Why I Like the Free Water Protocol In this opinion piece, I present my major reasons for advocating for the free water protocol (FWP). Although there is a lack of strong direct evidence in support of the FWP, there are multiple bits of indirect evidence supporting it: patients do not like thick liquids and avoid them; thick ... Article
Article  |   December 01, 2011
Why I Like the Free Water Protocol
Author Affiliations & Notes
  • Susan E. Langmore
    Boston University Medical Center and Speech Language and Hearing Sciences at Boston University, Boston, MA
Article Information
Swallowing, Dysphagia & Feeding Disorders / Articles
Article   |   December 01, 2011
Why I Like the Free Water Protocol
SIG 13 Perspectives on Swallowing and Swallowing Disorders (Dysphagia), December 2011, Vol. 20, 116-120. doi:10.1044/sasd20.4.116
SIG 13 Perspectives on Swallowing and Swallowing Disorders (Dysphagia), December 2011, Vol. 20, 116-120. doi:10.1044/sasd20.4.116

In this opinion piece, I present my major reasons for advocating for the free water protocol (FWP). Although there is a lack of strong direct evidence in support of the FWP, there are multiple bits of indirect evidence supporting it: patients do not like thick liquids and avoid them; thick liquids are more harmful to the lungs than are thin liquids; feeding tubes are associated with high rates of pneumonia; and thin liquids, especially water, are relatively benign to the lungs. We need solid evidence in the form of a randomized clinical trial, but, in the meantime, decisions regarding allowing free water to patients who aspirate this consistency should be made on a case-by-case basis.

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