1. Preventing Aspiration Pnemonia in Patients with Dysphasia
Jess A. BS-SL,
Yen D., Brando G., John K.

2. Background
Dysphagia is a significant problem in patients in the United States today and poses a distinct risk for causing aspiration pneumonia (AHRQ, 2009). 
Two methods that have been researched to prevent aspiration include using the chin- down method and the use of liquid thickeners (AHRQ, 2009).

3. Purpose
The purpose of our literature review is to compare the effectiveness of the chin down and liquid thickener feeding methods in avoiding the development of aspiration pneumonia in patients with dysphagia. 

4. Methods of search Database searched: EBSCOhost Article research:
Retrieved: 32 
Read: 19
Used: 9
Key words:
dysphagia, aspiration pneumonia, chin-down, liquid thickener
Elimination & selection techniques:
Time period, scanning, quan. vs qual., peer- reviewed, research relevance

5. Method of organization
How did you categorize your L.R. articles?
Treatment options (chin-down vs liquid thickeners)
Liquid viscosity

6. Findings: Compare & Contrast of Chin-down method
Logemann et al. (2008), found the chin-down method less effective.
Terre & Mearin (2012)  found that only about 55% of patients were successful when using the chin-down method.
Robbins et al. (2008) also assessed the effectiveness of the chin-down method, but the results were not conclusive.
Sakuma & Kida (2010) found that the chin- down position widens the vallecula epiglottica and narrows the laryngeal vestibule, resulting in a reduction in laryngeal penetration and aspiration.

7. Findings: Compare & Contrast of Liquid Thickener
Logemann et al. (2008), Leder et al. (2012). & Diniz et al. (2009) found the liquid thickeners to be more effective in preventing aspiration .
Leder et al. (2012) determined that the nectar-like thickened liquids would be the best option, since they are less thick and still produce a pass rate of 100%.
Diniz et al. (2009) Aspiration occurred in only 3 patients (4.9%) with the spoon-thick consistency vs 24 patients (39.3%) with the liquid consistency.

8. Findings: Gaps
The study discovered that numerous healthcare providers were not preparing the liquids according to the instructions (Garcia et al., 2010).
Further education was needed on how to prepare the liquids correctly.
Having too thick or too thin of a liquid could be detrimental.

9. Findings: Summary
Overall, while the chin-down method appears to be somewhat helpful in preventing aspiration pneumonia, it is not the most effective way.
Liquid thickeners were found to be most effective in preventing aspiration.

10. References
DeFabrizio, M.E. & Rajappa, A. (2010). Contemporary approaches to dysphagia management. The Journal
for Nurse Practitioners (6) 8, 622–630.
Diniz, P., Vanin, G., Xavier, R., & Parente, M. (2009). Reduced incidence of aspiration with spoon-thick
consistency in stroke patients. Nutrition In Clinical Practice, 24(3), doi: /
Garcia, J.M., Chambers IV, E., Clark, M., Helverson, J., & Matta, Z. (2010). Quality of care issues for
dysphagia: Modifications involving oral fluids. Journal of Clinical Nursing, 19, doi: /j x.
Leder, S.B., Judson, B.L., Sliwinski, E., & Madson, L. (2012). Promoting safe swallowing when puree is
swallowed without aspiration but thin liquid is aspirated: Nectar is enough. Dysphagia, 28, doi: /s
Logemann, J.A., Gensler, G., Robbins, J., Lindblad, A.S., Hind, J.A., Kosek, S.,  … Gardner, P.J. M. (2008). A
randomized study of three interventions for aspiration of thin liquids in patients with Dementia or Parkinson’s disease. Journal of Speech, Language, and Hearing Research, 51, doi: /
Nicholson, T. M., Torley, P. J., & Cichero, J. Y. (2008). The measurement of thickened liquids used for the
management of dysphagia. American Institute of Physics. Conference Proceedings, 1027(1), doi: /
Robbins, J., Gensler, G., Hind, J., Logemann, J.A., Lindblad, A.S., Brandt, D., … Gardner, P.J.M. (2008).
Comparison of 2 interventions for liquid aspiration on pneumonia incidence. Annals of Internal Medicine, 148,
Sakuma, T., & Kida, I. (2010). Relationship between ease of swallowing and deglutition-related muscle
activity in various postures. Journal of Oral Rehabilitation, 37(8), doi: /j x
Terre, R., & Mearin, F. (2012). Effectiveness of chin-down posture to prevent tracheal aspiration in
dysphagia secondary to acquired brain injury: A videofluoroscopy study. Neurogastroenterol Motility, 24, 414-e206. doi: /j x.