Linking the impact of aspiration to host variables using the BOLUS framework: support from a rapid review.
Phyllis M Palmer, Aaron H Padilla
PMID 39071771WHAT IT FOUND
Poor oral health and the presence of feeding or tracheostomy tubes strongly increase the risk of pulmonary complications in patients with aspiration.
However, there is insufficient evidence to link aspiration of thick liquids to pneumonia or to predict mortality, so decisions on diet texture and NPO status remain complex.
Key findings
01Strong evidence supports that poor oral health and the presence of tubes in the oropharynx increase the risk of pulmonary adverse events.
02The rapid review found insufficient evidence to determine if aspiration of thick or dense materials increases the risk of pulmonary consequences or mortality.
03There is insufficient evidence to confirm a linkage between oral health or oral care and survival rates in individuals who aspirate.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The rapid review methodology missed key articles known to the authors, including 97% of the references from their original framework paper. No studies were identified for the 'System health' component of the BOLUS framework, leaving a major gap in the evidence. Many categories (Lifestyle, Unintended risks) had very few data points (3 each), limiting the strength of conclusions. The authors state the conclusions must be viewed in combination with the wider literature due to the small number of studies included.
Declared interests
The authors declare no financial support was received for the research, authorship, and/or publication of this article.
The easy way to misread this
Do not interpret the lack of strong evidence for thick liquids as proof that they are safe or that thin liquids are dangerous. The review found insufficient data to confirm a link between bolus thickness and pulmonary outcomes, meaning texture choices cannot be justified by this specific evidence base alone.