Allergy Diagnosis in India: Current and Future Trends.

Recognized by the World Health Organization, oropharyngeal dysphagia is defined as the inability to safely and effectively transfer a bolus of solids or liquids from the oral cavity to the esophagus []. Oropharyngeal dysphagia is a serious concern among hospitalized patients due to its impact on the safety and efficiency of oral intake, with a potential for severe consequences, including aspiration, malnutrition, and prolonged hospitalization []. In the in-patient hospital setting, mildly thick liquids (MTL), also known as nectar-thick liquids, have been utilized to reduce the risk of oropharyngeal aspiration since the 1990s, classically when transitioning patients from a nil per os (NPO) diet to a regular texture liquids (thin liquids) diet []. In comparison to thin liquids (1-50 centiPoise), MTL liquids (51-350 centiPoise) are more viscous and can improve swallow safety for patients with poor oral bolus organization or delayed pharyngeal swallow initiation [-]. The hospitalized patient often has limited nutrition/hydration options if there is concern for aspiration and resulting pulmonary complications with thin liquids. If a patient is deemed safe from aspiration risk with mildly thick liquid, this option is often preferred over enteral nutrition or nothing by mouth, as prolonged nothing by mouth status places the patient at high risk for malnutrition, prolonged hospitalization, and minimizes options for medication delivery []. A modified diet including mildly thick liquid may be preferred by the medical team and the patient when there is an expectation to improve in the short term (less than one week) or a need for optimization (following acute neurological injury, following a short intubation period, etc.) prior to instrumental swallow evaluation. However, research indicates that MTLs are not without risk. Studies looking at the effects of aspiration of MTL in animal models have raised concerns for initiating this diet at bedside without an instrumental swallow evaluation [-]. Long-term use of MTLs poses concern for dehydration, unsatisfied feelings of thirst, slow gastric emptying, risk of reflux, risk of pharyngeal residue, risk of aspiration without overt coughing, and other potential negatives []. At this academic tertiary hospital center, patients who demonstrate overt signs of aspiration with thin liquids are considered for temporary use of MTLs as a bridge to baseline diet using a strict algorithm. This study aims to evaluate the safety of this algorithm.