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Su J, Li Y, Xu Z, Sun D, Zhu X, Dong Y, He M, Bu B, Sun J. Effect of thickened water swallow training in tube-feeding and dysphagia patients in the acute and early subacute phases of stroke: A quasi-experimental study. J Oral Rehabil 2024; 51:743-753. [PMID: 38126235 DOI: 10.1111/joor.13645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/30/2023] [Accepted: 12/08/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Thickened water has been widely used in patients with dysphagia who receive oral feeding, but there is little evidence for tube-feeding patients. OBJECTIVE To explore the effects of thickened water swallow training in tube-feeding and dysphagia patients in the acute and early subacute phases of stroke. METHODS A quasi-experimental study. Hospitalised patients with acute and early subacute stroke who received tube feeding due to dysphagia were recruited from March to December 2021. Patients assigned to the intervention group (n = 23) received thickened water swallow training three times daily until the feeding tube was removed or they were discharged, and patients in the control group (n = 23) received usual care. The main outcomes were duration of tube feeding and rates of weaning at discharge. RESULTS Patients in the intervention group had a shorter tube-feeding duration (p = .046) and a higher rate of weaning at discharge (p = .017) than those in the control group. Significant interaction effects between time and group were detected regarding quality of life except for the swallowing burden dimension. CONCLUSIONS Thickened water swallow training is feasible and effective for stroke patients with tube feeding and can shorten the duration of tube feeding and improve the rates of weaning and quality of life. Healthcare providers in nonrehabilitation units should actively conduct swallowing function intervention training to maximise the potential for acute and early subacute phase rehabilitation.
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Affiliation(s)
- Jianping Su
- School of Nursing, Jilin University, Changchun, Jilin, China
- School of Nursing, Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Yijing Li
- Evidence-based Nursing Center, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Zhihua Xu
- China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Dan Sun
- China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Xiangning Zhu
- School of Nursing, Jilin University, Changchun, Jilin, China
| | - Yueyang Dong
- School of Nursing, Jilin University, Changchun, Jilin, China
| | - Meng He
- School of Nursing, Jilin University, Changchun, Jilin, China
| | - Buyin Bu
- School of Nursing, Jilin University, Changchun, Jilin, China
| | - Jiao Sun
- School of Nursing, Jilin University, Changchun, Jilin, China
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Chen J, Lu G, Wang Z, Zhang J, Ding J, Zeng Q, Chai L, Zhao L, Yu H, Li Y. Prediction Models for Dysphagia in Intensive Care Unit after Mechanical Ventilation: A Systematic Review and Meta-analysis. Laryngoscope 2024; 134:517-525. [PMID: 37543979 DOI: 10.1002/lary.30931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/16/2023] [Accepted: 07/13/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVE Dysphagia is a common condition that can independently lead to death in patients in the intensive care unit (ICU), particularly those who require mechanical ventilation. Despite extensive research on the predictors of dysphagia development, consistency across these studies is lacking. Therefore, this study aimed to identify predictors and summarize existing prediction models for dysphagia in ICU patients undergoing invasive mechanical ventilation. METHODS We searched five databases: PubMed, EMBASE, Web of Science, Cochrane Library, and the China National Knowledge Infrastructure. Studies that developed a post-extubation dysphagia risk prediction model in ICU were included. A meta-analysis of individual predictor variables was performed with mixed-effects models. The risk of bias was assessed using the prediction model risk of bias assessment tool (PROBAST). RESULTS After screening 1,923 references, we ultimately included nine studies in our analysis. The most commonly identified risk predictors included in the final risk prediction model were the length of indwelling endotracheal tube ≥72 h, Acute Physiology and Chronic Health Evaluation (APACHE) II score ≥15, age ≥65 years, and duration of gastric tube ≥72 h. However, PROBAST analysis revealed a high risk of bias in the performance of these prediction models, mainly because of the lack of external validation, inadequate pre-screening of variables, and improper treatment of continuous and categorical predictors. CONCLUSIONS These models are particularly susceptible to bias because of numerous limitations in their development and inadequate external validation. Future research should focus on externally validating the existing model in ICU patients with varying characteristics. Moreover, assessing the acceptance and effectiveness of the model in clinical practice is needed. LEVEL OF EVIDENCE NA Laryngoscope, 134:517-525, 2024.
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Affiliation(s)
- Juan Chen
- School of Nursing and Public Health, Yangzhou University, Yangzhou, China
| | - Guangyu Lu
- Institute of Public Health, Medical College of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Zhiyao Wang
- Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou, China
- Neuro Intensive Care Unit, Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Jingyue Zhang
- School of Nursing and Public Health, Yangzhou University, Yangzhou, China
| | - Jiali Ding
- School of Nursing and Public Health, Yangzhou University, Yangzhou, China
| | - Qingping Zeng
- School of Nursing and Public Health, Yangzhou University, Yangzhou, China
| | - Liying Chai
- School of Nursing and Public Health, Yangzhou University, Yangzhou, China
- Institute of Public Health, Medical College of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Li Zhao
- School of Nursing and Public Health, Yangzhou University, Yangzhou, China
- Institute of Public Health, Medical College of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Hailong Yu
- Neuro Intensive Care Unit, Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou, China
- Department of Neurology, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Yuping Li
- Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou, China
- Neuro Intensive Care Unit, Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou, China
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Ishibashi S, Kumori K, Manako J, Funabashi N, Senaha Y, Hidaka M. Open Gastrostomy by Mini-Laparotomy: Our Method. Cureus 2023; 15:e45506. [PMID: 37868450 PMCID: PMC10585052 DOI: 10.7759/cureus.45506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 10/24/2023] Open
Abstract
When percutaneous endoscopic gastrostomy (PEG) is not feasible owing to anatomical obstacles, laparotomic or laparoscopic gastrostomy (LAG) is an alternative. At our institution, LAG has been the first choice for patients who are unable to undergo PEG; however, we have introduced a small open gastrostomy through a 2-cm-long transverse incision since 2020. By December 2022, 12 patients had undergone this procedure without complications. In one case where the stomach was located cephalad to the rib arch and the patient had a round dorsum, the incision wound was extended, and a lengthy operation was required. We believe that our small-incision gastrostomy is a useful option in addition to LAG for cases in which PEG is difficult to perform. Further studies are required to determine the indications for this procedure.
