Abstract / Summary
Abstract Silent aspiration of oropharyngeal secretions is difficult to manage in older adults with cognitive impairment and may contribute to persistent pulmonary infection. A 93-year-old Han Chinese man with mild cognitive impairment developed persistent remittent fever and copious sputum despite 11 days of intensified broad-spectrum antibiotic therapy and frequent passive suctioning. Fiberoptic endoscopic evaluation of swallowing demonstrated severe pooling of saliva in the valleculae and bilateral pyriform sinuses with silent aspiration. Following multidisciplinary assessment, a modified gastric-nasopharyngeal suction catheter was used to provide continuous low-negative-pressure supraglottic secretion drainage while preserving enteral feeding through the main lumen. Body temperature normalized within 24 hours, sputum volume fell from 50-80 mL/day to less than 10 mL/day, and suctioning frequency decreased from 24-30 times/day to no routine suctioning. Procalcitonin and high-sensitivity C-reactive protein subsequently decreased. On Days 21 and 22, temporary occlusion of the suction lumen was accompanied by recurrent fever and increased sputum; clinical stability returned after catheter patency was restored. The catheter remained in place for 34 days without documented mucosal injury. No catheter-related adverse events were observed during the observation period. This case suggests that continuous supraglottic secretion drainage may represent a feasible adjunctive approach for selected non-ventilated patients with persistent silent aspiration. Clinical trial registration Not applicable (single case report).