Does access to water improve the hydration of patients with dysphagia post-stroke?

Synopsis: Individuals with dysphagia post-stroke are considered to be at risk of inadequate fluid intake and dehydration, especially if their fluid intake is not supplemented non-orally. Offering these patients water in between meals has been suggested as a way of improving fluid intake even if aspiration occurs. A randomized control trial was conducted across three inpatient rehabilitation facilities in Adelaide, SA, which measured the fluid intake, hydration status, specific adverse health outcomes and patient satisfaction for 14 patients with known thin-fluid aspiration. They were randomized to receive either thickened fluids only as per standard practice or a water protocol. Participants in the water protocol group consumed on average 1103 ml (SD 215 ml) per day of which 299 ml (SD274) was water. This was not significantly different to the average intake of participants in the thickened fluids only group (mean = 1103 ml, SD = 247 ml). The hydration results of the water protocol group improved over two weeks as demonstrated by a decreasing urea/creatinine ratio from 91 to 83, whereas the thickened fluids only group deteriorated from 82 to 101. The water protocol group also had fewer adverse health events and faster resolution of their dysphagia. Given there were no increased adverse outcomes, including pneumonia, for those patients with access to water, patients with dysphagia in rehabilitation may benefit from the improved hydration that water facilitates.