Implementing the Free Water Protocol Does Not Result in Aspiration Pneumonia in Carefully Selected Patients With Dysphagia: A Systematic Review
Dysphagia
Gillman, A., Winkler, R., et al. (2017).
Dysphagia, 32(3), 345-361.
This systematic review and meta-analysis investigates the effects of the Frazier Free Water Protocol on outcomes (e.g., hydration, compliance with swallowing guidelines, quality of life) in individuals with oropharyngeal dysphagia at risk of aspiration on thin liquids.
Not stated
Adapted/modified versions of the Frazier Free Water Protocol were included based on a list of necessary elements for such protocols, provided in Table 2.
Up to July 2016
Published, peer-reviewed studies (not further specified)
8
Findings demonstrated that the use of the Free Water Protocol was not associated with increased odds of having lung complications (OR= 1.51, 95% CI= 0.2- 100.03) in inpatient adults when a strict exlusion criteria was applied (i.e., exclude if they are medically instable, have active respiratory compromise, have a degenerative neurological condition, have immobility and/or the inability to sit fully upright, a strong cough response to water, have inadequate cognition or supervision to support use, or have oral or dental infection). Low-level evidence demonstrated an increase in fluid intake with the Free Water Protocol (MS= 179.4 ml, 95% CI= -70.5 to 529.2). Although swallowing-related quality of life appeared to improve across studies, no meta-analysis was completed for this outcome.The importance of adherence to guidelines of the Free Water Protocol, including thorough oral care and interdisciplinary training (full outline of guidelines in Table 2, p. 348), was emphasized.
