For people who are critically ill that require a feeding tube, there is evidence suggesting that the risk of aspiration pneumonia may be reduced by inserting the feeding tube into the duodenum or the jejunum (post-pyloric feeding), when compared to inserting the feeding tube into the stomach (gastric feeding). Enhanced swallow
Many people at risk for aspiration pneumonia have an impaired swallowing mechanism, which may increase the chance of aspiration of food particles with meals. There is some evidence to indicate that training of various parts of the body involved in the act of swallowing, including the tongue and lips, may reduce episodes of aspiration and aspiration pneumonia; however, further research is required to confirm this benefit. Other simple actions during feeding can improve the swallowing capability of a person and thus reduce the risk of aspiration, including changes in position and feeding assistance. After surgery
Many instances of aspiration occur during surgical operations, especially during anesthesia induction. The administration of anesthesia causes suppression of protective reflexes, most importantly the gag reflex. As a result, stomach particles can easily enter the lungs. Certain risk factors predispose individuals to aspiration, especially conditions causing dysfunction of the upper gastrointestinal system. Identifying these conditions before the operation begins is essential for proper preparation during the procedure. It is recommended that patients fast prior to procedures as well. Other practices that may be beneficial but have not been well-studied include medication that reduce the acidity of gastric contents and rapid sequence induction.
Parkinsons disease
The reported prevalence of dysphagia in patients with Parkinsons disease ranges from 20% to 100% due to variations in the methods of assessing the swallowing function. Unlike some medical problems, such as stroke, dysphagia in Parkinsons Disease degenerates with disease progression. Aspiration pneumonia was the most common reason for the emergency admission of patients with Parkinsons Disease whose disease duration was >5 years and pneumonia was one of the main causes of death. Dementia
The familiar model of care for people with advanced dementia and dysphagia is the revolving door of recurrent chest infections, frequently associated with aspiration and related readmissions. Many individuals with dementia resist or are indifferent to food and fail to manage the food bolus. There are also many contributory factors such as poor oral hygiene, high dependency levels for being positioned and fed, as well as the need for oral suctioning. While tube feeding might therefore be considered a safer option, tube feeding has not been shown to be beneficial in people with advanced dementia. The preferred option therefore is to continue eating and drinking orally despite the risk of developing chest infections. See also
Dysphagia
Meconium aspiration syndrome
Nosocomial pneumonia
Chemical pneumonitis

References


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