Findings of Videofluoroscopic Swallowing Studies AreAssociated with Tube Feeding Dependency at Discharge in StrokePatients with Dysphagia

Lin, Yi-Nien; Chen, Ssu-Yuan; Wang, Tyng-Guey; Chang, Yeun‐Chung; Chie, Wei‐Chu; Lien, I-Nan

doi:10.1007/s00455-004-0021-6

Cited by 9 publications

(21 citation statements)

References 35 publications

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“…We also noted that the weaned group was younger than the nonweaned group; however, this difference was not strong enough to achieve statistical significance. In contrast to previous studies [ 8 ], no significant association was observed between prior stroke and nasogastric tube removal ( P value = 0.55); however, functional status before this stroke was statistically different ( P value = 0.03).…”

Section: Discussioncontrasting

confidence: 99%

“…In our study, the rate of nasogastric tube removal was 45.8%. This finding is in agreement with those of other studies, in which the weaned rate was 31–74% [ 1 , 8 – 10 ]. Previous studies have reported that younger patients were more likely to have tube feeding removed before discharge compared with older patients [ 1 , 9 ].…”

Section: Discussionsupporting

confidence: 94%

“…Our finding that type of stroke (infarct or hemorrhage) had no significant effect on nasogastric tube removal in patients with dysphagia is similar to those of previous studies [ 8 , 11 ]. Several studies have shown no significant association between the lateralization of brain injury and dysphagia [ 11 , 12 ].…”

Section: Discussionsupporting

confidence: 92%

“…We describe two studies similar to ours. One used FIM-motor, FIM-cognition, days after onset and age to construct the equation [ 10 ]; the other used the findings of video-fluoroscopic swallowing studies (VSS), age, prior stroke, duration from stroke onset to receive VSS and functional status at discharge [ 8 ]. We used the Barthel index at admission, lip closing status, ability to answer simple questions and functional independence before stroke to construct the equation in our study.…”

Section: Discussionmentioning

confidence: 99%

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Predictors of nasogastric tube removal in patients with stroke and dysphagia

Lee¹,

Liu²,

Tzeng

et al. 2021

International Journal of Rehabilitation Research

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Dysphagia is present in 25–50% of patients with stroke. Therefore, studying the probability of nasogastric tube removal in such patients before discharge from the rehabilitation ward is crucial. In this study, we developed a model to predict the outcome of dysphagia in patients with stroke. A retrospective study was performed from May 2015 to December 2018. We reviewed the medical charts of all patients with a diagnosis of stroke receiving nasogastric tube feeding. Patients were divided into weaned and nonweaned groups to compare baseline characteristics and functional status. The weaned and nonweaned groups comprised 55 and 65 patients, respectively. In the final logistic regression analysis model, the Barthel index at admission, lip closing status, ability to answer simple questions and functional independence before stroke were used to develop a predictive model (Logit = 0.8942 × functional independence before this stroke + 1.1279 × ability to answer simple question + 0.5345 × lip-close status + 0.0546 × Barthel index at admission − 2.2805). The optimal cutoff point based on Youden’s index was more than −0.8403 with a sensitivity and specificity of 85.45 and 73.85%, respectively. The positive predicted value was 73.44%. In patients with stroke and dysphagia, a high Barthel index, intact lip closing status, ability to answer simple questions and better functional status before stroke appeared to affect nasogastric tube removal before discharge from the rehabilitation ward. Based on the final regression model, the proposed equation will help physicians and speech pathologists in planning patient care.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionsupporting

confidence: 94%

Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

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Predictors of nasogastric tube removal in patients with stroke and dysphagia

Lee¹,

Liu²,

Tzeng

et al. 2021

International Journal of Rehabilitation Research

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“…Ickenstein et al (8) found that one-third of patients (31.2%; 24/77) underwent PEG removal before discharge and resumed oral diets. Lin et al (9) reported that 25.9% of the 181 patients with stroke underwent PEG removal at discharge. Kim et al's study (10) provided promising results.…”

mentioning

confidence: 99%

Can non-swallowing function assessment predict nasogastric tube removal in patients with poststroke dysphagia? A clinical study

Zhang²,

Zhao³

et al. 2023

Front. Neurol.