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Affiliation(s)
- Shuichi Ishibashi
- Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, JPN
| | - Koji Kumori
- Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, JPN
| | - Junko Manako
- Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, JPN
| | - Narimasa Funabashi
- Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, JPN
| | - Yoko Senaha
- Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, JPN
| | - Masaaki Hidaka
- Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, JPN
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Ikenaga Y, Fudeya M, Kusunoki T, Yamaguchi H. Factors Contributing to Complete Oral Intake in Dysphagic Stroke Patients with Enteral Feeding Tubes in Convalescent Rehabilitation Wards. Prog Rehabil Med 2023; 8:20230011. [PMID: 37006382 PMCID: PMC10061229 DOI: 10.2490/prm.20230011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 03/01/2023] [Indexed: 04/03/2023] Open
Abstract
Objectives: This study investigated the factors contributing to complete oral intake (COI) in dysphagic stroke patients with enteral feeding tubes in the local clinical setting. Methods: Data of patients with percutaneous endoscopic gastrostomy (PEG) or nasogastric tube (NGT) feeding on admission to convalescent rehabilitation wards (CRWs) were extracted from the Kaga Regional Cooperation Clinical Pathway for Stroke database for multiple centers including 19 acute care hospitals and 11 hospitals with CRWs. Patients were divided into two groups based on their status regarding COI or incomplete oral intake (ICOI) at discharge. Logistic regression analysis with forced-entry variables was used to identify factors contributing to COI. Results: On discharge from CRWs, COI and ICOI were observed in 140 and 207 cases, respectively. The COI group was younger, had a higher rate of initial stroke, higher Functional Oral Intake Scale (FOIS) scores, higher Functional Independence Measure (FIM) motor and cognitive scores, higher Body Mass Index (BMI), lower rate of patients with PEG, and shorter stays in acute care wards. Logistic regression analysis with forced entry revealed that younger age; initial stroke; higher FOIS score, FIM cognitive score, and BMI; and shorter stay in the acute care ward contributed to COI. Conclusions: The primary factors contributing to COI in dysphagic stroke patients with enteral feeding tubes were younger age, initial stroke, higher swallowing and cognitive function, good nutritional status, and shorter stay in the acute care ward.
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Affiliation(s)
- Yasunori Ikenaga
- Department of Rehabilitation Medicine, Yawata Medical Center, Komatsu, Japan
- Council of Kaga Local Stroke Network, Nonoichi, Ishikawa, Japan
| | - Masami Fudeya
- Council of Kaga Local Stroke Network, Nonoichi, Ishikawa, Japan
| | | | - Hiromi Yamaguchi
- Department of Rehabilitation Medicine, Yawata Medical Center, Komatsu, Japan
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Chuang ST, Yen YH, Hsu H, Lai MW, Hung YF, Tsai SW. Predictive Factors for Nasogastric Tube Removal in Post-Stroke Patients. Medicina (Kaunas) 2023; 59:medicina59020368. [PMID: 36837569 PMCID: PMC9960104 DOI: 10.3390/medicina59020368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 02/09/2023] [Accepted: 02/13/2023] [Indexed: 02/17/2023]
Abstract
Background and Objectives: Stroke patients have different levels of functional impairment, and rehabilitation is essential to achieving functional recovery. Many post-stroke patients transition from acute treatment to post-acute care (PAC) with nasogastric tubes (NGTs) for rehabilitation. However, long-term NGT placement can lead to several complications, and its earlier removal can effectively reduce the incidence of mortality. This study aimed to use a PAC-cerebrovascular disease (CVD) program and physical functional evaluation scale tools to demonstrate the factors associated with NGT removal before post-stroke patient discharge. Materials and Methods: In this retrospective cohort study, data were collected between January 2017 and August 2022. We divided patients who had NGTs at admission into discharged with and without NGT groups to compare their baseline characteristics and physical functional status. Logistic regression analysis was used to detect the predictive factors for NGT removal. Results: There were 63 participants: 22 without NGT removal and 41 with NGT removal. The NGT removal rate was 65%. Age and scores for the activities of daily living by the Barthel index (BI), Functional Oral Intake Scale (FOIS), Mini-Mental State Examination, and Concise Chinese Aphasia Test were significantly different in terms of NGT removal status, but only the BI and FOIS were significantly correlated with NGT removal. Patients' BI scores indicating severe to moderate dependence (21-90) had a 4.55 times greater chance of NGT removal (odds ratio, 4.55; p < 0.05) than patients who had total dependence (<20). Every one-point increase in FOIS score indicated a 3.07 times greater chance of NGT removal (odds ratio, 3.07; p < 0.05). Conclusions: The BI and FOIS evaluations may indicate the probability of NGT removal in patients.
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Affiliation(s)
- Shu-Ting Chuang
- Department of Nursing, Taichung Tzu Chi Hospital Buddhist Tzu Chi Medical Foundation, Taichung City 427213, Taiwan
- Department of Nursing, Tzu Chi University of Science and Technology, Hualien 970046, Taiwan
| | - Ya-Hui Yen
- Department of Nursing, Taichung Tzu Chi Hospital Buddhist Tzu Chi Medical Foundation, Taichung City 427213, Taiwan
- Department of Nursing, National Chi Nan University, Puli Township 545301, Taiwan
| | - Honda Hsu
- Division of Plastic Surgery, Dalin Tzu Chi Hospital Buddhist Tzu Chi Medical Foundation, Chiayi City 622007, Taiwan
- School of Medicine, Tzu Chi University, Hualien 970374, Taiwan
| | - Ming-Wei Lai
- School of Medicine, Tzu Chi University, Hualien 970374, Taiwan
- Department of Physical Medicine and Rehabilitation, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung City 427213, Taiwan
- Department of Post-Acute Care Center, Taichung Tzu Chi Hospital Buddhist Tzu Chi Medical Foundation, Taichung City 427213, Taiwan
| | - Yu-Fang Hung
- Department of Nursing, Taichung Tzu Chi Hospital Buddhist Tzu Chi Medical Foundation, Taichung City 427213, Taiwan
| | - Sen-Wei Tsai
- School of Medicine, Tzu Chi University, Hualien 970374, Taiwan
- Department of Physical Medicine and Rehabilitation, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung City 427213, Taiwan
- Department of Post-Acute Care Center, Taichung Tzu Chi Hospital Buddhist Tzu Chi Medical Foundation, Taichung City 427213, Taiwan
- Correspondence: ; Tel.: +886-975358968
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Tang JY, Feng XQ, Huang XX, Zhang YP, Guo ZT, Chen L, Chen HT, Ying XX. Development and validation of a predictive model for patients with post-extubation dysphagia. World J Emerg Med 2023; 14:49-55. [PMID: 36713334 PMCID: PMC9842464 DOI: 10.5847/wjem.j.1920-8642.2023.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 12/20/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Swallowing disorder is a common clinical symptom that can lead to a series of complications, including aspiration, aspiration pneumonia, and malnutrition. This study aimed to investigate risk factors of post-extubation dysphagia (PED) in intensive care unit (ICU) patients with endotracheal intubation, and to develop a risk-predictive model for PED, which could serve as an assessment tool for the prevention and control of PED. METHODS Patients retrospectively selected from June to December 2021 in a tertiary hospital served as the derivation cohort. Patients recruited from the same hospital from March to June 2022 served as the external validation cohort for the predictive model. We used a combination of variable screening and least absolute shrinkage and selection operator (LASSO) regression to select the most useful candidate predictors and checked the multicollinearity of independent variables using the variance inflation factor method. Multivariate logistic regression analysis was performed to calculate the odds ratio (OR; 95% confidence interval [95% CI]) and P-value for each variable to predict diagnosis. The screened risk factors were introduced into R software to build a nomogram model. The performance of the model, including discrimination ability, calibration, and clinical benefit, was evaluated by plotting the receiver operating characteristic (ROC), calibration, and decision curves. RESULTS A total of 305 patients were included in this study. Among them, 235 patients (53 PED vs. 182 non-PED) were enrolled in the derivation cohort, while 70 patients (17 PED vs. 53 non-PED) were enrolled in the validation cohort. The independent predictors included age, pause of sedatives, level of consciousness, activities of daily living (ADL) score, nasogastric tube, sore throat, and voice disorder. These predictors were used to establish the predictive nomogram model. The model demonstrated good discriminative ability, and the area under the ROC curve (AUC) was 0.945 (95% CI 0.904-0.970). Applying the predictive model to the validation cohort demonstrated good discrimination with an AUC of 0.907 (95% CI 0.831-0.983) and good calibration. The decision-curve analysis of this nomogram showed a net benefit of the model. CONCLUSION A predictive model that incorporates age, pause of sedatives, level of consciousness, ADL score, nasogastric tube, sore throat, and voice disorder may have the potential to predict PED in ICU patients.
