| 제목 |
Status of viscosity modified-diet in dysphagia patients with brain lesions |
| 소속 |
Asan Medical Center, University of Ulsan College of Medicine, Department of Rehabilitation Medicine1, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Department of Physical Medicine & Rehabilitation Medicine2 |
| 저자 |
Hye Joon Ahn1*, Min Ho Chun1†, June Kyung Lee2 |
OBJECTIVE
The aim of this study was to investigate viscosity of thickened fluid ingested by dysphagic patients with brain lesions and incidence of adverse effects according to the fluid viscosity.
METHODS
This study was a prospective study. We enrolled dysphagic patients with brain lesions who were observed more than penetration on thin fluid and recommended to use thickeners in the videofluoroscopic swallowing study (VFSS). All patients were provided an education to use thickener. The educated viscosity of fluid was nectar-thick or honey-thick, which is consistent with International Dysphagia Diet Standardisation Initiative (IDDSI) Flow test level 2 or 3, respectively.
We evaluated the viscosity of fluid using IDDSI Flow test once a week for two week and reviewed following data from medical chart: 1) Pneumonia; 2) Urinary tract infection (UTI) ; 3) Constipation; 4) Hydration status measured by blood urea nitrogen (BUN) to creatinine ratio at discharge. The patients were divided into two groups based on the fluid viscosity: a thin fluid group (level 0-2), a thick fluid group (level 3-4). Adverse events including pneumonia, UTI, constipation and hydration status were compared between two groups. Patients with viscosity of fluid below level 1 at second evaluation were interviewed for the reasons of not following the educated viscosity.
RESULTS
A total of 17 patients were enrolled, 16 patients completed the two times of evaluation. 1 patient was dropped out because the VFSS result after enrollment to this study concluded that the patient does not need thickener anymore.
The distribution of fluid viscosity for 16 patients is as below; level 0(6.3%); level 1(6.3%); level 2(37.5%); level 3(37.5%); level 4(12.5%) (Table 1). The change of fluid viscosity between measurements is as below; sustained(62.4%); increased (6.3%); decreased(31.2%) (Figure 1).
Average of total hospital day after thickener use was 26.5 days. No pneumonia or UTI occurred in all patients. Constipation was observed in 11 patients, however there was no significant difference between two groups (p=0.302). BUN to creatinine ratio at discharge showed no significant difference between two groups (p=0.342) (Table 2).
Four patients with viscosity of fluid below level 1 on second evaluation responded to the interview regarding the reasons for not following the educated viscosity. The responses were dissatisfaction with taste (2 patients) and texture (2 patients).
CONCLUSION
Despite this study was conducted in hospitalized patients with short-term follow-up, 25% of patients did not follow the educated viscosity, and 31.2% showed decreased viscosity in a follow-up evaluation. Considering that there were no significant differences in the incidence of adverse effects including pneumonia according to the fluid viscosity and that patients dissatisfied with taste and texture of thickened fluid, further study is necessary to establish a stringent criteria to apply thickener in limited patients.
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Table 1. The distribution of fluid viscosity which the patients actually drink
Table 2. Adverse event after thickener use
Figure 1. The change of fluid viscosity which the patients actually drink
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