Slow recruitment (preemptive treatment of gurglers, after association was published)

Hospital inpatients who have gurgling sounds heard during speech or breathing have been observed to have a higher risk of hospital acquired pneumonia. Patients who gurgle and who consent to participation will be randomized to receive routine clinical management or management to include measures employed to reduce risks of aspiration, namely, 1. head of bed up (30 degrees or higher), 2. swallowing evaluation by speech therapist (and feeding predicated on formal evaluation), 3. prompting managing physicians to reduce sedating medications to minimal effective dose.

Inclusion Criteria:

• Gurglers who consent to participate

Exclusion Criteria:

• Non-gurglers
• Patients presenting with pneumonia prior to identification with gurgling
• Patients receiving comfort-care-only