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Affiliation(s)
- Jia-ying Tang
- Nursing Department, the Second Affi liated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Xiu-qin Feng
- Nursing Department, the Second Affi liated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China,Corresponding Author: Xiu-qin Feng,
| | - Xiao-xia Huang
- Nursing Department, the Second Affi liated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Yu-ping Zhang
- Nursing Department, the Second Affi liated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Zhi-ting Guo
- Nursing Department, the Second Affi liated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Lan Chen
- Nursing Department, the Second Affi liated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Hao-tian Chen
- Nursing Department, the Second Affi liated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Xiao-xiao Ying
- Nursing Department, the Second Affi liated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
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Yamada T, Ochiai R, Kotake Y. Changes in Maximum Tongue Pressure and Postoperative Dysphagia in Mechanically Ventilated Patients after Cardiovascular Surgery. Indian J Crit Care Med 2022; 26:1253-1258. [PMID: 36755636 PMCID: PMC9886018 DOI: 10.5005/jp-journals-10071-24365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 10/19/2022] [Indexed: 12/03/2022] Open
Abstract
Background There is no objective quantitative parameter for dysphagia, and the relationship between changes in maximum tongue pressure values and dysphagia is unknown. This study aimed to determine whether there is a difference in the change in maximal tongue pressure after extubating patients who were ventilated after cardiovascular surgery, with or without dysphagia. Materials and methods Adult patients who underwent mechanical ventilation via endotracheal intubation following cardiovascular surgery were included. Tongue pressure was measured before cardiovascular surgery and at 6 hours; 3 and 7 days after extubation. Dysphagia was confirmed by the functional oral intake scale (FOIS) on day 7 after extubation; an FOIS level above or equal to 6 was considered "dysphagia-negative." Results Of 68 patients, 15 (22.1%) were in the dysphagia-positive group, which significantly showed a history of diabetes mellitus, prolonged mechanical ventilation, and postextubation hospitalization. Additionally, the postoperative C-reactive protein level was significantly higher in the dysphagia-positive group than in the dysphagia-negative group. Maximum tongue pressure was significantly lower in the dysphagia-positive group at 3 and 7 days postextubation. Using a cutoff value of 27.6 kPa in a receiver operating characteristic (ROC) curve for maximum tongue pressure at 3 days after extubation, the area under the curve (AUC) was 0.82, sensitivity was 84.9%, and specificity was 84.2%. Conclusion Tongue pressure at 3 days after extubation is significantly lower in patients with dysphagia after cardiovascular surgery than in patients without dysphagia. If the maximum tongue pressure value is below 27.6 kPa on the third day following extubation, oral intake should be performed with caution. How to cite this article Yamada T, Ochiai R, Kotake Y. Changes in Maximum Tongue Pressure and Postoperative Dysphagia in Mechanically Ventilated Patients after Cardiovascular Surgery. Indian J Crit Care Med 2022;26(12):1253-1258.
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Affiliation(s)
- Toru Yamada
- Department of Anesthesiology, Toho University Graduate School of Medicine, Ota-ku Omorinishi, Tokyo, Japan,Toru Yamada, Department of Anesthesiology, Toho University Graduate School of Medicine, Ota-ku Omorinishi, Tokyo, Japan, Phone: +81 337624151, e-mail:
| | | | - Yoshifumi Kotake
- Department of Anesthesiology, Ohashi Medical Center, Toho University, Ohashi, Tokyo, Japan
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Le JM, Ying YP, Seri C, Deatherage H, Bourne G, Morlandt AB. Does early oral intake after microvascular free flap reconstruction of the oral cavity lead to increased postoperative complications? J Oral Maxillofac Surg 2022; 80:1705-1715. [DOI: 10.1016/j.joms.2022.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 06/15/2022] [Accepted: 06/16/2022] [Indexed: 02/07/2023]
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Lin TH, Yang CW, Chang WK. Evaluation of Oropharyngeal Dysphagia in Older Patients for Risk Stratification of Pneumonia. Front Immunol 2022; 12:800029. [PMID: 35185865 PMCID: PMC8847226 DOI: 10.3389/fimmu.2021.800029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 12/27/2021] [Indexed: 11/13/2022] Open
Abstract
Objective Nasogastric tube (NGT) and percutaneous endoscopic gastrostomy (PEG) are widely used techniques to feed older patients with oropharyngeal dysphagia. Aspiration pneumonia is the most common cause of death in these patients. This study aimed to evaluate the role of oropharyngeal dysphagia in older patients on long-term enteral feeding for risk stratification of pneumonia requiring hospitalization. Methods We performed modified flexible endoscopic evaluation of swallowing to evaluate oropharyngeal dysphagia in older patients and conducted prospective follow-up for pneumonia requiring hospitalization. A total of 664 oral-feeding patients and 155 tube-feeding patients were enrolled. Multivariate Cox analysis was performed to identify risk factors of pneumonia requiring hospitalization. Results Multivariate analyses showed that the risk of pneumonia requiring hospitalization significantly increased in older patients and in patients with neurological disorders, tube feeding, and oropharyngeal dysphagia. Subgroup analysis revealed that the risk of pneumonia requiring hospitalization was significantly lower in patients with PEG than in those with NGT among the patients with oropharyngeal dysphagia (adjusted hazard ratio 0.26, 95% confidence interval: 0.11–0.63, P = 0.003). Conclusions For older patients with oropharyngeal dysphagia requiring long-term enteral tube feeding, PEG is a better choice than NGT. Further research is needed to elucidate the role of oropharyngeal dysphagia in enteral feeding in older patients.
