Effects of Nasogastric Tubes on the Young, Normal Swallowing Mechanism

Huggins, Phillipa Sarah; Tuomi, Seppo K.; Young, Christopher C.

doi:10.1007/pl00009598

Cited by 74 publications

(52 citation statements)

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“…In der FOOD-Studie fanden sich im Hinblick auf den Endpunkt "Tod nach 6 Monaten" bei 321 dysphagischen Schlaganfallpatienten keine Unterschiede zwischen Ernährung per PEG-und nasogastraler Sonde [65,66] [102]. Zusätzlich zu einer weiteren Studie, die die Veränderungen im Schluckakt bei gesunden Freiwilligen untersuchte [103], führten diese Ergebnisse teilweise zur Annahme, dass eine Dysphagiebehandlung bei nasogastraler Sonde in situ nicht möglich wäre. Drei neuere Studien (2 davon mit Schlaganfallpatienten) bestätigten diese Annahme nicht und ließen keine negativen Auswirkungen der nasogastralen Sondenernährung auf die Schluckfunktion erkennen [52,104,105].…”

Section: Welche Methoden Sollten Für Dasunclassified

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2013

Aktuel Ernahrungsmed

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Aktuel Ernahrungsmed

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“…the wider the tube, the greater the change. 5 Another RCT on normal aging reported an age effect: 6 in the presence of a manometry tube, durational changes were observed amongst all age groups but in the oldest participants they noted an increased frequency of airway 7 penetration while drinking. 6 Observed changes in swallowing patterns in the elderly may be attributed to the effects of aging on the swallowing mechanism, which is already slower, weaker, and more susceptible to airway penetration and aspiration.…”

Section: Introductionmentioning

confidence: 98%

“…Investigations of the impact of pharyngeal tubes (nasogastric or manometry) on the swallowing physiology of healthy volunteers [4][5][6] or clinical populations 7-10 are limited, with considerable methodological variation. To date evidence does not suggest that NGT presence increases aspiration risk [4][5][6][7][8][9][10] however the impact on swallowing physiology and function remains unclear.…”

Section: Introductionmentioning

confidence: 99%

“…To date evidence does not suggest that NGT presence increases aspiration risk [4][5][6][7][8][9][10] however the impact on swallowing physiology and function remains unclear. [4][5][6][7]10 Durational changes (i.e. a change in timing of swallowing events) associated with tube presence have been reported in two studies [5][6] with one (a randomized controlled trial [RCT] on young volunteers) documenting an effect associated with tube sizei.e.…”

Section: Introductionmentioning

confidence: 99%

“…[4][5][6][7]10 Durational changes (i.e. a change in timing of swallowing events) associated with tube presence have been reported in two studies [5][6] with one (a randomized controlled trial [RCT] on young volunteers) documenting an effect associated with tube sizei.e. the wider the tube, the greater the change.…”

Section: Introductionmentioning

confidence: 99%

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Impact of nasogastric tubes on swallowing physiology in older, healthy subjects: A randomized controlled crossover trial

et al. 2015

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Background & Aims:The presence of a nasogastric tube (NGT) affects swallowing physiology but not function in healthy young adults. The swallowing mechanism changes with increasing age, therefore the impact of a NGT on swallowing in elderly individuals is likely to be different but is not yet known. The aims of this study were to determine the effects of NGTs of different diameter on (1) airway penetration-aspiration, (2) pharyngeal residue, and (3) pharyngeal transit, in older healthy subjects. Methods:Randomized controlled crossover design. Healthy elderly volunteers underwent 3 modified barium swallow studies in which multiple diet and fluid consistencies were swallowed under the following conditions: (A) no NGT (control), (B) fine bore NGT, and (C) wide bore NGT. The control condition was assessed first to establish baseline swallowing function, then NGT order was randomly allocated. Results:Of the 15 volunteers (median age 65 years, range 60-81) complete data sets were obtained for 9 (4 with allocation order ABC; 5 with ACB). Wide bore NGT data could not be obtained for 6 volunteers mainly due to tube intolerance. The presence of a NGT was associated with: (i) an increase in airway penetration-aspiration (fine bore NGT with serial liquid swallows and puree) (p<0.01); (ii) increased pharyngeal residue (p<0.05) in the pyriform sinus (fine bore NGT with puree); and in the valleculae (both fine and wide bore NGT with soft solids); and (iii) an increase in pharyngeal transit duration regardless of consistency (p<0.01), with longest swallowing durations with the widest tube. Conclusions:NGT presence increases airway penetration-aspiration, pharyngeal residue and prolongs transit through the pharynx in older healthy individuals. Consideration of NGT impact on swallowing during concurrent oral and enteral feeding is recommended, with 4 further systematic investigation required in elderly patients recovering from critical illness.

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Subclinical dysphagia in persons with Prader–Willi syndrome

Gross

Gisser

Cherpes

et al. 2016

American J of Med Genetics Pt A

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Prader-Willi Syndrome (PWS) is caused by a genetic imprinting abnormality resulting from the lack of expression of the paternal genes at 15q11-q13. Intellectual disability, low muscle tone, and life-threatening hyperphagia are hallmarks of the phenotype. The need for the Heimlich maneuver, death from choking, and pulmonary infection occur in a disproportionally high number of persons with PWS. The widely held belief is that eating behaviors are responsible for choking and aspiration; yet, no investigation had sought to determine if swallowing impairments were present in persons with PWS. To address this research and clinical gap, simultaneous videofluoroscopy and nasal respiratory signals were used to record swallowing function and breathing/swallowing coordination in 30 participants with PWS. Subjects consumed thin liquid and barium cookies under two randomized conditions as follows: (i) controlled (cues to swallow and standardized bolus sizes); (ii) spontaneous (no cues or bolus size control). Under videofluoroscopy, the cohort showed disordered pharyngeal and esophageal swallowing in both conditions with disturbances in timing, clearance, and coordination of swallowing with the respiratory cycle. No participant showed a sensory response such as attempting to clear residue or coughing; thereby supporting the lack of overt symptoms. We conclude that the high death rate from choking and pulmonary infection in children and adults with PWS may be related, in part, to underlying, asymptomatic dysphagia. The combination of rapid eating and dysphagia would increase the risk of aspiration-related morbidity and mortality. © 2016 Wiley Periodicals, Inc.

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Effects of Nasogastric Tubes on the Young, Normal Swallowing Mechanism

Cited by 74 publications

References 12 publications

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Impact of nasogastric tubes on swallowing physiology in older, healthy subjects: A randomized controlled crossover trial

Subclinical dysphagia in persons with Prader–Willi syndrome

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