Aspiration pneumonia among enteral fed home care adult patients in Qatar

Introduction: Aspiration Pneumonia is common in older people. Aspiration is preceded by symptoms of dysphagia, difficulty of oral intake, and malnutrition. The use of enteral feeding is the last option for providing nutrition and hydration. 40% of patients receiving enteral nutrition develop aspiration pneumonia with mortality rate of 17-62%.

Methods: Retrospective study method was used to collect information regarding aspiration pneumonia events among all enteral-fed home healthcare patients who met the criteria for inclusion. 276 patients were included after excluding patients who did not meet the criteria. Data collected included: age, sex, time under enteral feeding, mode of enteral feeding (bolus, continuous), route of administration (NGT, PEG), infusion rate feed volume, total calorie per day, total water flushing volume, and total water flushing and feed volume, feed strength and aspiration. Data was collected by three dietitians and checked by the principal investigator.

Results: Incidence rate of aspiration pneumonia during the year 2023 among the study population was 36.96% and mean age was 79.61 years. No significant difference was found between the variables (Sex, age, BMI, route of administration, mode of administration and use of pump). There was a noted decrease in aspiration pneumonia among those who are using pump and those using PEG. When we combined these variables against no pump use and NGT, it was not a statistically significant difference.

A statistically significant difference for aspiration pneumonia was found with less time under enteral feed, and less total water flushing per day (P-Value < 0.05). A statistically significant difference was found with higher calorie intake (P-Value < 0.01). When checked standard adult feeds with other concentrated formulas as a reference group, a significant difference was found between standard formula and 1.5 feed concentration formulas (P- Value < 0.05). All other concentrated formulas have higher aspiration percentages but are not statistically significant. The mean volumes from feed and flushing water were almost the same. The main reason for aspiration is the increased calorie intake through feeds which have higher osmolarity or osmolality.

Conclusion: Homecare patients have no active medical issues that require admission; they are considered medically stable. It is important to emphasize the application of safe enteral feeding strategies to individual patient needs.