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Affiliation(s)
- Tai-Han Lin
- Department of Pathology and Graduate Institute of Pathology and Parasitology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chih-Wei Yang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wei-Kuo Chang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Philips R, Topf MC, Vimawala S, Luginbuhl A, Curry JM, Cognetti DM. Risk factors for gastrostomy tube dependence in transoral robotic surgery patients. Am J Otolaryngol 2022; 43:103175. [PMID: 34418824 DOI: 10.1016/j.amjoto.2021.103175] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 06/26/2021] [Accepted: 08/04/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine the rate of gastrostomy tube dependence after transoral robotic surgery (TORS), and to determine which patient or surgical factors increase the likelihood of gastrostomy tube dependence. METHODS Retrospective chart review of all patients who underwent TORS for oropharyngeal squamous cell carcinoma (OPSCC) at a single institution from January 2011 through July 2016. Patients who underwent TORS for recurrent OPSCC were excluded. Primary outcome was gastrostomy tube (g-tube) dependence. Univariable and multivariable logistic regression were performed to identify risk factors for g-tube dependence at 3-months and 1-year. RESULTS A total of 231 patients underwent TORS during the study period. At 3-month follow-up, 58/226 patients (25.7%) required g-tube. At 1-year and 2-year follow-up, 8/203 (3.9%) and 5/176 (2.8%), remained dependent on g-tube, respectively. Advanced T stage (T3) (OR = 6.07; 95% CI, 1.28-28.9) and discharge from the hospital with enteral access (OR = 7.50; 95% CI, 1.37-41.1) were independently associated with increased risk of postoperative gastrostomy tube dependence at 1 year on multivariable analysis. CONCLUSIONS Long-term gastrostomy tube dependence following TORS is rare, particularly in patients that receive surgery alone. Patients with advanced T stage tumors have poorer functional outcomes. Early functional outcomes, as early as discharge from the hospital, are a strong predictor for long-term functional outcomes.
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Affiliation(s)
- Ramez Philips
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, 925 Chestnut Street, 6th Floor, Philadelphia, PA 19107, USA.
| | - Michael C Topf
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, 1215 21st Ave. S. Suite 7209, Nashville, TN 37232, USA
| | - Swar Vimawala
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, 925 Chestnut Street, 6th Floor, Philadelphia, PA 19107, USA
| | - Adam Luginbuhl
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, 925 Chestnut Street, 6th Floor, Philadelphia, PA 19107, USA
| | - Joseph M Curry
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, 925 Chestnut Street, 6th Floor, Philadelphia, PA 19107, USA
| | - David M Cognetti
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, 925 Chestnut Street, 6th Floor, Philadelphia, PA 19107, USA
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Zhang D, Li Y, Li H, Fu W, Zeng J, Zeng X. Analysis of Factors That Influence the Prognosis of Swallowing Function Rehabilitation Therapy in Patients with Dysphagia After Medullary Infarction. Neuropsychiatr Dis Treat 2022; 18:97-107. [PMID: 35079218 PMCID: PMC8776725 DOI: 10.2147/ndt.s341353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 12/29/2021] [Indexed: 01/01/2023] Open
Abstract
PURPOSE This study investigated the factors that influence the prognosis of swallowing function rehabilitation therapy in patients with dysphagia after medullary infarction. PATIENTS AND METHODS This retrospective study was conducted using the clinical data of 51 patients who were diagnosed with dysphagia after medullary infarction and hospitalized at our institution between January 2019 and January 2021. As per the water swallow test (WST) grade at 1 month after rehabilitation treatment, patients were classified into the good prognosis group and the poor prognosis group. Univariate analysis as well as univariate and multivariate logistic regression analysis were used to analyze factors that influence the prognosis of swallowing function rehabilitation therapy in patients with dysphagia after medullary infarction. Receiver operating characteristic (ROC) curves were then used to test the predictive ability of the significant parameters to predict the prognosis of the rehabilitation therapy in these patients. RESULTS Univariate analysis and univariate logistic regression analysis showed that previous stroke (odds ratio [OR] = 1.361), dysarthria (OR = 3.771), disease course (OR = 1.112), National Institutes of Health Stroke Scale (NIHSS) score at admission (OR = 2.596), and infarct site (OR = 11.071) were all significantly correlated with the prognosis of swallowing function rehabilitation therapy in patients with dysphagia after medullary infarction (P < 0.05). Multivariate logistic regression analysis showed that dysarthria (OR = 5.519, 95% confidence interval (CI) 1.413-21.566), infarct site (OR = 18.634, 95% CI 1.696-204.73), and the NIHSS score (OR = 1.001, 95% CI 1.536-4.820) were independent influencing factors of the prognosis of swallowing function rehabilitation therapy in these patients. The ROC curve showed that the area under the curve for the combined prediction of the three indicators was 0.943. CONCLUSION The NIHSS score, dysarthria, and infarct site are independent influencing factors for the prognosis of swallowing function rehabilitation therapy in patients with dysphagia after medullary infarction.
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Affiliation(s)
- Di Zhang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou City, Henan Province, People's Republic of China
| | - Yi Li
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou City, Henan Province, People's Republic of China
| | - Heping Li
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou City, Henan Province, People's Republic of China
| | - Weifeng Fu
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou City, Henan Province, People's Republic of China
| | - Jing Zeng
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou City, Henan Province, People's Republic of China
| | - Xi Zeng
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou City, Henan Province, People's Republic of China
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Mun SJ, Jeon HS, Choi ES, Lee R, Kim SH, Han SY. Oral health status of inpatients with varying physical activity limitations in rehabilitation wards: A cross-sectional study. Medicine (Baltimore) 2021; 100:e26880. [PMID: 34397904 PMCID: PMC8360428 DOI: 10.1097/md.0000000000026880] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 07/22/2021] [Indexed: 01/04/2023] Open
Abstract
Poor oral hygiene can be potentially life-threatening in inpatients. However, no basic protocol on oral hygiene customized for inpatients exists, and lack of oral care related knowledge, attitude, and skills among caregivers could be detrimental to the general health of patients. This study sought to identify the oral care practices and oral health status of inpatients with varying physical activity limitations in a rehabilitation ward.Sixty-one inpatients in a rehabilitation ward were evaluated for their medical and physical conditions and oral health status. These were assessed using the bedside oral exam, decayed, missing, filled teeth index, plaque index, gingival index, and caries activity test.In total, 40 men and 21 women (mean age, 56.6 years) were included in this study. Among them, 50.8% of the patients could brush their teeth unassisted, whereas 49.2% required assistance from an assistant for oral care. The proportion of patients receiving nasogastric tube feeding was higher in the group that could not provide oral self-care; 36.7% and 33.3% of these patients showed moderate and severe dysfunction, respectively, based on bedside oral exam. Scores for the swallowing, tongue, and total domains of bedside oral exam were poorer for patients who could not provide oral self-care (P < .01). The caries activity test indicated a moderate risk for both groups.Our findings suggest that an oral care protocol that considers the physical activity limitations in inpatients in rehabilitation wards is necessary to minimize negative influences on the systemic health of these patients.
