Dysphagia and tube feeding after stroke are associated with poorer functional and mortality outcomes

Souza, Juli Thomaz de; Ribeiro, Paulo Domingos; Paiva, Sérgio Alberto Rupp de; Tanni, Suzana Erico; Minicucci, Marcos F.; Zornoff, Leonardo A. M.; Polegato, Bertha Furlan; Bazan, Silméia Garcia Zanati; Módolo, Gabriel Pinheiro; Bazan, Rodrigo; Azevedo, Paula Schmidt

doi:10.1016/j.clnu.2019.11.042

Cited by 48 publications

(53 citation statements)

References 29 publications

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“…In addition, the patient can pull out the gastric tube after intermittent tube feeding, without worrying about the impact of indwelling nasogastric tube on training and uncomfortable problems, so that the digestive tract can maintain a normal physiological structure, and other swallowing rehabilitation training can be routinely performed (36). At the same time, intermittent tube feeding avoids the disadvantages of continuously indwelling a nasogastric tube, such as delays in raising the larynx and incomplete closure of the esophageal sphincter, thereby further promoting the recovery of swallowing function in stroke patients with dysphagia (37). However, the intermittent tube feeding may also have many disadvantages, it requires frequently tube insertion and removal, which will increase the workload of nurses and cost of tube expense.…”

Section: Discussionmentioning

confidence: 99%

Intermittent tube feeding for stroke patients with dysphagia: a meta-analysis and systematic review

Wu¹,

Zhu²,

Zhou³

et al. 2021

Ann Palliat Med

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Background: Nutrition supports is essential to the prognosis of stroke patients with dysphagia. It's necessary to evaluate the effects and safety of intermittent tube feeding for stroke patients with dysphagia, to provide evidence for the management of dysphagia.Methods: Cochrane Library et al. databases were searched for randomized controlled trials (RCTs) on the intermittent tube feeding for stroke patients with dysphagia up to Feb 15, 2021. Bias risk assessment tool recommended by Cochrane was used for quality assessment, and Revman5.3 software was used for data analysis.Results: A total of 11 RCTs involving 762 stroke patients with dysphagia were included. Meta-analysis indicated that intermittent tube feeding could significantly increase the rate of dysphagia function

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Section: Discussionmentioning

confidence: 99%

Intermittent tube feeding for stroke patients with dysphagia: a meta-analysis and systematic review

Wu¹,

Zhu²,

Zhou³

et al. 2021

Ann Palliat Med

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“…Nearly half of the elderly in Spain (47.4%) who are over 70 years old experienced dysphagia (4). Dysphagia can lead to complications, such as aspiration pneumonia; dehydration; and malnutrition (1, 2, 4, 6, 10, 20, 24), which in turn can lead to prolonged hospital stay; psychological disorders such as stress, anxiety, and depression; decreased quality of life; increased health costs; increased mortality and decreased patient outcomes after stroke (8). Management of dysphagia patients is carried out by a multidisciplinary team approach, consisting of doctors, nurses, speech therapists, occupational therapists, and nutritionists.…”

Section: Dysphagiamentioning

confidence: 99%

“…However, in some patients dysphagia will improve spontaneously within one week after the attack, about 50% will persist for up to six months, and a small proportion will be permanent. A study conducted by Souza et al showed that stroke patients with dysphagia and had nasogastric tube increased the risk of disability (OR: 14,97); CI: 2.68-83.65; p = 0.002) and mortality (OR: 9.79; CI: 2.21-43.4; p = 0.003) within 90 days after stroke (8) Dysphagia screening can detect swallowing problems early in acute stroke patients and prevent aspiration or other complications such as dehydration or nutritional problems. According to the recommendations of the American Heart Association (AHA) / American Stroke Association, screening for dysphagia should be performed in all acute stroke patients before giving the patient any food, water, or an oral medicine.…”

Section: Introductionmentioning

confidence: 99%

“…The physiological swallowing process consists of three phases, namely the oral, pharyngeal, and esophageal phases. Approximately 65-90% of dysphagia patients experience disturbances in the oropharyngeal phase, changes in lung function, risk of aspiration, nutrition, and quality of life (8). However, in some patients dysphagia will improve spontaneously within one week after the attack, about 50% will persist for up to six months, and a small proportion will be permanent.…”

Section: Introductionmentioning

confidence: 99%

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<strong></strong>Dysphagia Screening Protocol For Acute Stroke Patient: A Literature Review

