How Do Thick Purees Perform in Terms of Safety and Efficacy in Hospitalized Patients With Swallowing Impairments?

The therapeutic effect and optimal rheological properties of thick purees for hospitalized patients with oropharyngeal dysphagia (OD) have not yet been settled.

The objectives of this study were to (a) Quantify the rheological properties of 6 thick purees Texture C, BDA; (b) Determine the biomechanics of oral processing and its effect on the rheological properties; (c) Evaluate the safety and efficacy of swallowing the purees in patients with OD.

Six pureed dishes (30 g) were given to 20 patients with OD aged 84 ± 7.2 years. Oral processing was measured using electromyography. Rheological and textural properties were analyzed before and after oral processing using a rheometer and texture analyzer. The safety and efficacy of swallowing were evaluated using the Volume-Viscosity Swallow Test (V-VST).

All dishes met Texture C BDA. Basal shear viscosity at 50s-1 ranged from 1200 to 2200 mPa·s; maximum force, 0.47-0.67 N; cohesiveness, 0.73-0.82; and adhesiveness, 0.77-1.1 N·s. Oral processing reduced shear viscosity and maximum force without altering cohesiveness. To achieve bolus ready-to-swallow, 17-20 mastication cycles (MC) and 15-22 s at 0.98-1.44 MC/S frequency were needed. All purees were significantly safer to swallow (98%-100%) compared to thin liquids (87%) (p < 0.001) and 250 mPa·s nectar fluids (94% p < 0.008). Oral residue prevalence increased to 28% and pharyngeal residue to 21% for purees. Palatability resulted in 40%-60% liking all dishes.

This study shows that thick purees within a viscosity range of 1200-2200 mPa·s are a safe treatment for nutritional support for most hospitalized older patients with oropharyngeal dysphagia.