11/10/2023 0 Comments Nectar thick liquids![]() Think about the patient who coughs on every sip of thin (no fun, right?). BUT, there are a minority of patients who do prefer thickened liquids. Why not? They taste bad (as if you needed research to qualify that statement). Most patients dislike them and will not drink them (or at least not as much of them). ![]() Then since thickened liquids can be helpful for some patients, we should be thoughtful about who we are recommending them for (and we should only make that decision under their guidance of an instrumental study).įirst things first, what does the patient think of thickened liquids? And will they drink them? Sounds like a simple question, but it’s probably the most important one to ask when considering this intervention. But this is only applicable to patients who are able to use safe swallow strategies and for patients who have a low risk of pneumonia. Research shows that there is no significant difference in pneumonia rates for patients with dysphagia who take thickened liquids and those who take thin with safety strategies. BUT is the elimination (or even reduction) of airway compromise at all costs the end goal? Some argue not. So yes, thickened liquids are an excellent choice to improve airway protection (especially gum-based or naturally thickened liquids) for some patients. On the other hand, gum-based thickeners are more stable and tend to be more cohesive, making them less likely to cause residue after the swallow. Starch-based thickeners, for example, get thicker as they sit making their viscosity highly variable. Unfortunately, there is no agreement over where this cutoff point is and so we don’t know which viscosity is “best.” And don’t forget, not all thickener is created equal. So there is a cutoff point as to when the benefits of thickened liquids start to decrease and the cons ( increased residue) start to increase. Thicker = heavier and a heavier bolus will naturally be more difficult to propel. ![]() Thickened liquids aren’t a panacea though. This may mean increased residue for thin liquids- Something not always considered since intuition would make us think the opposite. Thickened liquids, instead, are more cohesive so they keep their shape as they move down the oropharynx. Even in patients who don’t have a timing issue, as thin liquids speed down the oropharynx the bolus stretches out making it difficult to propel in one fell swoop. They are slippery and move fast through oropharynx which will have obvious implications on a patient with decreased bolus control and/or decreased laryngeal vestibule closure response time (bombs away!). We’ve all had them go down the wrong pipe from time to time. They have clear benefits that are well supported by the research including improved timing, control, sensation, and hydration, as well as reduced penetration and aspiration. Thickened liquids DO in fact have value in some circumstances. Let’s look at the research before we dive any deeper into thick liquid. While thickened liquids hold value, that value has been up on a pedestal for so long that many clinicians don’t even consider any other options first. If a tree falls in the forest and there’s nobody around to hear it, does it make a sound? Similarly, do your recommendations have any value if nobody follows them in the first place? Of course, this isn't the case for everyone (but it is for most). For the most part, they’re over-recommended and under-utilized. Thickened liquids have been a point of much contention. George Barnes with editing and guidance from Dr.
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