Patient discussions
Agree an escalation plan with the patient and/or their family/carers as early as possible. Aspiration pneumonia may indicate a terminal event of a chronic progressive illness.[8]
This should include:[71]
Resuscitation status (i.e., ‘Do Not Attempt Cardiopulmonary Resuscitation’ [DNACPR] decision)
Ceiling of care (e.g., suitability for intubation or intensive care admission).
Escalation plans should take account of advanced care planning, including legally binding advanced directives.[71]
The importance of dental prophylaxis and good oral hygiene should be emphasised. Oral care, including a combination of professional cleaning of the oral cavity and gargling of disinfectant solution, can reduce the number of pathogenic bacteria in the oropharyngeal secretions.[36]
The patient should remain in an upright or elevated position at least 1 to 2 hours after meals. Older or neurologically impaired people should be advised to eat small meals at a slow pace and of an appropriate consistency to prevent choking or regurgitation.
Discuss feeding strategies carefully with the patient and/or family because the risk of aspiration may be outweighed by the patient’s quality-of-life needs, especially in progressive disease. It may be preferable for the patient to eat and drink (while accepting it is unsafe) rather than using a modified diet, feeding tube, or ‘nil by mouth’ regimen.[72] This strategy is also known as ‘risk feeding.’[91]
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