Predictors of Aspiration Pneumonia AP
As clinicians, we take every patient as seriously as the next. Prevention is KEY to success in treatment. The terms penetration and aspiration are used to describe different degrees of abnormal airway protection that are associated with eating and drinking. Penetration occurs when material enters the laryngeal area to the level of the true vocal folds; aspiration occurs when material moves below the true vocal folds and enters the trachea. A chest X-ray may show infiltrates confirming diagnosis of pneumonia, most consistently in the right lower lobe. A bronchoscopy can give a definitive diagnosis.
Pneumonia, a prevalent infection in nursing home patients, has the highest mortality rate of any secondary infection in institutionalized elderly patients. Most of the previous research on this subject focused on the treatment of aspiration pneumonia, while the high mortality rate associated with pneumonia continued to rise. Langmore, S.E., Skarupski, K.A., Park, P.S., & Fries, B.E. (2002) study decided to adopt the more recent notion of preventing aspiration, instead of remedying it. This theory involves other pre-existing conditions or important risk factors that most likely are the cause of aspiration. Therefore, if these pathologies can be identified, clinicians would be able to pre-treat them, which would help prevent aspiration pneumonia. Previous research was unable to establish dysphagia as a key early predictor of aspiration pneumonia. Because that finding is counter intuitive, the researchers decided to evaluate and identify the flaws that existed in the prior studies to find out if there is, in fact, a link. Langmore et al (2002) concluded the following to be principal predictors for Aspiration Pneumonia in elderly patients listed from strongest to weakest predictors:
Independent Variables Odds Ratio (95% CI)
Suctioning 2.55 (2.06, 3.15)
COPD 2.49 (2.27, 2.72)
CHF 1.75 (1.61, 1.90)
Feeding tube 1.73 (1.51, 1.98)
Bedfast 1.72 (1.53, 1.92)
Case mix index 1.67 (1.55, 1.79)
Indicators of delirium/less alert 1.63 (1.38, 1.92)
Weight loss 1.60 (1.47, 1.74)
Swallowing problem/dysphagia 1.46 (1.31, 1.62)
Urinary tract infection 1.39 (1.25, 1.53)
Mechanically altered diet 1.24 (1.14, 1.36)
Dependence, eating 1.17 (1.05, 1.31)
Dependence, bed 1.07 (0.96, 1.19)
Dependence, locomotion 1.05 (0.94, 1.17)
Number of medications 1.04 (1.03, 1.04)
Age 1.01 (1.00, 1.01)
CVA 0.83 (0.75, 0.91)
Tracheotomy care 0.38 (0.25, 0.60)
**** One important note: the authors' of this study found dependence of oral care, number of decayed teeth, current smoker and multiple medical diagnoses were important predictors in the prior GOSP study, and were not found to be significant in the current. This doesn't mean that the prior should be ignored in treatment/prevention.
Pneumonia, a prevalent infection in nursing home patients, has the highest mortality rate of any secondary infection in institutionalized elderly patients. Most of the previous research on this subject focused on the treatment of aspiration pneumonia, while the high mortality rate associated with pneumonia continued to rise. Langmore, S.E., Skarupski, K.A., Park, P.S., & Fries, B.E. (2002) study decided to adopt the more recent notion of preventing aspiration, instead of remedying it. This theory involves other pre-existing conditions or important risk factors that most likely are the cause of aspiration. Therefore, if these pathologies can be identified, clinicians would be able to pre-treat them, which would help prevent aspiration pneumonia. Previous research was unable to establish dysphagia as a key early predictor of aspiration pneumonia. Because that finding is counter intuitive, the researchers decided to evaluate and identify the flaws that existed in the prior studies to find out if there is, in fact, a link. Langmore et al (2002) concluded the following to be principal predictors for Aspiration Pneumonia in elderly patients listed from strongest to weakest predictors:
Independent Variables Odds Ratio (95% CI)
Suctioning 2.55 (2.06, 3.15)
COPD 2.49 (2.27, 2.72)
CHF 1.75 (1.61, 1.90)
Feeding tube 1.73 (1.51, 1.98)
Bedfast 1.72 (1.53, 1.92)
Case mix index 1.67 (1.55, 1.79)
Indicators of delirium/less alert 1.63 (1.38, 1.92)
Weight loss 1.60 (1.47, 1.74)
Swallowing problem/dysphagia 1.46 (1.31, 1.62)
Urinary tract infection 1.39 (1.25, 1.53)
Mechanically altered diet 1.24 (1.14, 1.36)
Dependence, eating 1.17 (1.05, 1.31)
Dependence, bed 1.07 (0.96, 1.19)
Dependence, locomotion 1.05 (0.94, 1.17)
Number of medications 1.04 (1.03, 1.04)
Age 1.01 (1.00, 1.01)
CVA 0.83 (0.75, 0.91)
Tracheotomy care 0.38 (0.25, 0.60)
**** One important note: the authors' of this study found dependence of oral care, number of decayed teeth, current smoker and multiple medical diagnoses were important predictors in the prior GOSP study, and were not found to be significant in the current. This doesn't mean that the prior should be ignored in treatment/prevention.
