Individual research recommendation details

Recommendation ID

NG128/04

Question

Avoidance of aspiration pneumonia: Does the withdrawal of oral liquids or the use of modified (thickened) oral fluids prevent the development of aspiration pneumonia after an acute stroke?

Any explanatory notes
(if applicable)

People with dysphagia after an acute stroke are at higher risk of aspiration pneumonia. The guideline development group considered how best to reduce the likelihood of people with acute stroke developing aspiration pneumonia, but there was insufficient evidence on which to base a recommendation. Current clinical practice dictates that those people with clinical evidence of aspiration are given 'nil by mouth' or are given modified (thickened) oral fluids. However, there is little evidence to suggest that withdrawal or modification of fluids reduces the incidence of pneumonia. Oral hygiene is impaired by the withdrawal of oral fluids, and aspirated saliva (up to 2 litres/day) may be infected as a result. Medications are not given orally, and patients may be distressed by the withholding of oral fluids. The research question is whether allowing people with evidence of aspiration free access to water predisposes them to the development of aspiration pneumonia compared with withdrawal of oral liquids or the use of modified (thickened) oral fluids.

Source guidance details

Comes from guidance

Stroke and transient ischaemic attack in over 16s: diagnosis and initial management

Number

NG128

Date issued

May 2019

Other details