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Affiliation(s)
- So Jung Mun
- Department of Dental Hygiene, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju, Republic of Korea
| | - Hyun Sun Jeon
- Department of Dental Hygiene, Yeoju Institute of Technology, Yeoju, Republic of Korea
| | - Eun Sil Choi
- Department of Dental Hygiene, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju, Republic of Korea
| | - Ree Lee
- Department of Dental Hygiene, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju, Republic of Korea
| | - Sung Hoon Kim
- Department of Rehabilitation Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Sun Young Han
- Department of Dental Hygiene, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju, Republic of Korea
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Yuan T, Zeng G, Yang Q, He Y, Kong P, Wang S, Zhou X, Cao J. The effects of total enteral nutrition via nasal feeding and percutaneous radiologic gastrostomy in patients with dysphagia following a cerebral infarction. Am J Transl Res 2021; 13:6352-6361. [PMID: 34306374 PMCID: PMC8290671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 01/22/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To explore the effects of total enteral nutrition (TEN) via nasal feeding and percutaneous radiologic gastrostomy (PRG) on the nutritional status, quality of life, and prognosis in long-term bedridden patients with dysphagia after cerebral infarction. METHODS One hundred and sixty long-term bedridden patients with dysphagia after cerebral infarction were randomly divided into a control group (CG, n=80) and an observation group (OG, n=80). The CG was administered TEN via nasal feeding, and the OG was administered TEN via PRG. The two groups' results were compared. RESULTS The Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD) scores in the OG were lower than the corresponding scores in the CG at 3 and 6 months after the TEN (P < 0.05). The OG had a higher proportion of high compliance, but a lower proportion of both moderate and low compliance than the CG (P < 0.05). The total incidence of TEN intolerance was 8.75% in the OG, lower than the 20.00% in the CG (P < 0.05). The AST, ALB, ALT, TBIL, Scr, and BUN levels showed no significant differences between the OG and the CG at 3 and 6 months after the TEN (P > 0.05). The IgM, IgG, IgA, hemoglobin, total protein, albumin, and transferrin levels showed no significant differences between the OG and the CG at 3 and 6 months after the TEN (P > 0.05). The incidence of catheterization complications was 20.00% in the OG, higher than the 8.75% in the CG (P < 0.05). The OG had higher SF-36 scores than the CG at 6 months after the TEN (P < 0.05). CONCLUSION Both nasal feeding and TEN via PRG can effectively improve patients' nutritional status, enhance their immune function, and improve their liver and renal function, but TEN after PRG is more effective at reducing intolerance and promoting quality of life in long-term bedridden patients with dysphagia after cerebral infarction. However, TEN after PRG will also increase the occurrence of recent complications, complications that should get additional clinical attention.
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Affiliation(s)
- Tianwen Yuan
- Department of Interventional Oncology, Dahua HospitalXuhui District, Shanghai 200237, China
| | - Guoqing Zeng
- Department of Internal Medicine Community Health Service Center of Huajing StreetXuhui District, Shanghai 200237, China
| | - Qi Yang
- Department of Internal Medicine Community Health Service Center of Tianlin StreetXuhui District, Shanghai 200237, China
| | - Yang He
- Department of Interventional Oncology, Dahua HospitalXuhui District, Shanghai 200237, China
| | - Peng Kong
- Department of Interventional Oncology, Dahua HospitalXuhui District, Shanghai 200237, China
| | - Saibo Wang
- Department of Interventional Oncology, Dahua HospitalXuhui District, Shanghai 200237, China
| | - Xing Zhou
- Department of Interventional Oncology, Dahua HospitalXuhui District, Shanghai 200237, China
| | - Jun Cao
- Department of Interventional Oncology, Dahua HospitalXuhui District, Shanghai 200237, China
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Zeng L, Song Y, Dong Y, Wu Q, Zhang L, Yu L, Gao L, Shi Y. Risk Score for Predicting Dysphagia in Patients After Neurosurgery: A Prospective Observational Trial. Front Neurol 2021; 12:605687. [PMID: 34046001 PMCID: PMC8144441 DOI: 10.3389/fneur.2021.605687] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 04/12/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Acquired dysphagia is common in patients with tracheal intubation and neurological disease, leading to increased mortality. This study aimed to ascertain the risk factors and develop a prediction model for acquired dysphagia in patients after neurosurgery. Methods: A multicenter prospective observational study was performed on 293 patients who underwent neurosurgery. A standardized swallowing assessment was performed bedside within 24 h of extubation, and logistic regression analysis with a best subset selection strategy was performed to select predictors. A nomogram model was then established and verified. Results: The incidence of acquired dysphagia in our study was 23.2% (68/293). Among the variables, days of neurointensive care unit (NICU) stay [odds ratio (OR), 1.433; 95% confidence interval (CI), 1.141–1.882; P = 0.005], tracheal intubation duration (OR, 1.021; CI, 1.001–1.062; P = 0.175), use of a nasogastric feeding tube (OR, 9.131; CI, 1.364–62.289; P = 0.021), and Acute Physiology and Chronic Health Evaluation (APACHE)-II C score (OR, 1.709; CI, 1.421–2.148; P < 0.001) were selected as risk predictors for dysphagia and included in the nomogram model. The area under the receiver operating characteristic curve was 0.980 (CI, 0.965–0.996) in the training set and 0.971 (0.937–1) in the validation set, with Brier scores of 0.045 and 0.056, respectively. Conclusion: Patients who stay longer in the NICU, have a longer duration of tracheal intubation, require a nasogastric feeding tube, and have higher APACHE-II C scores after neurosurgery are likely to develop dysphagia. This developed model is a convenient and efficient tool for predicting the development of dysphagia.
