Incidence of pneumonia associated with the Frazier free water protocol

Francisco Angulo Parker, PGY2UKY PM&R

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.

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.

Objectives

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

Objectives

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

Objectives

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

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.

Population•N= 80•Stroke patients in Cardinal Hill

Rehabilitation Hospital•Evaluated during hospital stay.

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.

Interventions

•Experimental group:▫Receiving the Frazier free water protocol,

oral hygiene.

•Control group:▫Receiving oral hygiene only.

Frazier Free Water Protocol

•Water can be given freely 30 minutes after a meal

•Water can be given before a meal.

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

Tools

• Modified Barium Swallow test.

• Evaluate aspiration to different consistencies. Several MBS may be performed during hospitalization.

• Clinical signs and symptoms

Outcome measures

•Chest X-ray. For diagnosis of pneumonia.

•BMP. Hydration status

•VAS. Patient satisfaction

Preliminary Information

•IRB approval Jan 2012

• N= 1

Obstacles

• Enrollment.▫Complexity of

patients▫Comunication▫Patient

unwillingness

Questions