Curiosity, Dialogue, and Knowledge
In medicine, if there is an acronym be warned… it’s probably Latin. NPO stands for nil per os~ nothing by mouth. If the acronym instead was NFD~ no food or drink, I don’t think it would improve things much for families or patients, but it might add transparency (a badly needed fix in our current medical environment).
Making a patient NPO is a tough thing to do, but a necessary evil. There are actually some really great reasons to temporarily make a patient NPO: recent stroke or neurological damage, severe delirium resulting in an inability to attend to feeding, upcoming surgery, and recent trauma to the larynx, mouth or esophagus (just to name a few reasons). These decisions are made routinely and for good reason in hospitals all across the country.
Issues do tend to come up, however.
My point with all these questions is to complicate things, because things are complicated. I think I have good answers to many of these questions, but my answers have come from the last four years of practicing Speech Pathology with adults, digging through the research, and getting expert advice at conferences on dysphagia. Sometimes my answers conflict with the Doctor’s answers, in which case I defer judgement to him or her. Sometimes my answers conflict with the family’s answers, in which case I defer judgement to them after making sure I educate as best I can, as respectfully as I can.
If you are a new clinician and this seems like a tough recommendation to make to the Doctor, then realize that you are right. If you are a family member of a patient that has been made NPO or a patient that has been made NPO, know that for the majority of us that take part in making this decision, it ain’t easy. Even though the process for making my decisions is far more refined than when I started, I never take it lightly.
To deal with those questions I posed, I’d like to list a few articles as food for thought:
Paul E. Marik, M.B., B.Ch., Aspiration Pneumonitis and Aspiration Pneumonia, N Engl J Med 2001; 344:665-671 March 1, 2001.
(I found this free online at http://jewishhospital-cincinnati.com/files/Aspiration_Pneumonitis_and_Pneumonia.pdf)
John R. Ashford, Oral Care Across Ages: A Review, Perspectives on Swallowing and Swallowing Disorders (Dysphagia) March 2012 vol. 21 no. 1 3-8.
Susan E. Langmore, Margaret S. Terpenning, Anthony Schork, Yinmiao Chen, Joseph T. Murray, Dennis Lopatin and Walter J. Loesche, Predictors of Aspiration Pneumonia: How Important Is Dysphagia?, Dysphagia,Volume 13, Number 2, 69-81.
Lori A. Davis Karol K. Rideout University of Tulsa, OK, A Survey of Speech-Language Pathologists’ Criteria To Determine Safety for Oral Intake, Contemporary Issues in Communication Science and Disorders • Volume 29 • 141–145 • Fall 2002.
If you would like to see what aspiration pneumonia looks like, there are some pictures here.
I will also gladly try to answer any specific questions via email.