Recommendation of Nasogastric Tube Removal in Acute Stroke Patients Based on Videofluoroscopic Swallow Study
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Objective To evaluate the safety of nasogastric tube (NGT) removal and change to oral feeding with a food thickener for acute stroke patients in whom a videofluoroscopic swallow study (VFSS) confirmed thin liquid aspiration.Methods We retrospectively examined data of 199 patients with first stroke who were diagnosed with dysphagia from 2011 to 2015. Swallowing function was evaluated using VFSS. Patients included in this study were monitored for 4 weeks to identify the occurrence of aspiration pneumonia. The penetration-aspiration scale (PAS) was used to assess VFSS findings. The patients were divided into thin-liquid aspiration group (group 1, n=104) and no thin-liquid aspiration group (group 2, n=95).Results The feeding method was changed from NGT feeding to oral feeding with food thickener (group 1) and without food thickener (group 2). The PAS scores of thin and thick liquids were 6.46±0.65 and 1.92±0.73, respectively, in group 1 and 2.65±0.74 and 1.53±0.58, respectively, in group 2. Aspiration pneumonia developed in 1.9% of group 1 and 3.2% of group 2 (p=0.578), with no significant difference between the groups.Conclusion We concluded that removing the NGT and changing to oral feeding with a food thickener is a safe food modification for acute stroke patients with thin liquid aspiration. Therefore, we recommend that VFSS should be conducted promptly in acute stroke patients to avoid unnecessary prolonged NGT feeding.
Abstract
Objective To evaluate the safety of nasogastric tube (NGT) removal and change to oral feeding with a food thickener for acute stroke patients in whom a videofluoroscopic swallow study (VFSS) confirmed thin liquid aspiration.Methods We retrospectively examined data of 199 patients with first stroke who were diagnosed with dysphagia from 2011 to 2015. Swallowing function was evaluated using VFSS. Patients included in this study were monitored for 4 weeks to identify the occurrence of aspiration pneumonia. The penetration-aspiration scale (PAS) was used to assess VFSS findings. The patients were divided into thin-liquid aspiration group (group 1, n=104) and no thin-liquid aspiration group (group 2, n=95).Results The feeding method was changed from NGT feeding to oral feeding with food thickener (group 1) and without food thickener (group 2). The PAS scores of thin and thick liquids were 6.46±0.65 and 1.92±0.73, respectively, in group 1 and 2.65±0.74 and 1.53±0.58, respectively, in group 2. Aspiration pneumonia developed in 1.9% of group 1 and 3.2% of group 2 (p=0.578), with no significant difference between the groups.Conclusion We concluded that removing the NGT and changing to oral feeding with a food thickener is a safe food modification for acute stroke patients with thin liquid aspiration. Therefore, we recommend that VFSS should be conducted promptly in acute stroke patients to avoid unnecessary prolonged NGT feeding.
