The implementation of thickened fluids in patients with dysphagia is widely considered an effective strategy for safe and physiologically improved swallow. However, there is limited evidence to suggest that this intervention reduces the risk of dysphagia-related complications including aspiration pneumonia. In addition, there is growing evidence that this approach is associated with adverse clinical effects including dehydration, malnutrition and reduced health-related quality of life. This review summarises the rationale for thickened fluids, the evidence base (or lack thereof) underpinning their use, and current guideline recommendations.Educational aimsTo review the evidence base for thickened fluids in the management of dysphagia.To examine the evidence that thickened fluids reduce aspiration pneumonia.To provide an overview of the advantages and disadvantages of thickened fluids in the management of dysphagia.

The implementation of thickened fluids in patients with dysphagia is widely considered an effective strategy for safe and physiologically improved swallow. However, there is limited evidence to suggest that this intervention reduces the risk of dysphagia-related complications including aspiration pneumonia. In addition, there is growing evidence that this approach is associated with adverse clinical effects including dehydration, malnutrition and reduced health-related quality of life. This review summarises the rationale for thickened fluids, the evidence base (or lack thereof) underpinning their use, and current guideline recommendations. Educational aims To review the evidence base for thickened fluids in the management of dysphagia. To examine the evidence that thickened fluids reduce aspiration pneumonia. To provide an overview of the advantages and disadvantages of thickened fluids in the management of dysphagia. Despite being a commonly prescribed treatment, there is limited evidence to support the benefits of thickened fluids in the treatment of dysphagia. This disconnect highlights the importance of a considered approach when prescribing this intervention. https://bit.ly/3a2BDwD

Hypertensive response to exercise (HTR - peak systolic blood pressure (BP) ≥190 mmHg in women; ≥220 mmHg in men during exercise) contributes to the development of HFpEF and subsequent exercise intolerance. This study assesses the reliability of non-invasive (NI) BP monitoring for the diagnosis of HTR in suspected HFpEF patients undergoing exercise right heart catheterisation (ExRHC). Methods: Data from 12 patients with suspected HFpEF undergoing ExRHC were retrospectively analysed. BP was recorded simultaneously from invasive radial arterial monitoring (IBP) and NI cuff measurements. 6 patients met HTR criteria from IBP monitoring, and 6 did not (non-HTR). BP at rest and peak exercise in the HTR and non-HTR subgroups were correlated and also analysed for agreement using the Bland-Altman method and plotted graphically as shown. Results: NIBP monitoring detected HTR in only 2 of 6 (33%) cases. Poor correlation between IBP and NIBP at exercise in HTR is demonstrated from Pearson correlation coefficient analysis: Non-HTR – rest r = 0.88; exercise r = 0.87 – HTR: rest r = 0.81; exercise r = 0.44. Agreement between measurement techniques diverges at peak exercise; with this discrepancy exaggerated in patients with HTR. Conclusion: Invasive BP monitoring may be required to accurately diagnose HTR in this patient cohort, and its use could be considered during ExRHC.