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Aspiration Pneumonia: Who Gets Sick and How Can We Help?

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1.  Stroke Associated Pneumonia:
  1. Occurs most frequently in patients with chronic deficits
  2. Is more likely in patients with brainstem infarcts
  3. Is related to immunodepression and alterations in oral flora
  4. Is related to Gastro-Esophageal Reflux Disease
2.  Aspiration pneumonia is caused by:
  1. Aspiration of food or liquid
  2. Aspiration of secretions
  3. Aspiration of refluxate
  4. All of the above
3.  When assessing tolerance for aspiration, clinicians should consider:
  1. Medical conditions, nutritional status and oral hygiene
  2. Pulmonary status, GERD, and history of stroke
  3. Hydration status, water protocols, and time post onset
  4. Oral hygiene, dependence for care, and aspiration tolerance
4.  Head of the bed elevation:
  1. Has been proven to reduce pneumonia risk
  2. Has been demonstrated to reduce reflux episodes
  3. Must be at 40 degrees to be effective
  4. Is more achievable in beds with under-bed measuring devices
5.  Bundled intervention strategies:
  1. Appear to reduce pneumonia risk but make it difficult to determine which factors are effective
  2. Typically include some combination of hand hygiene, HOB elevation, and free water protocols
  3. Include tracheostomy, mobilization and swallow evaluations
  4. Appear to reduce pneumonia risk by reducing aspiration risk