Aspiration Pneumonia with Thickeners

I have not recently reviewed research on that topic.  But what we do know so far with free water protocol and such is that if straight water goes into your lungs, we're not too worried about it.  However, if we’re washing bacteria from the mouth down into the lungs, then we're concerned of a pneumonia being exacerbated or initiated.  So with thickener and the greater likelihood of aspirating thickener into the lungs, would that spark a pneumonia more so than liquid that is not thickened?  I have not seen research on this recently, so I can't answer that.  It is a balancing act, because if you have the thin liquid that is being aspirated for anything other than water, you don't have a neutral PH balance.  So anything more than water might be more likely to cause a pneumonia than just water itself.  So do I let my patient aspirate the material without thickener in it, or do I try to add the thickener to slow it down and decrease the risk of aspiration? We do see that thickener does decrease the risk of aspiration and the rate of aspiration.  Or do I take that risk of them actually aspirating the thickened material?  It is really a tough line to draw and a tough call to make.  Of course you need to keep in mind that just because you aspirate something doesn't mean you're going to get pneumonia from it.  So it depends on the patient's overall physical strength, medical stability and how much/how often they aspirate. There are a lot of variables in that question as well.

Dr. Burkhead Morgan has practiced speech-language pathology since 1994 in a variety of settings.  She earned a Ph.D. from the University of Florida in 2005, focusing on using exercise-based principles in dysphagia diagnosis and management.