Tube Feeding In Patients Research Articles

Clinical Outcomes of Tube Feeding vs. Hand Feeding in Advanced Dementia.

Dementia is a growing public health issue, with the number of cases projected to triple by 2050 as society ages. Although the American Geriatrics Society recommends careful hand feeding over tube feeding for patients with advanced dementia, an increasing proportion of patients are receiving tube feeding. Although decisions regarding tube feeding are often based on the physician, recent studies have shown that tube feeding has significant implications for clinical outcomes and quality of life. Tube feeding is associated with an increased risk of mortality, pneumonia and the use of restraints. Although tube feeding may reduce caregiver burden, it does not improve survival or nutritional status and incurs significant financial costs. Caregivers that hand feed patients often experience stress, particularly in regions where support services are limited. However, there are various strategies available to promote hand feeding which include environmental interventions, mealtime assistance and caregiver training. Although hand feeding is the most comfortable option for patients, the frequency of mealtimes and financial and mental health impact on caregivers requires the physician to conduct a holistic assessment of the patient when deciding on the mode of feeding for patients with advanced dementia.

Adult bolus tube feeding patients report improved health-related quality of life, reduced feeding time, and good tolerance, compliance and acceptability with a ready-to-use, squeezable bolus tube feeding pouch

Adult bolus tube feeding patients report improved health-related quality of life, reduced feeding time, and good tolerance, compliance and acceptability with a ready-to-use, squeezable bolus tube feeding pouch

Tube feeding in patients with head and neck cancer undergoing chemoradio-/radio therapy: A systematic review and meta-analysis based on the GRADE approach

ScopeThe scope of this systematic review (SR) was to determine whether a nasogastric tube (NGT) or percutaneous endoscopic gastrostomy (PEG) is a more useful supportive therapy in patients with oral cancer undergoing chemoradio-/radio therapy. MethodsFor the review, two authors searched MEDLINE, Cochrane CENTRAL and Ichushi-Web to identify clinical practice guidelines, SRs and randomised controlled trials (RCTs) according to pre-determined criteria. RevMan Web was used to combine trials and analyse the data. We evaluated the certainty of the evidence using the Grading of Recommendations, Assessment, Development and Evaluation system approach. ResultsIt was not possible to perform a meta-analysis of only treatment completion based on the included RCTs; therefore, we performed a meta-analysis of treatment breaks as a surrogate outcome. A meta-analysis of potential treatment breaks, including treatment discontinuation, revealed no superiority between PEG and NGT (risk ratio=0.64 [0.23, 1.79]). A meta-analysis was conducted on two RCTs regarding the harms of infection. There does not appear to be a significant increase in the risk of infection with either PEG or NGT (risk ratio=1.18 [0.45, 3.08]). The certainty of the evidence for two outcomes was judged to be very low. Further, meta-analyses of quality of life and nutritional status were not possible because of differences in assessment methods. ConclusionWe could not determine the superiority of NGT or PEG in the supportive care of oral cancer patients who received chemoradio-/radio therapy. The effect of PEG feeding is uncertain, and it is necessary to consider indications for each case.

Adapting services to meet the needs of home tube-feeding patients and respond to the evolving NHS landscape.

Adapting services to meet the needs of home tube-feeding patients and respond to the evolving NHS landscape.

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.

Thickened water has been widely used in patients with dysphagia who receive oral feeding, but there is little evidence for tube-feeding patients. To explore the effects of thickened water swallow training in tube-feeding and dysphagia patients in the acute and early subacute phases of stroke. 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. 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. 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.

Pharyngeal Cavity Electrical Stimulation-Assisted Swallowing for Post-stroke Dysphagia: A Systematic Review and Meta-analysis of Randomized Controlled Studies.