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ObjectiveThis study aimed to predict nasogastric tube (NGT) removal in patients with poststroke dysphagia (PSD) by non-swallowing function assessment.MethodsWe enrolled 232 eligible patients and performed rehabilitation. The Fugl-Meyer assessment motor (FMM) and National Institute of Health Stroke Scale (NIHSS) scores were used to measure the motor and overall nervous system functions. Predictors for NGT removal in patients with PSD after rehabilitation were analyzed.ResultsOf the 232 included patients, the NGTs were removed from 78% of them, while 22% were dependent on a feeding tube after 4 weeks of rehabilitation. Compared to the preserved NGT group, older age, a higher rate of intubation or tracheostomy, and more severe baseline functions were found in the NGT removal group. Age [odds ratio (OR) = 0.907; 95% confidence interval (CI): 0.859–0.957; p = 0.000], difference in the FMM score after 4 weeks of rehabilitation (OR = 1.219; 95% CI: 1.145–1.299; p = 0.00), and item 9 of NIHSS (OR = 0.488; 95% CI: 0.252–0.946; p = 0.034) were predictors of NGT removal after rehabilitation.ConclusionWe established a predictive model in patients with PSD using a non-swallowing assessment, which enabled us to predict swallowing recovery based on the non-swallowing function.

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Tracheostomy in Stroke Patients

Bösel

2013

Curr Treat Options Neurol

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Patients with severe ischemic and hemorrhagic stroke may require tracheostomy in the course of their disease. This may apply to stroke unit patients whose deficits include a severe dysphagia posing such risk of aspiration as it cannot be sufficiently counteracted by tube feeding and swallowing therapy alone. More often, however, tracheostomy is performed in stroke patients so severely afflicted that they require intensive care unit treatment and mechanical ventilation. In these, long-term ventilation and prolonged insufficient airway protection are the main indications for tracheostomy. Accepted advantages are less pharyngeal and laryngeal lesions than with prolonged orotracheal intubation, better oral hygiene and nursing care, and higher patient comfort. Optimal timing of tracheostomy is unclear, in general, as in stroke intensive care unit patients. Potential benefits of early tracheostomy concerning ventilation duration and length of stay, respirator weaning, airway safety, rate of pneumonia, and other complications, outcome and mortality have been suggested in studies on non-neurologic subgroups of critical care patients. Stroke patients have hardly been investigated with regard to these aspects, and mainly retrospectively. A single randomized pilot trial on early tracheostomy in 60 ventilated patients with severe hemorrhagic and ischemic stroke demonstrated feasibility, safety, and less need of sedation. Regarding the technique, bedside percutaneous dilational tracheostomy should be preferred over surgical tracheostomy because of several reported advantages. As the procedural risk is low and early tracheostomy does not seem to worsen the clinical course of the ventilated stroke patient, it is reasonable to assess the need of further ventilation at the end of the first week of intensive care and proceed to tracheostomy if extubation is not feasible. Reliable prediction of prolonged ventilation need and outcome benefits of early tracheostomy, however, await further clarification. Decannulation of stroke patients after discontinued ventilation has to follow reliable confirmation of swallowing ability, as by endoscopy.

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Findings of Videofluoroscopic Swallowing Studies AreAssociated with Tube Feeding Dependency at Discharge in StrokePatients with Dysphagia

Cited by 9 publications

References 35 publications

Predictors of nasogastric tube removal in patients with stroke and dysphagia

Predictors of nasogastric tube removal in patients with stroke and dysphagia

Can non-swallowing function assessment predict nasogastric tube removal in patients with poststroke dysphagia? A clinical study

Tracheostomy in Stroke Patients

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