The Safety of Oral Rehydration Solution Jelly for Water and Electrolyte Intake in Patients with Dysphagia

Figures & data

Table 1 Patient Characteristics (N=36)

Sex
Male, n (%)	15 (41.6)
Female, n (%)	21 (58.4)
Age, median (range)	80 (39–92)
Primary Disease of Dysphagia, n (%)
Cerebrovascular disease	12 (33.3)
Disuse syndrome	7 (19.5)
Postoperative oral cancer	6 (16.7)
Dementia	5 (13.9)
Respiratory disease	3 (8.3)
Others	3 (8.3)

Table 2 Dysphagia Severity Scale and Functional Oral Intake Scale Scores

Dysphagia Severity Scale, n (%)		Functional Oral Intake Scale, n (%)
1	0 (0)	1	0 (0)
2	0 (0)	2	3 (8.3)
3	4 (11.1)	3	4 (11.1)
4	10 (27.8)	4	4 (11.1)
5	8 (22.2)	5	8 (22.2)
6	14 (38.9)	6	17 (47.3)
7	0 (0)	7	0 (0)

Notes: Dysphagia Severity Scale: 1, saliva aspiration; 2, food aspiration; 3, water aspiration; 4, occasional aspiration; 5, oral problems; 6, minimal problems; 7, within normal limits. Functional Oral Intake Scale: 1, no oral intake; 2, tube-dependent with minimal/inconsistent oral intake; 3, tube supplements with consistent oral intake; 4, total oral intake of a single consistency; 5, total oral intake of multiple consistencies requiring special preparation; 6, total oral intake with no special preparation, but with specific food limitations; 7, total oral intake with no restrictions.

Table 3 Comparison of Thickened Water and Oral Rehydration Solution Jelly

	Thickened Water (Median, Range)	OS-1 Jelly (Median, Range)	p value
Number of swallows	2 (1–5)	1.75 (1–5)	0.364
Time until swallowing reflex (s)	1.12 (0.4–5.8)	0.83 (0.3–4.2)	<0.001*
Position of the bolus that triggered the swallowing reflex	2 (2–3)	2 (1–3)	0.043*
Pharyngeal residue	2 (1–5)	2 (1–4)	0.048*
Penetration-Aspiration Scale score	1 (1–4)	1 (1–4)	0.260

Notes: *p<0.05. Position of the bolus that triggered the swallowing reflex: 1, in the oral cavity; 2, from the distal part of the oral cavity to the vallecula of the epiglottis; 3, from the distal part of the vallecula of the epiglottis to the pyriform sinus. Pharyngeal residue: 1, none; 2, trace; 3, mild (less than one-quarter); 4, moderate (less than half); 5, severe (more than half). Penetration-Aspiration Scale: 1, none (material does not enter the airway); 2, material enters the airway, remains above the vocal folds, and is ejected from the airway; 3, material enters the airway, remains above the vocal folds, and is not ejected from the airway; 4, material enters the airway, contacts the vocal folds, and is ejected from the airway.

Figure 1 Distribution of the position of the tip of the food bolus just before swallowing thickened water or oral rehydration solution (ORS) jelly. In the case of thickened water, the swallowing reflex was most frequently induced in the area between the distal part of the oral cavity and the vallecula of the epiglottis. With the ORS jelly, the same tendency was observed. However, some jelly was partially retained in the oral cavity (p<0.05). 1: in the oral cavity, 2: from the distal part of the oral cavity to the vallecula of the epiglottis, 3: from the distal part of the vallecula of the epiglottis to the pyriform sinus. *p<0.05.

Figure 2 Pharyngeal residue after swallowing. The thickened water group included one patient (2.8%) with a score of 5 (more than half remained in the pharynx after swallowing), whereas the oral rehydration solution jelly group included patients with scores ranging from 1–4 (p<0.05), with no patient scoring 5. Yale Pharyngeal Residue Severity Rating Scale: 1, none; 2, trace; 3, mild (less than one-quarter); 4, moderate (less than half); and 5, severe (more than half). *p<0.05.

Figure 3 Penetration-Aspiration Scale results. Thickened water and oral rehydration solution jelly showed no aspiration, and 41.7% and 30.6% (total of those with a score 2 or above), respectively, showed penetration (p=0.062). 1, none (material does not enter the airway); 2, material enters the airway, remains above the vocal folds, and is ejected from the airway; 3, material enters the airway, remains above the vocal folds, and is not ejected from the airway; 4, material enters the airway, contracts the vocal folds, and is ejected from the airway.

Abbreviations: n.s., not significant.