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Affiliation(s)
- Li Zeng
- Neurosurgical Intensive Care Unit, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China.,Department of Nursing, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yu Song
- Department of Neurosurgery, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yan Dong
- Department of Neurosurgery, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China.,Clinical Medicine Scientifific and Technical Innovation Park, Shanghai Tenth People's Hospital, Shanghai, China
| | - Qian Wu
- Department of Nursing, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Lu Zhang
- Department of Nursing, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Lei Yu
- Department of Anesthesiology, Dongfang Hospital Affifiliated to Tongji University, Shanghai, China
| | - Liang Gao
- Department of Neurosurgery, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yan Shi
- Department of Nursing, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
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Chauhan D, Varma S, Dani M, Fertleman MB, Koizia LJ. Nasogastric Tube Feeding in Older Patients: A Review of Current Practice and Challenges Faced. Curr Gerontol Geriatr Res 2021; 2021:6650675. [PMID: 33936197 DOI: 10.1155/2021/6650675] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/06/2021] [Accepted: 01/08/2021] [Indexed: 01/05/2023] Open
Abstract
Nasogastric tube feeding is an essential way of delivering enteral nutrition when the oral route is insufficient or unsafe. Malnutrition is recognised as a reversible factor for sarcopenia and frailty. It is therefore crucial that malnutrition is treated in older inpatients who have dysphagia and require enteral nutrition. Despite five National Patient Safety Alerts since 2005, “Never Events” related to nasogastric feeding persist. In addition to placement errors, current practice often leads to delays in feeding, which subsequently result in worse patient outcomes. It is crucial that tube placement is confirmed accurately and in a timely way. Medical advancements in this area have been slow to find a solution which meets this need. In this paper, we provide an updated review on the current use of feeding nasogastric tubes in the older population, the issues associated with confirming correct placement, and innovative solutions for improving safety and outcomes in older patients.
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Zhang J, Wu Y, Huang Y, Zhang S, Xu L, Huang X, Wang X, Huang Q. Effect of the Mendelsohn maneuver and swallowing training in patients with senile vascular dementia complicated with dysphagia. J Int Med Res 2021; 49:3000605211013198. [PMID: 33990151 PMCID: PMC8127777 DOI: 10.1177/03000605211013198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE We investigated the effect of the Mendelsohn maneuver and swallowing training in patients with senile vascular dementia complicated with dysphagia. METHODS We randomly classified 214 patients with senile vascular dementia and swallowing dysfunction into a control group (CG, n = 106) and observation group (OG, n = 108). Both groups underwent health education, psychological intervention, and training of the oral muscle group. The OG additionally underwent the Mendelsohn maneuver and swallowing training. The Hasegawa Dementia Scale (HDS), China Stroke Scale (CSS), and Neurobehavioral Cognitive Status Examination (NCSE) were used to evaluate dementia, neurological impairment, and cognitive dysfunction, respectively. RESULTS The OG had a higher rate of effective therapy than the CG. After intervention, the OG showed better swallowing function than the CG. At 15 days and 1 month after intervention, the OG had higher video fluoroscopic swallowing exam scores than the CG. The OG had lower serum interleukin (IL)-1, IL-6, and tumor necrosis factor-α levels than the CG. After intervention, the OG had higher HDS and NCSE scores and lower CSS scores than the CG. CONCLUSIONS The Mendelsohn maneuver and swallowing training can improve swallowing function in patients with senile vascular dementia complicated with dysphagia and help to ameliorate the inflammatory response.
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Affiliation(s)
- Jianrong Zhang
- Nursing Department, Houjie Hospital of Dongguan, Dongguan, Guangdong, China
| | - Yu’e Wu
- Department of Neurology, Houjie Hospital of Dongguan, Dongguan, Guangdong, China
| | - Yanfang Huang
- Nursing Department, Houjie Hospital of Dongguan, Dongguan, Guangdong, China
| | - Shuqing Zhang
- Nursing Department, Houjie Hospital of Dongguan, Dongguan, Guangdong, China
| | - Liuqin Xu
- Nursing Department, Houjie Hospital of Dongguan, Dongguan, Guangdong, China
| | - Xiaoyun Huang
- Dean's Office, Houjie Hospital of Dongguan, Dongguan, Guangdong, China
| | - Xingshui Wang
- Department of Rehabilitation, Houjie Hospital of Dongguan, Dongguan, Guangdong, China
| | - Qingping Huang
- Nursing Department, Houjie Hospital of Dongguan, Dongguan, Guangdong, China
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Lee JH, Kwon HY, Kwon KS, Park SH, Suh YJ, Kim JS, Kim H, Shin YW. Percutaneous endoscopic gastrostomy feeding effects in patients with neurogenic dysphagia and recurrent pneumonia. Ther Adv Respir Dis 2021; 15:1753466621992735. [PMID: 33764224 PMCID: PMC8010805 DOI: 10.1177/1753466621992735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background: Percutaneous endoscopic gastrostomy (PEG) feeding provides enteral nutrition to patients with neurological dysphagia. However, the conditions in which PEG should be applied to prevent pneumonia remain unclear. We aimed to evaluate the effect of PEG for patients with neurological dysphagia in preventing pneumonia. Methods: We undertook a retrospective data review of 232 patients with neurological dysphagia who had undergone PEG from January 2008 to December 2018 at Inha University Hospital, in Incheon, Korea. We excluded patients who had not been followed up 6 months pre- and post-PEG feeding. In total, our study comprised 42 patients. We compared pneumonia episodes and incidence pre- and post-PEG. Results: During the median post-PEG follow-up period, the 6-month pneumonia incidence among patients who had undergone PEG had decreased [median 0.3 (interquartile range (IQR) 0.0–0.7) versus 0.1 (IQR 0.1–0.3) episodes, p = 0.04]. In a multiple mixed model, PEG did not decrease the incidence of pneumonia (p = 0.76). However, the association between PEG and the incidence of pneumonia differed significantly depending on the presence or absence of recurrent pneumonia (p < 0.001). Conclusions: PEG could effectively reduce the incidence of pneumonia in patients with neurogenic dysphagia, especially in those who had experienced recurrent pneumonia. The reviews of this paper are available via the supplemental material section.
