Nil per os in the management of oropharyngeal dysphagia-exploring the unintended consequences.
Michelle Cimoli, Jennifer Gibney, Mathew Lim and 2 others
PMID 38957683WHAT IT FOUND
Nil per os (NPO) does not reliably prevent aspiration pneumonia and causes significant harm, including dehydration, muscle wasting, and reduced quality of life.
Clinicians should avoid using NPO as a default intervention and instead weigh the transfer of risk to other body systems.
Key findings
01Observational studies show NPO does not prevent aspiration pneumonia, with patients in NPO groups still developing the condition.
02NPO leads to dehydration, malnutrition, and muscle atrophy, which can worsen swallowing function and increase mortality.
03Patients on NPO frequently experience thirst, psychological distress, and loss of social connection, impacting overall well-being.
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
This is a narrative review, not a systematic review or meta-analysis, so the selection of studies may be subject to author bias. There are no randomized controlled trials directly comparing NPO to oral feeding for aspiration prevention, so the evidence relies on observational data. The review synthesizes existing literature but does not present new primary data.
The easy way to misread this
Do not assume NPO is a safe 'holding pattern' while awaiting further assessment. The review indicates that even short periods of NPO can cause rapid dehydration and muscle loss, which may worsen swallowing function and increase overall health risks.