This case involves a seventy-nine-year-old male patient who was receiving care at an assisted living facility following a stroke. The patient had a history of COPD and mild dementia but his family stated that he was generally alert, communicative, and social with friends at the nursing home. The patient was taken to a local hospital for an exacerbation of COPD and had an admitting diagnosis of pneumonia with acute respiratory distress. During the hospitalization, the patient became increasingly confused and agitated and the neurologist on staff diagnosed the patient with septic encephalopathy. The patient was hospitalized for two weeks with minimal improvement of symptoms, but medical plans called for him to be discharged back to the senior living facility after chest imaging was performed. The patient arrived at the nursing home and was evaluated by in-house physicians that addressed mucous build up issues and the inability of the patient to swallow or eat. The patient’s condition continued to deteriorate and he was transferred back to the hospital where he was scheduled for a lung aspiration procedure. The patient died before the procedure could be performed and the cause of death was reported as aspiration pneumonia.
Question(s) For Expert Witness
- 1. How could this case of aspiration pneumonia have been prevented?
Expert Witness Response E-001516
It is important to position patients with altered consciousness in a semirecumbent position with the head of the bed at a 30-45° angle. This reduces the risk of aspiration leading to pneumonia. For patients with known swallowing dysfunction (eg, dysphagia and/or a poor gag reflex), helpful compensatory techniques to reduce aspiration include a soft diet reducing the bite size, keeping the chin tucked and the head turned, and repeated swallowing. Although body positioning and changing the consistency of food are reasonable steps, their efficacy has not been proven in controlled trials. In addition, feeding through a nasogastric or gastric tube may be required for patients suffering from recurring aspiration episodes. Feedback provided by a medical malpractice expert witness.