The Difference between Ideal and Actual Fasting Duration in the Treatment of Patients with Aspiration Pneumonia: A Nationwide Survey of Clinicians in Japan

The Difference between Ideal and Actual Fasting Duration in the Treatment of Patients with Aspiration Pneumonia: A Nationwide Survey of Clinicians in Japan

TSUNEAKI KENZAKA,^1,2 KOKI KOSAMI,² YASUFUMI MATSUOKA,^2,3 AYAKO NODA⁴ and AYAKO KUMABE²

¹Division of Community Medicine and Career Development, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
²Division of General Medicine, Center for Community Medicine, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan
³Department of General Medicine, National Health Insurance Ooma Hospital, Ooma, Aomori, Japan
⁴Department of General Medicine and Primary Care, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan

In Japan, aspiration pneumonia is common among the elderly and patients are often treated by temporary discontinuation of meals. However, there are few published studies on the fasting duration for aspiration pneumonia treatment. Therefore, we conducted the present study to assess the opinions of clinicians regarding the fasting duration for the treatment of patients with aspiration pneumonia and the actual medical practice with regard to oral ingestion in hospitalized patients with aspiration pneumonia. We targeted hospitals with internal medicine and respiratory medicine departments across Japan. A questionnaire regarding the fasting duration for aspiration pneumonia treatment and oral ingestion in hospitalized patients with aspiration pneumonia was mailed to physicians treating patients with pneumonia at 2,490 hospitals. We received appropriate responses from 350 facilities (response rate, 14.1%). Most clinicians (78.3%) responded that it best to keep the fasting duration for treatment as short as possible and considered that fasting is absolutely unnecessary. Regarding oral ingestion in hospitalized patients, more than 25% of clinicians restricted oral intake for a certain number of days. The majority of these clinicians (53.3%) preferred prolonged fasting for 3 to 7 days. Although most physicians preferred the fasting duration to be as short as possible, there was a difference between the ideal and actual scenarios in reintroducing oral intake early in patients with aspiration pneumonia. Improving physicians' knowledge and experience will bridge the gap between the ideal situation and what currently occurs. Further studies should investigate the acceptable fasting duration for the treatment of aspiration pneumonia.

keywords —— aspiration pneumonia, fasting, general internal physicians, respiratory specialists, reintroduce oral ingestion

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Tohoku J. Exp. Med., 2016, 240, 227-233

Correspondence: Tsuneaki Kenzaka, Division of Community Medicine and Career Development, Kobe University Graduate School of Medicine, 2-1-5 Arata-cho, Hyogo-ku, Kobe, Hyogo 652-0032, Japan.

e-mail: smile.kenzaka@jichi.ac.jp