Mulyatsih¹,

Pandin²

2021

Preprint

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Background: Nearly two-thirds of acute stroke patients have dysphagia. Dysphagia defined as difficulty in swallowing of liquids or food, vary in severity with symptoms ranging from mild throat discomfort to inability to eat. It’s well known that dysphagia is associated with aspiration pneumonia, dehydration, malnutrition, prolonged length of stay, and increased mortality. Early screening reduces pneumonia rates in stroke and it is usually performed by nurses. Dysphagia screening is recommended but no protocol or tool is pointed.Aim: the aim of this study is to conduct a literature review of dysphagia screening for stroke patient Methods: Literature search three databases (Scopus, Proquest, and Science Direct), with the keywords "Dysphagia" AND "Stroke" AND "Nursing", published in English between 2019 and 2021. Result: Twenty five publications relating to dysphagia screening met the inclusion criteria. There are five methods of dysphagia screening performed by nurses or other health workers: 1) a simple Questionnaire Test (4QT) method, which is by asking the following four questions: does the patient cough or choke while eating or drinking; whether the patient takes longer than usual to eat; does the patient change the thickness of the food to be able to swallow, and whether the voice turns hoarse after eating or drinking; 2) Water Swallow Test (WST) method; 3) Bed Side Screening Tool for Dysphagia (BSTD) method; 4) Volume Viscosity Swallow Test (V-VST) method, namely modification of feeding with first pudding, nectar and finally water; 5) Simplified Cough Test Method. The five screening methods for dysphagia above have been tested for sensitivity and specificity, as well as positive and negative predictive valuesConclusion: screening is a first step in the identification of swallowing impairment or dysphagia of stroke patient. Dysphagia is an independent predictor of poor patient outcome and prolonged recovery time. Nurse has an important role to conduct a screening and must ensure that the selected tools has high reliability and concurrent validity. Key Words: Stroke, Dysphagia, Screening, Nursing

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“…Dysphagia is a common complication of stroke, with an incidence rate of 65%–90%. 1 Studies have shown that dysphagia after stroke causes malnutrition in patients and can easily lead to aspiration pneumonia and even asphyxiation in severe cases. 2 , 3 Dysphagia further reduces the quality of life of these patients, increases the risk of death, slows the recovery of body function, and significantly prolongs hospitalization.…”

Section: Introductionmentioning

confidence: 99%

Analysis of Factors That Influence the Prognosis of Swallowing Function Rehabilitation Therapy in Patients with Dysphagia After Medullary Infarction

Zhang¹,

Li²,

Li³

et al. 2022

NDT

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Purpose This study investigated the factors that influence the prognosis of swallowing function rehabilitation therapy in patients with dysphagia after medullary infarction. Patients and Methods This retrospective study was conducted using the clinical data of 51 patients who were diagnosed with dysphagia after medullary infarction and hospitalized at our institution between January 2019 and January 2021. As per the water swallow test (WST) grade at 1 month after rehabilitation treatment, patients were classified into the good prognosis group and the poor prognosis group. Univariate analysis as well as univariate and multivariate logistic regression analysis were used to analyze factors that influence the prognosis of swallowing function rehabilitation therapy in patients with dysphagia after medullary infarction. Receiver operating characteristic (ROC) curves were then used to test the predictive ability of the significant parameters to predict the prognosis of the rehabilitation therapy in these patients. Results Univariate analysis and univariate logistic regression analysis showed that previous stroke (odds ratio [OR] = 1.361), dysarthria (OR = 3.771), disease course (OR = 1.112), National Institutes of Health Stroke Scale (NIHSS) score at admission (OR = 2.596), and infarct site (OR = 11.071) were all significantly correlated with the prognosis of swallowing function rehabilitation therapy in patients with dysphagia after medullary infarction ( P < 0.05). Multivariate logistic regression analysis showed that dysarthria (OR = 5.519, 95% confidence interval (CI) 1.413–21.566), infarct site (OR = 18.634, 95% CI 1.696–204.73), and the NIHSS score (OR = 1.001, 95% CI 1.536–4.820) were independent influencing factors of the prognosis of swallowing function rehabilitation therapy in these patients. The ROC curve showed that the area under the curve for the combined prediction of the three indicators was 0.943. Conclusion The NIHSS score, dysarthria, and infarct site are independent influencing factors for the prognosis of swallowing function rehabilitation therapy in patients with dysphagia after medullary infarction.

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Dysphagia and tube feeding after stroke are associated with poorer functional and mortality outcomes

Cited by 48 publications

References 29 publications

Intermittent tube feeding for stroke patients with dysphagia: a meta-analysis and systematic review

Intermittent tube feeding for stroke patients with dysphagia: a meta-analysis and systematic review

<strong></strong>Dysphagia Screening Protocol For Acute Stroke Patient: A Literature Review

Analysis of Factors That Influence the Prognosis of Swallowing Function Rehabilitation Therapy in Patients with Dysphagia After Medullary Infarction

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