Effect of an indwelling nasogastric tube on swallowing function in elderly post-stroke dysphagia patients with long-term nasal feeding

Zhi-Yong Wang,Jian-Min Chen,Guo-Xin Ni

doi:10.1186/s12883-019-1314-6

Abstract

BackgroundIn clinical practice, a large number of post-stroke survivors require nasogastric tube (NGT) placement and nasal feeding for a relatively long period. However, its impact on the swallowing function remains largely unknown. This study examines the impact of prolonged placement of an NGT on the swallowing function of elderly post-stroke patients.MethodsThe participants of this study were 30 elderly post-stroke patients who had been using an NGT for more than 2 months. A videofluoroscopic swallowing study (VFSS) was performed before and 5 h after removal of the NGT. The following parameters were analyzed and compared, the functional dysphagia scale (FDS), residue in the valleculae, residue in the pyriform sinuses, and the penetration-aspiration scale (PAS). In addition, prior to the VFSS, the pharynx and larynx were examined using a fiberoptic laryngoscope.ResultsSignificant differences were observed between the total scores of the FDS, pharyngeal transit times (PTTs), the residue in the valleculae, and the residue in the pyriform sinuses before and after the NGT removal, suggesting an improved swallowing function following the removal of the NGT. A significantly lower penetration-aspiration degree was found after removing the NGT compared with that before its removal. In addition, examinations using the fiberoptic laryngoscope showed that laryngopharyngeal edema was present in three quarters of the patients.ConclusionsOur results demonstrate that prolonged placement of the NGT had a negative impact on the swallowing function of elderly post-stroke dysphagia patients, mainly on the pharyngeal phase.

Highlights

In clinical practice, a large number of post-stroke survivors require nasogastric tube (NGT) placement and nasal feeding for a relatively long period
No significant differences were observed in the oral transit time (OTT) between before and after the NGT removal; the pharyngeal transit time (PTT) was significantly faster after the NGT removal compared with before the NGT removal. These results suggest that the NGT removal had little effect on the OTT, but led to a significantly faster PTT
NGT is commonly applied to elderly poststroke patient, the impact of prolonged NGT placement on the swallowing function remains unknown

Summary

Introduction

A large number of post-stroke survivors require nasogastric tube (NGT) placement and nasal feeding for a relatively long period. This study examines the impact of prolonged placement of an NGT on the swallowing function of elderly post-stroke patients. As one of the potentially fatal complications [2], dysphagia is present in more than 50% of post-stroke survivors [3]. This problem relates to the high risk of post-stroke pneumonia, long length of hospital stay, malnutrition, and even mortality [4]. Investigations on acute stroke patient suggest that the NGT does not lead to either increased post-stroke pneumonia incidence and mortality or poor functional outcome [8]. Dziewas et al compared the swallowing functions of acute stroke patients with and without an NGT in place using fiberoptic endoscopic evaluation of swallowing (FEES), and demonstrated that a correctly

Methods

Results

Discussion

Conclusion