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Affiliation(s)
- Jung Hwan Lee
- Division of Gastroenterology, Department of Internal Medicine, Inha University School of Medicine, Incheon, South Korea.,Department of Hospital Medicine, Inha University School of Medicine, Incheon, South Korea
| | - Hea Yoon Kwon
- Division of Infectious Disease, Department of Internal Medicine, Inha University School of Medicine, Incheon, South Korea
| | - Kye Sook Kwon
- Division of Gastroenterology, Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, 27 Inhang-ro, Jung-gu, Incheon 22332, Republic of Korea
| | - Soo-Hyun Park
- Department of Hospital Medicine, Inha University School of Medicine, Incheon, South Korea
| | - Young Ju Suh
- Department of Biomedical Sciences, Inha University School of Medicine, Incheon, South Korea
| | - Jung-Soo Kim
- Department of Hospital Medicine, Inha University School of Medicine, Incheon, South Korea
| | - Hyungkil Kim
- Division of Gastroenterology, Department of Internal Medicine, Inha University School of Medicine, Incheon, South Korea
| | - Yong Woon Shin
- Division of Gastroenterology, Department of Internal Medicine, Inha University School of Medicine, Incheon, South Korea
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Milinis K, Gaskell P, Lau A, Lancaster J, Jones T. Early versus late oral feeding following total (pharyngo)laryngectomy: Systematic review and meta-analysis. Head Neck 2021; 43:1359-1368. [PMID: 33543554 DOI: 10.1002/hed.26616] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 11/24/2020] [Accepted: 01/14/2021] [Indexed: 11/07/2022] Open
Abstract
Timing of oral feeding following total laryngectomy is a contentious issue with highly varied practices. Multiple database search was performed to identify studies comparing outcomes of early (≤5 days) versus late (>5 days) oral feeding. Bias assessment was carried out using Cochrane bias tool. Random-effects meta-analysis was used. The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The rate of pharyngocutaneous fistula (PCF) in randomized control trials (RCTs) in early versus late feeding was 15.2% versus 11.7% (RR 1.35, 95%CI [0.68-2.7], p = 0.40). The rate of PCF in the cohort studies was 14.1% versus 20.5% (RR 1.0, 95%CI [0.76-1.3], p = 0.98). The length of hospital stay was significantly shorter in the early feeding group (mean difference (days) -4.68 (-6.2 to -3.1, p < 0.0001). Early oral feeding appears to be safe and is associated with shorter hospital stay. However, the quality of evidence is low and the patient characteristics are not representative of current practices.
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Affiliation(s)
- Kristijonas Milinis
- Department of Otorhinolaryngology - Head and Neck Surgery, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
- Liverpool Head and Neck Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Peter Gaskell
- Department of Otorhinolaryngology - Head and Neck Surgery, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
- Liverpool Head and Neck Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Andrew Lau
- Department of Otorhinolaryngology - Head and Neck Surgery, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
- Liverpool Head and Neck Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Jeffrey Lancaster
- Department of Otorhinolaryngology - Head and Neck Surgery, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
- Liverpool Head and Neck Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Terry Jones
- Department of Otorhinolaryngology - Head and Neck Surgery, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
- Liverpool Head and Neck Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
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Arai H, Takeuchi J, Nozoe M, Fukuoka T, Matsumoto S, Morimoto T. Association Between Active Gait Training for Severely Disabled Patients with Nasogastric Tube Feeding or Gastrostoma and Recovery of Oral Feeding: A Retrospective Cohort Study. Clin Interv Aging 2020; 15:1963-1970. [PMID: 33116450 PMCID: PMC7569029 DOI: 10.2147/cia.s270277] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 09/24/2020] [Indexed: 12/29/2022] Open
Abstract
PURPOSE This study evaluates the effect of introducing active gait training (AGT) to patients who are severely disabled with nasogastric tube feeding or gastrostoma on the recovery of oral feeding. PATIENTS AND METHODS We conducted a historical cohort study at a single rehabilitation center in Japan between January 2013 and December 2019. In this study, 154 severely disabled patients with nasogastric tube feeding or gastrostoma due to neurological diseases or disuse syndrome admitted in a rehabilitation ward were included, and their median age was 84 years. AGT was systematically implemented in August 2016, which consisted of using orthosis or assistance from physical therapists. We compared the recovery of oral feeding between periods before (Pre-AGT) and after (Post-AGT) the introduction of AGT. RESULTS Among the 154 severely disabled patients included, 59 (38%) were admitted in the Post-AGT period. Twenty-eight (30%) and 54 patients (92%) started gait training in the Pre-AGT and Post-AGT periods, respectively (p < 0.001). Significantly more patients recovered oral feeding in the Post-AGT than in the Pre-AGT periods (49% vs 19%, respectively; p < 0.001). After the introduction of AGT, the adjusted hazard ratio for the recovery of oral feeding was 4.0 (95% confidence interval, 1.9-8.3; p < 0.001). CONCLUSION After the introduction of AGT to patients, increased recovery of oral feeding was observed in this retrospective evaluation. AGT should be considered for patients with tube feeding to help them recover oral feeding even if patients were severely disabled and required full assistance during gait training.
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Affiliation(s)
- Hideki Arai
- Department of Rehabilitation, Toyonaka Heisei Hospital, Toyonaka, Osaka, Japan
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Jiro Takeuchi
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Masafumi Nozoe
- Department of Physical Therapy, Faculty of Nursing and Rehabilitation, Konan Women’s University, Kobe, Hyogo, Japan
| | - Tatsuyuki Fukuoka
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Higashihiroshima, Hiroshima, Japan
| | - Satoru Matsumoto
- Department of Rehabilitation, Toyonaka Heisei Hospital, Toyonaka, Osaka, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
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Castagna A, Ferrara L, Asnaghi E, Colombo V, Rega V, Fiorini G. Post-stroke dysphagia rehabilitation in the old and oldest old: outcome and relevance for discharge home. Int J Rehabil Res 2020; 43:55-61. [DOI: 10.1097/mrr.0000000000000385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Choi JS, Bang H, Lee GJ, Seo HG, Oh BM, Han TR. Epiglottic Retroflexion is a Key Indicator of Functional Recovery of Post-stroke Dysphagia. Ann Rehabil Med 2020; 44:1-10. [PMID: 32130834 PMCID: PMC7056332 DOI: 10.5535/arm.2020.44.1.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 09/09/2019] [Indexed: 11/21/2022] Open
Abstract
Objective To evaluate the longitudinal changes of swallowing kinematics based on videofluoroscopic swallowing studies (VFSSs) in subacute stroke patients grouped according to the method of dietary intake. Methods Sixty-nine subacute stroke patients who had taken at least 2 successive VFSSs were included. Subjects were allocated into 3 groups according to the degree of swallowing function recovery—not improved group (tube feeding recommended to patients at both studies), improved group (tube feedings recommended initially to patients and oral feeding recommended at follow-up study), and well-maintained group (oral feeding at both studies recommended to patients). Initial VFSS was performed during the subacute stage of stroke, 1 to 12 weeks after the onset of stroke, and follow-up VFSS was performed at least once. Kinematic variables were calculated by two-dimensional motion analysis of multiple structures, including the hyoid bone, epiglottis, and vocal cord. Changes of kinematic variables were analyzed in serial VFSSs. Results At the initial VFSS, the well-maintained group showed significantly larger angles of epiglottic folding than the not improved group, while at the follow-up VFSS, the improved and the well-maintained groups showed significantly larger epiglottic folding angles than the not improved group. The distribution of epiglottic folding angles was in a dichotomous pattern, and each cluster was related to the swallowing function. Conclusion This study showed that improved epiglottic folding angles are associated with the recovery of the swallowing process and suitability for oral feeding among various kinematic variables in subacute stroke patients.