참고문헌 (33)
- Smithard DG, "Complications and outcome after acute stroke. Does dysphagia matter?", Stroke, 27, pp.1200~1204 (1996)
- Mann G, "Swallowing disorders following acute stroke: prevalence and diagnostic accuracy", Cerebrovasc Dis, 10, pp.380~386 (2000)
- Finestone HM, "Malnutrition in stroke patients on the rehabilitation service and at follow-up: prevalence and predictors", Arch Phys Med Rehabil, 76, pp.310~316 (1995)
- Holas MA, "Aspiration and relative risk of medical complications following stroke", Arch Neurol, 51, pp.1051~1053 (1994)
- Aslanyan S, "Pneumonia and urinary tract infection after acute ischaemic stroke: a tertiary analysis of the GAIN International trial", Eur J Neurol, 11, pp.49~53 (2004)
- Palmer JB, "Physical medicine and rehabilitation", pp.581~597 (2011), Saunders
- 정세희, "비디오 투시 연하 검사에 근거한 연하곤란 임상 척도의 타당도 평가", Annals of Rehabilitation Medicine, 29(4), pp.343~350 (2005), 대한재활의학회
- Eyal H, "Evaluation and treatment of swallowing disorders (dysphagia): the American model as an opportunity for improving patient care and cost containment in Israel’s healthcare system", Harefuah, 132, pp.775~778 (1997)
- Dennis MS, "Effect of timing and method of enteral tube feeding for dysphagic stroke patients (FOOD): a multicentre randomised controlled trial", Lancet, 365, pp.764~772 (2005)
- Gomes CA Jr, "Percutaneous endoscopic gastrostomy versus nasogastric tube feeding for adults with swallowing disturbances", Cochrane Database Syst Rev, (3), pp.CD008096~ (2012)
- Kuhlemeier KV, "Effect of liquid bolus consistency and delivery method on aspiration and pharyngeal retention in dysphagia patients", Dysphagia, 16, pp.119~122 (2001)
- Horner J, "Managing dysphagia. Special problems in patients with neurologic disease", Postgrad Med, 89, pp.203~213 (1991)
- Logemann JA, "Evaluation and treatment of swallowing disorders" (1998), Pro-Ed
- Lim SH, "Accuracy of bedside clinical methods compared with fiberoptic endoscopic examination of swallowing (FEES) in determining the risk of aspiration in acute stroke patients", Dysphagia, 16, pp.1~6 (2001)
- Rosenbek JC, "A penetration-aspiration scale", Dysphagia, 11, pp.93~98 (1996)
- Marik PE, "Aspiration pneumonitis and aspiration pneumonia", N Engl J Med, 344, pp.665~671 (2001)
- Altman DG, "Practical statistics for medical research" (1991), Chapman & Hall
- Katzan IL, "The cost of pneumonia after acute stroke", Neurology, 68, pp.1938~1943 (2007)
- Falsetti P, "Oropharyngeal dysphagia after stroke:incidence, diagnosis, and clinical predictors in patients admitted to a neurorehabilitation unit", J Stroke Cerebrovasc Dis, 18, pp.329~335 (2009)
- Langmore SE, "Behavioral treatment for adults with oropharyngeal dysphagia", Arch Phys Med Rehabil, 75, pp.1154~1160 (1994)
- Cook IJ, "AGA technical review on management of oropharyngeal dysphagia", Gastroenterology, 116, pp.455~478 (1999)
- Logemann JA, "Evaluation and treatment of swallowing disorders", pp.307~326 (1998), Pro-Ed
- Hilker R, "Nosocomial pneumonia after acute stroke: implications for neurological intensive care medicine", Stroke, 34, pp.975~981 (2003)
- Lakshminarayan K, "Utility of dysphagia screening results in predicting poststroke pneumonia", Stroke, 41, pp.2849~2854 (2010)
- Silveira MH, "Quality of life in swallowing disorders after nonsurgical treatment for head and neck cancer", Int Arch Otorhinolaryngol, 19, pp.46~54 (2015)
- Launois R, "Integration of patients’ preferences in individual and collective health choices", Rev Epidemiol Sante Publique, 42, pp.246~262 (1994)
- Grindel CG, "Quality of life and nutritional support in patients with cancer", Cancer Pract, 4, pp.81~87 (1996)
- Lazarus CL, "Effects of bolus volume, viscosity, and repeated swallows in nonstroke subjects and stroke patients", Arch Phys Med Rehabil, 74, pp.1066~1070 (1993)
- Ku DN, "A kinematic study of the oropharyngeal swallowing of a liquid", Ann Biomed Eng, 18, pp.655~669 (1990)
- Schmidt J, "Videofluoroscopic evidence of aspiration predicts pneumonia and death but not dehydration following stroke", Dysphagia, 9, pp.7~11 (1994)
- Terpenning M, "Bacterial colonization of saliva and plaque in the elderly", Clin Infect Dis, 16(Suppl 4), pp.S314~S316 (1993)
- Mann G, "Swallowing function after stroke: prognosis and prognostic factors at 6months", Stroke, 30, pp.744~748 (1999)
- Barer DH, "The natural history and functional consequences of dysphagia after hemispheric stroke", J Neurol Neurosurg Psychiatr, 52, pp.236~241 (1989)