Respiratory and Nutritional Complications in Oropharyngeal Dysphagia

Abstract

INTRODUCTION: The probability of occurrence of aspiration pneumonia in the acute stroke phase is around 7% and two-third of all stroke patients develop aspiration pneumonia or malnutrition in long term. Studies have shown that neurogenic oropharyngeal dysphagia (NOD) is the most important risk factor for stroke-associated pneumonia. METHODS: Our prospective study in dysphagic stroke patients (n=85) over a period of 3 months included the evaluation of the Swallowing-specific Quality of Life (SWAL-QoL) in a patient population of stroke patients in a stroke unit centre. Within a dysphagia management concept (DMC) an initial swallowing screening (MSA) and clinical swallowing examination (CSE) as well as endoscopic and radiological supported diagnostic instruments (FEES=flexible endoscopic examination of swallowing; VFSS=Videoflouroscopic swallowing study) were used to grade the severity of dysphagia. RESULTS: The analysis of type and composition of solid and liquid food indicate that more adaptations in food/liquid consistencies are done in the first week of inpatient care setting. In the outpatient setting after 3 months when patients are back home, the implementation of therapeutic interventions regarding different food/liquid consistencies seems more problematic. The analyses of the subscales of SWAL-QoL in stroke patients show, that the „fear of choking“ only marginally affected the QoL. On the other hand, it was observed, that eating habits, communication and fatigue were more likely to create problems and have a negative effect on the patients quality of life (QoL). DISCUSSION: Importantly patients and their relatives should be informed intensively about the possibilities of adapting different food/liquid consistencies, thus a dysphagia-specific nutrition can be guaranteed also in an outpatient setting. Another important step could be a continuous medical education regarding neurogenic oropharyngeal dysphagia in outpatient setting by using brochures and training methods to enhance further treatment beyond clinical rehabilitative settings. It seems that the greatest limitation of quality of life is the eating duration, whereas interestingly the least restriction is caused by „fear of choking“ in stroke patients with oropharyngeal dysphagia (OD).