| 제목 |
In Patients with Mild Dysphagia, Adding Fluid Thickener when Ingesting Water Leads to Dehydration |
| 소속 |
Bundang Jesaeng Hospital, Department of Rehabilitation Medicine1 |
| 저자 |
Jeong A Ham1, Seo Yeon Yoon1, Sung Joon Chung1, Hyun Im Moon1†, Yeon Gyu Jeong1* |
Objective
To evaluate the hypothesis that in patients with mild dysphagia, adding fluid thickener when ingesting water does not have obvious benefit in preventing pneumonia, but rather causes dehydration which is inferred by elevated blood urea nitrogen(BUN) creatinine(Cr) ratio.
Methods
We retrospectively reviewed the medical records of patients who underwent videofluoroscopic swallowing study(VFSS) from 2016.01 to 2020.01. The patients diagnosed with stroke through brain magnetic resonance imaging or brain computed tomography and who showed penetration or aspiration only at the fluid phase of VFSS thought to have mild dysphagia were enrolled in this study.
The exclusion criteria were as follows: (1) signs of aspiration at any of the Puree, Semisolid or Solid phase of VFSS; (2) penetration-aspiration scale(PAS) score 8 at the fluid phase of VFSS; (3) medical history which may elevate baseline Cr level; (4) history of degenerative nervous system diseases which cause dysphagia. Then, the patients enrolled were classified into two groups, according to the diet instructions of VFSS results. Free fluid group(A) patients were allowed to freely consume water with a regular diet. Fluid thickener group(B) patients had been shown to be able to take a regular diet, but recommended to add fluid thickener when ingesting water. We reviewed VFSS records of those enrolled patients; review the PAS score and severity of pharyngeal pooling indicated as 0/1/2/3 at Liquid 2cc/5cc/cup phase. We checked the serum BUN Cr ratio twice, initially and 1 month after. The presence of pneumonia read on chest X-ray and fever event over 38.0 within a month after VFSS test was reviewed.
The paired T test was used to compare the differences of BUN Cr ratio between initial and 1 month f/u blood tests of each group. The analysis of the comparison of the ΔBUN Cr ratio between the two groups was done by the independent T test.
Results
There were no significant differences in clinical characteristics except for the diet before the VFSS test and no significant differences in the incidence of pneumonia or fever(>38.0) between the two groups in Table 1. The PAS score was significantly higher at Liquid 2cc/5cc/cup phase in group B(P<0.05) in Table 2. When comparing BUN Cr ratio of 1 month lab to the initial one, it decreased significantly in group A(P=0.024) and increased significantly in group B(P=0.007), and there was a significant difference of ΔBUN Cr ratio between the two groups(P=001) in Table 3.
Conclusion
In patients with mild dysphagia, adding fluid thickener when ingesting water leads to dehydration without obvious benefit in preventing pneumonia.
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Table 1. Demographical and Clinical Characteristic of the Two Groups
Table 2. Comparison of the VFSS Results Between the Two Groups
Table 3. Comparison of the BUN Cr Ratio Between Initial and 1 Month f/u Blood tests of Each Group and Comparison of the Change in the Values of BUN Cr Ratio Between the Two Groups
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