1. Incidence of pneumonia associated with the Frazier free water protocol
Francisco Angulo Parker, PGY2
UKY PM&R

2. Background 47 to 81% of patients with stroke present with dysphagia.
Dysphagia is one of the markers for poor prognosis.
Association with high risk for aspiration pneumonia.

3. Background Frazier free water protocol.
Based on hypothesis that absorbed water, if proper oral care involved, is harmless.
Widely used.
However, no strong evidence of safety.

4. Objectives
Specific aim #1: To evaluate the incidence of pneumonia associated with the population receiving the Frazier free water protocol.

5. Objectives
Specific aim #2: To evaluate hydration status  with The Frazier Free Water Protocol compared to a control group.

6. Objectives
Specific aim #3: To evaluate patient’s satisfaction in the group receiving The Frazier Free Water Protocol compared to the control group.

7. Study design
This is a prospective, randomized, single- blinded controlled study.
Patients will be randomly enrolled to one of the following groups:
1) The Frazier Free Water Protocol, or
2) Oral hygiene. No free water.

8. Population
N= 80
Stroke patients in Cardinal Hill Rehabilitation Hospital
Evaluated during hospital stay.

9. Inclusion criteria
a) Stroke pt with dysphagia. b) 18 years and older. c) Able to swallow water without demonstrating excessive coughing. d) Able to maintain alertness and arousal to participate in evaluation e) Patients able to elicit a timely/efficient swallow (determined by SLP). f) Able to maintain upright posture.

10. Interventions Experimental group: Control group:
Receiving the Frazier free water protocol, oral hygiene.
Control group:
Receiving oral hygiene only.

11. Frazier Free Water Protocol
Water can be given freely 30 minutes after a meal
Water can be given before a meal.

12. Oral hygiene Brush teeth at least 2 times a day
Suction and clear oral secretions
Rinse 3 times a day with peroxide mixed with water

13. Tools Modified Barium Swallow test.
Evaluate aspiration to different consistencies. Several MBS may be performed during hospitalization.
Clinical signs and symptoms

14. Outcome measures Chest X-ray. For diagnosis of pneumonia.
BMP. Hydration status
VAS. Patient satisfaction

15. Preliminary Information
IRB approval Jan 2012
N= 1

16. Obstacles Enrollment. Complexity of patients Comunication
Patient unwillingness

17. Questions