Abstract
BackgroundStroke is a major cause of dysphagia, but little is known about when and how dysphagic patients should be fed and treated after an acute stroke. The purpose of this study is to establish the feasibility, risks and clinical outcomes of early intensive oral care and a new speech and language therapist/nurse led structured policy for oral feeding in patients with an acute intracerebral hemorrhage (ICH).MethodsA total of 219 patients with spontaneous ICH who were admitted to our institution from 2004 to 2007 were retrospectively analyzed. An early intervention program for oral feeding, which consisted of intensive oral care and early behavioral interventions, was introduced from April 2005 and fully operational by January 2006. Outcomes were compared between an early intervention group of 129 patients recruited after January 2006 and a historical control group of 90 patients recruited between January 2004 and March 2005. A logistic regression technique was used to adjust for baseline differences between the groups. To analyze time to attain oral feeding, the Kaplan-Meier method and Cox proportional hazard model were used.ResultsThe proportion of patients who could tolerate oral feeding was significantly higher in the early intervention group compared with the control group (112/129 (86.8%) vs. 61/90 (67.8%); odds ratio 3.13, 95% CI, 1.59-6.15; P < 0.001). After adjusting for baseline imbalances, the odds ratio was 4.42 (95% CI, 1.81-10.8; P = 0.001). The incidence of chest infection was lower in the early intervention group compared with the control group (27/129 (20.9%) vs. 32/90 (35.6%); odds ratio 0.48, 95% CI, 0.26-0.88; P = 0.016). A log-rank test found a significant difference in nutritional supplementation-free survival between the two groups (hazard ratio 1.94, 95% CI, 1.46-2.71; P < 0.001).ConclusionsOur data suggest that the techniques can be used safely and possibly with enough benefit to justify a randomized controlled trial. Further investigation is needed to solve the eating problems that are associated with patients recovering from a severe stroke.
Highlights
Stroke is a major cause of dysphagia, but little is known about when and how dysphagic patients should be fed and treated after an acute stroke
The purpose of this study is to examine the effects of early intensive oral care and a new speech and language therapist (SLT)/nurse led structured policy for oral feeding on clinical outcomes, in terms of survival, the incidence of chest infection, the length of the hospital stay and swallowing function in acute intracerebral hemorrhage (ICH) patients
Univariate comparisons showed that the proportion of patients with a Functional Oral Intake Scale (FOIS) score of 4-7 was significantly higher in the early intervention group compared with the control group (86.8% (112/129) vs. 67.8% (61/90); odds ratio 3.13, 95% CI, 1.59-6.15; P < 0.001) (Table 3)
Summary
Stroke is a major cause of dysphagia, but little is known about when and how dysphagic patients should be fed and treated after an acute stroke. The purpose of this study is to establish the feasibility, risks and clinical outcomes of early intensive oral care and a new speech and language therapist/nurse led structured policy for oral feeding in patients with an acute intracerebral hemorrhage (ICH). Stroke often alters a patient’s dietary intake because of both dysphagia and impaired consciousness. The insertion of a nasogastric tube or a percutaneous endoscopic gastrostomy may be performed in patients with impaired consciousness or severe dysphagia. Severe dysphagia is a predictor of poor outcomes, and high incidences of chest infection and death are each associated with both methods of tube-feeding [7,8,9]
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