Expiratory Flow Accelerator (EFA®) For Dysphagic Non-Coooperative Patients: A Pilot Study for Preventing Aspiration Pneumonia.

Background
“Ab ingestis” pneumonia is the second most common cause of nosocomial infections in inpatients and the most common cause of death in patients with dysphagia. Rates increase dramatically in patients with neurological diseases or an acquired brain injury. Early interdisciplinary rehabilitation protocols could reduce penetration-aspiration episodes.

Aim
This pilot study is aimed to investigate the effects of an expiratory flow accelerator (EFA®) device – usually aimed to manage airway secretions – in addition to usual care to prevent the penetration-aspiration (PA) risk in bedridden dysphagic low-alert patients, with ineffective cough, compared to a “usual care” control group. Patients from an intensive respiratory care unit were assessed by a multidisciplinary team and evaluated with FEES: 20 subjects were recruited in the EFA-group and 20 in the control group.

Design
Controlled study.

Setting
Inpatients of PRM unit
Population
Neurological with recent aspiration pneumonia dysphagic patients vigilant an cooperative (control group) or non cooperative with disorders of consciousness and ineffective cough (study group).

Methods
We analyzed the use of expiratory flow accelerator with a protocol to prevent relapses of PA in study group and compared with traditional treatments in cooperative patients.

Results
After 21-weeks, aspiration pneumonia occurred in two patients of the study group and in three patients of the control group. All patients showed a reduction of daily need for suctioning (p<0.0001), without differences between groups (p=0.53). Improvements in the penetration-aspiration scale(PAS) and in the peak expiratory flow (PEF) was significant in both groups with a prevalence in the study group (p = 0.0042 and p < 0.0001, respectively).Non-cooperative patients, with four or more PA risk factors, treated with EFA®had outcomes similar to lower-risk patients treated with usual prophylactic care alone.

Conclusion
This preliminary research showed the feasibility and reliability of the EFA® to prevent PA episodes in high-risk dysphagic patients and provides the framework to design a trial.

Clinical rehabilitation impact
The use of efa technology could be assessed and used in patients with severe acquired brain injury
and ineffective cough.