Effect of tube feeding method on establishment of oral intake in stroke patients with dysphagia: comparison of intermittent tube feeding and nasogastric tube feeding

Abstract

Purpose: To compare the effects of two tube feeding management methods; nasogastric tube feeding and intermittent tube feeding, implemented during the process of rehabilitation for dysphagia due to cerebrovascular disorders on the outcome of oral intake. Methods: Dysphagic patients who were admitted to convalescent rehabilitation wards because of cerebrovascular disorders were divided into two groups: 398 patients who underwent nasogastric tube feeding (NG group) and 114 patients who underwent intermittent tube feeding (ITF group). The two groups were compared with respect to outcome of dysphagia rehabilitation. Results:The proportion of patients who were able to meet nutrition needs by oral intake of three meals alone at discharge was significantly higher in the ITF group than in the NG group (71% versus 53%, p = 0.0007). The proportion of patients showing improvement in food intake level scale (FILS) during hospitalization was also significantly higher in the ITF group (p = 0.007). The mean duration from admission to start of direct training was significantly shorter in the ITF group than in the NG group (9.6 ± 13.9 days versus 19.1 ± 25.8 days, p = 0.001). The mean duration from admission to start of oral food intake was also significantly shorter in the ITF group than in the NG group (20.1 ± 26.4 days versus 27.3 ± 31.8 days, p = 0.049). Conclusion:The results in this study suggest that tube feeding management using ITF achieves better outcome of dysphagia rehabilitation compared to using NG.

Multicenter survey of dysphagia and nutritional status of stroke patients in Kaifukuki (convalescent) rehabilitation wards

“…It is possible that the implementation rate of indirect and direct swallowing training as well as the involvement of multidisciplinary personnel may have some effects. In addition, considering that another report showed a higher rate of transition to oral intake in patients who received intermittent tube feeding compared to patients receiving nasogastric tube feeding [21], 12% of the patients in the present study were on intermittent tube feeding and this may have also affected the result. In addition, the interquartile range of the time of starting oral intake of three meals in this study was 17 to 61 days, showing that some patients achieved oral intake of three meals more than 2 months after admission to KRW.…”

History, application, procedures, and effects of intermittent oral catheterization (IOC)

“…Oral intake of regular meals was highest in patients fed via IOC (54.5%), slightly lower in those fed via CNG (36.7%) and lowest in those fed via gastrostomy (12%). Sugawara et al [32] classified dysphagia patients who were hospitalized in a convalescent or rehabilitation institute due to a cerebrovascular disease into those who Staining showing severe belt-like ulcers (grey areas; Class D in the Los Angeles Classification) in many places. Inflamed mucous membrane (red) looks red due to the increased transparency of blood vessels.…”

“…According to a 2005 questionnaire survey by the Japan Society of Dysphagia Rehabilitation, IOC was used in only 4% of all the facilities surveyed (81 facilities including 66 hospitals). IOC had just started to receive the attention of advanced hospitals in swallowing rehabilitation, and the results of a comparative study on ITF (IC) including IOC and CNG were published in 2015 [32]. However, IOC is not included in the options for alternative nutrition.…”