Effect of timing and method of enteral tube feeding for dysphagic stroke patients (FOOD): a multicentre randomised controlled trial

Abstract

SummaryBackground Undernutrition is common in patients admitted with stroke. We aimed to establish whether the timing and route of enteral tube feeding after stroke affected patients' outcomes at 6 months. MethodsThe FOOD trials consist of three pragmatic multicentre randomised controlled trials, two of which included dysphagic stroke patients. In one trial, patients enrolled within 7 days of admission were randomly allocated to early enteral tube feeding or no tube feeding for more than 7 days (early versus avoid). In the other, patients were allocated percutaneous endoscopic gastrostomy (PEG) or nasogastric feeding. The primary outcome was death or poor outcome at 6 months. Analysis was by intention to treat.Findings Between Nov 1, 1996, and July 31, 2003, 859 patients were enrolled by 83 hospitals in 15 countries into the early versus avoid trial. Early tube feeding was associated with an absolute reduction in risk of death of 5·8% (95% CI -0·8 to 12·5, p=0·09) and a reduction in death or poor outcome of 1·2% (-4·2 to 6·6, p=0·7). In the PEG versus nasogastric tube trial, 321 patients were enrolled by 47 hospitals in 11 countries. PEG feeding was associated with an absolute increase in risk of death of 1·0% (-10·0 to 11·9, p=0·9) and an increased risk of death or poor outcome of 7·8% (0·0 to 15·5, p=0·05).Interpretation Early tube feeding might reduce case fatality, but at the expense of increasing the proportion surviving with poor outcome. Our data do not support a policy of early initiation of PEG feeding in dysphagic stroke patients.

Predictors of Recovery of Functional Swallow After Gastrostomy Tube Placement for Dysphagia in Stroke Patients After Inpatient Rehabilitation: A Pilot Study

“…Although PEG represents a safer and more effective intervention to manage long-term dysphagia [27], the efficacy of its use in the acute phase of stroke recovery (<3 weeks) is disputable [28]. Further research is needed to assess the clinically effective timing of PEG placements to support functional recovery of activity participation (including oral nutrition and hydration) among patients with acute stroke.…”

Symptomatic Treatment of Multiple Sclerosis

“…Mild complications during insertion of a PEG may occur in 13–43% of patients, severe complications in 0.4–8.4%, the mortality reaching 0–2% where the type of disease, age, other risk factors all seem to influence outcome [260]. In patients who required tube feeding within the first 2 or 3 weeks of stroke, fatality and poor outcome were significantly higher for those who were fed via PEG than via a nasogastric tube (class I evidence [265]). After 4 weeks, however, nutrition via a PEG proved to be more effective compared to a nasogastric tube, but was associated with more adverse effects (class I evidence [266]).…”

Electromagnetic Sensor-Guided Enteral Access Systems: A Literature Review

“…Trials that enrolled critically ill patients demonstrated several benefits associated with enteral nutrition including improvements in nitrogen balance, splanchnic blood flow, gastrointestinal mucosal barrier function, mortality among mechanically ventilated patients and length of hospital stay [2, 3, 5, 6]. Evidence is less clear in patients suffering with an acute neurovascular event; protein-energy malnutrition during the first week after an acute stroke increased the risk of death or Barthel index ≤50 on the 30th day of follow-up 3.5-fold, whereas, the FOOD study, although suggesting a modest absolute risk reduction in mortality and poor functional outcome, was not statistically significant (1.2 %, −4.2 to 6.6, p  = 0.7) [7, 8]. …”