kiyomiya H, Akagi J (2018) Silent aspiration predicts mortality in older adults with aspiration pneumonia admitted to acute hospitals. Geriatr Gerontol Int 18(6):828–832. https://doi.org/10.1111/ggi.13250CrossRefPubMed

64.

Kikuchi R, Watabe N, Konno T, Mishina N, Sekizawa K, Sasaki H (1994) High incidence of silent aspiration in elderly patients with community-acquired pneumonia. Am J Respir Crit Care Med 150(1):251–253. https://doi.org/10.1164/ajrccm.150.1.8025758CrossRefPubMed

65.

Komiya K, Ishii H, Kadota JI (2015) Healthcare-associated pneumonia and aspiration pneumonia. Aging Dis 6(1):27–37. https://doi.org/10.14336/AD.2014.0127CrossRefPubMed

66.

Addington WR, Stephens RE, Gilliland KA (1999) Assessing the laryngeal cough reflex and the risk of developing pneumonia after stroke: an interhospital comparison. Stroke 30(6):1203–1207. https://doi.org/10.1161/01.str.30.6.1203CrossRefPubMed

67.

Yamanda S, Ebinhara S, Ebihara T, Yamasaki M, Asamura T, Asada M, Une K, Arai H (2008) Impaired urge-to-cough in elderly patients with aspiration pneumonia. Cough 19:4–11. https://doi.org/10.1186/1745-9974-4-11CrossRef

68.

Satoru E, Ebihara T, Kohzuki M (2012) Effect of aging on cough and swallowing reflexes: implications for preventing aspiration pneumonia. Lung 190(1):29–33. https://doi.org/10.1007/s00408-011-9334-zCrossRef

69.

Tsai M, Yang Y, Liu C, Lin M, Chang G, Tsai YT, Li H, Tsai Y, Hsu C (2018) Unilateral vocal fold paralysis and risk of pneumonia: a Nationwide Population-Based Cohort Study. Otolaryngol Head Neck Surg 158(5):896–903. https://doi.org/10.1177/0194599818756285CrossRefPubMed

70.

Kim CM, Dewan K (2021) Vocal fold paralysis and dysphagia. Curr Otorhinolaryngol Rep 9:101–106. https://doi.org/10.1007/s40136-021-00332-yCrossRef

71.

Yoon H, Shim SS, Kim SJ, Lee JH, Chang JH, Lee SH, Rya YJ (2019) Long-term mortality and prognostic factors in aspiration pneumonia. J Am Med Dir Assoc 20(9):1098–1104. https://doi.org/10.1016/j.jamda.2019.03.029CrossRefPubMed

72.

Crary MA, Carnaby GD, LaGorio LA, Carvajal PJ (2012) Functional and physiological outcomes from an exercise-based dysphagia therapy: a pilot investigation of the Mcneill dysphagia therapy program. Arch Phys Med Rehabil 93(7):1173–1178. https://doi.org/10.1016/j.apmr.2011.11.008CrossRefPubMed

73.

Yoichiro A, Ohashi M, Funahashi R, Otaka Y, Saitoh E (2020) Oropharyngeal dysphagia and aspiration pneumonia following coronavirus disease 2019: a case report. Dysphagia 35(4):545–548. https://doi.org/10.1007/s00455-020-10140-zCrossRef

74.

Miles A, McRae J, Clunie G, Gillivan-Murphy P, Inamoto Y, Kalf H, Pillay M, Pownall S, Ratcliffe P, Richard T, Robinson U, Wallace S, Brodsky MB (2022) An international commentary on dysphagia and dysphonia during the COVID-19 pandemic. Dysphagia 37(6):1349–1374. https://doi.org/10.1007/s00455-021-10396-zCrossRefPubMedPubMedCentral

75.

Wallace S, McGrath B (2021) Laryngeal complications after tracheal intubation and tracheostomy. Br J Anaesth 21(7):250–257. https://doi.org/10.1016/j.bjae.2021.02.005CrossRef

Title: Predictors of aspiration pneumonia: developing a new matrix for speech and language therapists
Authors: Laura Ball
Lotte Meteyard
Roy J. Powell
Publication date: 06-08-2023
Publisher: Springer Berlin Heidelberg
Keywords: Aspiration Pneumonia
Dysphagia
Dysphagia
Aspiration
Foreign Body Aspiration
Foreign Body Aspiration
Pneumonia
Dysphagia
Published in: European Archives of Oto-Rhino-Laryngology / Issue 11/2023
Print ISSN: 0937-4477
Electronic ISSN: 1434-4726
DOI: https://doi.org/10.1007/s00405-023-08153-z

2024 ASCO Annual Meeting

Springer Medicine

Predictors of aspiration pneumonia: developing a new matrix for speech and language therapists

Abstract

Introduction

Method

Results

Discussion

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Introduction

Method

Results

Discussion

Please log in to get access to this content

Other articles of this Issue 11/2023

Prevalence and risk factors of hearing loss among the middle-aged and older population in China: a systematic review and meta-analysis

A study of otolith function in patients with orthostatic dizziness

Postnatal genetic umbilical cord analysis for earliest possible detection of inherited hearing impairment

Treatment of COVID-19 olfactory dysfunction with olfactory training, palmitoylethanolamide with luteolin, or combined therapy: a blinded controlled multicenter randomized trial

Comparison of narrow-band imaging with autofluorescence imaging for endoscopic detection of squamous cell carcinoma of the tonsil

Comparison of perichondrium–cartilage double and single underlay myringoplasty for subtotal perforations: a randomized controlled trial