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Affiliation(s)
- Ji Soo Choi
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Bang
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Goo Joo Lee
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.,National Traffic Injury Rehabilitation Hospital, Yangpyeong, Korea
| | - Tai Ryoon Han
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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22
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Niimi M, Hashimoto G, Hara T, Yamada N, Fujigasaki H, Ide T, Abo M. The 2-Minute Spontaneous Swallowing Screening Predicts Independence on Enteral Feeding in Patients with Acute Stroke. J Stroke Cerebrovasc Dis 2020; 29:104508. [PMID: 31759914 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 10/16/2019] [Accepted: 10/28/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND It is recommended that enteral feeding should be offered to patients with dysphagia estimated to be unable to take adequate diet orally within 7 days of admission after acute stroke, but there is no clear criterion for initiation of enteral feeding. Recent studies have reported that the frequency of spontaneous swallowing is useful in screening for dysphagia in acute stroke. The present study was aimed to investigate whether measurement of frequency of spontaneous swallowing for 2 minutes could predict independence on enteral feeding 1 week after admission in patients with acute stroke. METHODS Patients with acute stroke were subjected. Within 72 hours of stroke onset, the number of swallows for 2 minutes was measured by auscultation. Subsequently, 1-hour frequency of spontaneous swallowing was measured using a laryngeal microphone. Functional Oral Intake Scale (FOIS) was evaluated 1 week after admission. RESULTS Twenty-six out of 40 patients were independent on enteral feeding 1 week after admission based on FOIS. The presence of spontaneous swallowing for 2 minutes had .89 sensitivity, .54 specificity to predict independence on enteral feeding 1 week after admission, whereas the 1-hour frequency of spontaneous swallowing had 1.00 sensitivity, .46 specificity. Logistic regression analysis demonstrated that the presence of spontaneous swallowing for 2 minutes was independent predictor for independence on enteral feeding 1 week after admission, independently of age, sex, and NIHSS. CONCLUSIONS The 2-minute spontaneous swallowing screening predicts independence on enteral feeding 1 week after admission in patients with acute stroke.
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Affiliation(s)
- Masachika Niimi
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, Minato-Ku, Tokyo, Japan.
| | - Gentaro Hashimoto
- Department of Rehabilitation Medicine, Tokyo Metropolitan Bokutoh Hospital, Sumida-Ku, Tokyo, Japan
| | - Takatoshi Hara
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, Minato-Ku, Tokyo, Japan
| | - Naoki Yamada
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, Minato-Ku, Tokyo, Japan
| | - Hiroto Fujigasaki
- Department of Internal Medicine, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Sumida-Ku, Tokyo, Japan
| | - Takafumi Ide
- Department of Neurosurgery, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Sumida-Ku, Tokyo, Japan
| | - Masahiro Abo
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, Minato-Ku, Tokyo, Japan
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23
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Zoeller S, Bechtold ML, Burns B, Cattell T, Grenda B, Haffke L, Larimer C, Powers J, Reuning F, Tweel L, Guenter P. Dispelling Myths and Unfounded Practices About Enteral Nutrition. Nutr Clin Pract 2020; 35:196-204. [PMID: 31994794 DOI: 10.1002/ncp.10456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Many protocols and steps in the process of enteral nutrition (EN) use are not overly supported with strong research and have been done the same way over many years without questioning the use of best-practices evidence. This article reports many of the myths and unfounded practices surrounding EN and attempts to refute those myths with current evidence. These practices include those about enteral access devices, formulas, enteral administration, and complications.
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Affiliation(s)
| | - Matthew L Bechtold
- Division of Gastroenterology & Hepatology Department of Medicine University Hospital & Clinics, Columbia, Missouri, USA
| | - Berri Burns
- Infusion Pharmacy at Home, Center for Connected Care, Cleveland Clinic, BOC, Independence, Ohio, USA
| | - Theresa Cattell
- Nutrition Support Riverside Methodist Hospital, Columbus, Ohio, USA
| | | | - Lindsey Haffke
- CHI Health at Home - Home Infusion Pharmacy, Omaha, Nebraska, USA
| | - Cara Larimer
- Enteral Nutrition Moog Medical Devices Group, Salt Lake City, Utah, USA
| | - Jan Powers
- Nursing Research and Professional Practice, Parkview Health System, Fort Wayne, Indiana, USA
| | | | - Lauren Tweel
- Chinook Regional Hospital, Alberta Health Services, South Zone, Lethbridge, Alberta, Canada
| | - Peggi Guenter
- American Society for Parenteral and Enteral Nutrition, Silver Spring, Maryland, USA
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- Orlando VAMC, Orlando, Florida, USA
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24
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Chang WK, Huang HH, Lin HH, Tsai CL. Percutaneous Endoscopic Gastrostomy versus Nasogastric Tube Feeding: Oropharyngeal Dysphagia Increases Risk for Pneumonia Requiring Hospital Admission. Nutrients 2019; 11:E2969. [PMID: 31817381 DOI: 10.3390/nu11122969] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 11/21/2019] [Accepted: 12/04/2019] [Indexed: 02/06/2023] Open
Abstract
Background: Aspiration pneumonia is the most common cause of death in patients with percutaneous endoscopic gastrostomy (PEG) and nasogastric tube (NGT) feeding. This study aimed to compare PEG versus NGT feeding regarding the risk of pneumonia, according to the severity of pooling secretions in the pharyngolaryngeal region. Methods: Patients were stratified by endoscopic observation of the pooling secretions in the pharyngolaryngeal region: control group (<25% pooling secretions filling the pyriform sinus), pharyngeal group (25–100% pooling secretions filling the pyriform sinus), and laryngeal group (pooling secretions entering the laryngeal vestibule). Demographic data, swallowing level scale score, and pneumonia requiring hospital admission were recorded. Results: Patients with NGT (n = 97) had a significantly higher incidence of pneumonia (episodes/person-years) than those patients with PEG (n = 130) in the pharyngeal group (3.6 ± 1.0 vs. 2.3 ± 2.1, P < 0.001) and the laryngeal group (3.8 ± 0.5 vs. 2.3 ± 2.2 vs, P < 0.001). The risk of pneumonia was significantly higher in patients with NGT than in patients with PEG (adjusted hazard ratio = 2.85, 95% CI: 1.46–4.98, P < 0.001). Cumulative proportion of pneumonia was significantly higher in patients with NGT than with PEG for patients when combining the two groups (pharyngeal + laryngeal groups) (P = 0.035). Conclusion: PEG is a better choice than NGT feeding due to the decrease in risk of pneumonia requiring hospital admission, particularly in patients with abnormal amounts of pooling secretions accumulation in the pyriform sinus or leak into the laryngeal vestibule.
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