Silent Aspiration

If a patient is a silent aspirator...how would you know when to upgrade their diet? Xray shows lower right lobe infiltrates but patient presents with no signs or symptoms otherwise. Would I need to do another VSS? Deficit is reduced posterior tongue retraction causing vallecular pooling. Implemented chin tuck, effortful swallow, and alternating solids and liquids. PLOF was regular, patient is now on m/s. Reason for hospitalization is hip fracture. Thanks for help!
Yes, would need another instrumental exam like a VSS. Otherwise, work on exercises until then.
Usually yes another VFSS is indicated, except you have to take each of these on a case by case basis. What is the etiology of the dysphagia? Was aspiration before/during/after the swallow? They're here for a hip fracture.. so, how's the current mental status? If they were previously on regular/thins, what else could be causing dysphagia? How bad was the aspiration on the study? What is the rest of their overall level of function and pulmonary status? Are they showing developing pna or just the infiltrates? Were there any cued strategies that compensated for the silent aspiration seen on the study? If they were only downgraded to mechanical soft (with thins i presume?) based on the last MBSS which showed silent aspiration, then I assume their swallow was actually not that bad. Some folks tolerate some amount of (silent) aspiration and because their overall health and pulm fxn is fairly good, they'll do OK (until some other thing like a UTI or any other decompensation hits them, then they tank). You can do another swallow study, but what if they still silently aspirate? Then what does the study do for your clinical management? If there was some reason to put the pt on nectars, or if I saw on the first study that compensatory strategies were effective in reducing the aspiration, then I can see why repeating the study would be helpful after a course of treatment to see if any of the restrictions for PO could be lifted. But based on the recs of the study, I might also just watch the pt closely (lungs, WBC, fever, mental status, overall status/improvement) to help me make decisions. Also can really depend what setting you're in and what your resources are.
What liquid consistency is this patient on?

Were the chin tuck, effortful swallow or alternating solids liquids effective to eliminate aspiration?

Im assuming aspiration after the swallow of residuals? I'd like to assume this patient didn't aspirate regular and that's why they're on mechanical soft!



Do not upgrade
The patient is aspirating. Right lower lobe infiltrates are consistent with aspiration.