Stroke is the leading cause of death and disability among adults. The incidence of stroke per 100, 000 patient-years was 2875. As many as 37% to 78% of patients with acute strokes suffer dysphagia. Dysphagia can easily lead to inhalation pneumonia, dehydration, malnutrition, and other serious complications, affecting the quality of life of stroke patients and increasing their mortality. Effective prevention and treatment of post-stroke dysphagia are of great significance to improving the prognosis and quality of life of patients. Some studies have shown that Pharyngeal cavity electrical stimulation-assisted swallowing (PCES-assisted swallowing) has a positive effect on patients with post-stroke dysphagia. This study will evaluate the effects of PCES-assisted swallowing on post-stroke dysphagia, including swallowing function, withdrawal rate of nasal feeding tubes, duration of hospitalization, and so on. Randomized controlled trials (RCTs) of PCES-assisted swallowing in the treatment of post-stroke dysphagia were searched in eight databases, including Cochrane Library, Embase, PubMed, Web of Science, Chinese Biomedical Literature Database, VIP Information Resource System, CNKI, and Wanfang Medical Science. The retrieval time was from the database establishment to June 2022. Rayyan was used to screen the retrieved literature risk of bias for included studies and was calculated using ROB2.0. The RevMan 5.3 software was used for the meta-analysis with the standard mean difference (SMD) and 95% confidence interval (CI). The model type was a random effect model, The risk ratio (RR) was used as the effect size for the two categorical variables. The swallowing function scores, withdrawal rate of nasal feeding tubes, and Length of stay (LOS) of the intervention and control groups were extracted, and the results of the meta-analysis were presented using a forest plot. Six studies from 2010 to 2018 with a total of 341 people were included in the meta-analysis. All studies reported quantitative outcome measures for the severity of dysphagia, and some reported the withdrawal rate of nasal feeding tubes, LOS, and penetration-aspiration-scale (PAS). The overall swallowing function of the PCES group was better than that of the control group (SMD = -0.20, 95%CI -0.38 to -0.03, P = 0.02). In terms of the severity of dysphagia, there was a statistically significant difference in the Dysphagia Severity Rating scale (DSRS) between the Pharyngeal cavity electrical stimulation (PCES) group and the control group (SMD = -0.24, 95%CI -0.48 to 0, P = 0.05). The PCES group nasal feeding withdrawal rate of nasal feeding tubes was higher than the control group (RR = 2.88, 95% CI 1.15 to 7.26, P = 0.02). There was no significant difference in the LOS between the PCES group and the control group (SMD = -0.19, 95%CI -0.44 to 0.07, P = 0.15). This systematic review and meta-analysis provide reasonably reliable evidence that PCES-assisted swallowing can improve nasogastric feeding swallowing function and the withdrawal rate of nasal feeding tubes in patients with post-stroke dysphagia. However, the evidence for reducing oral feeding, aspiration, and length of hospitalization stay is lacking, and further studies are needed.

Association between tongue pressure and oral status and activities of daily living in stroke patients admitted to a convalescent rehabilitation unit.

Clarifying how tongue pressure in convalescent stroke patients affects oral condition andactivities of daily living (ADL) is important for developing oral rehabilitation programs and for rehabilitation care to reacquire ADL. To clarify how tongue pressure is associated with oral status, ADL, and nutritional status in stroke patients. Sixty-eight patients aged 77.9 ± 10.0 years participated. The Japanese version of the Oral Health Assessment Tool was used to evaluate oral status. Data such as the ADL index functional independence measure (FIM), nutritional intake method, serum albumin, and body mass index were extracted from medical records. To examine factors associated with tongue pressure, multiple regression analysis was performed adjusting for confounding factors. The level of statistical significance was set at p < .05. In recovery phase stroke patients, tongue pressure was significantly lower in the total assistance group than in the partial assistance/independent group. In addition, tongue pressure was significantly lower in tube feeding patients than in oral feeding patients. FIM cognition score was an independent factor that had a significant effect on tongue pressure. These findings suggest that ADL status also affects tongue pressure, thus patients' ADL including the FIM cognition subscale should also be evaluated while measuring tongue pressure.

Very Rare Complication of Percutaneous Endoscopic Jejunostomy Feeding Tubes in Patients with Intestinal Dysmotility

Very Rare Complication of Percutaneous Endoscopic Jejunostomy Feeding Tubes in Patients with Intestinal Dysmotility

Rheological and thermal properties of an enteral nutrition formula for nutritional support patients using a combined mixture of gelatin and maltodextrin.

Enteral nutrition is a type of nutritional support that provides the necessary sources of energy and protein for patients who suffer from dysphagia, chronic disease, and loss of appetite. In this study, a gelatin-maltodextrin binary biopolymer system has been incorporated into a semi-solid formula. The I-optimal combination design approach was used to create 19 formulations, and the dynamic rheological properties, dynamic laser scattering, and zeta potential responses were evaluated over 30 days of storage at 5°C. Solid viscoelastic behavior has been approved since G' > G″ in the frequency sweep test with no cross-over point. Maltodextrin may interfere within the gelatin network, and increasing the maltodextrin to gelatin (from 0.14 to 1) may lead to a wider linear viscoelastic (LVE) strain range (2.16%), a lower storage modulus at LVE (52%), a lower yield stress (46%), and a lower glass transition temperature (34%). The presence of maltodextrin may reduce the temperature of the sol-to-solid transformation by 48% and enhance its flexibility. In contrast, increasing the gelatin-to-maltodextrin ratio following melting at 37°C led to an increase in the cumulant mean and polydispersity index, indicating a relatively unstable system. The range of zeta potential values between -4.4 and 1.7 mV confirmed a tendency toward coagulation. Microscopic images revealed instability because of irregular or compact chains formed in the gelatin matrix by using higher amounts of maltodextrin. Finally, the best formula had the best rheological stability and was suitable for tube-feeding patients, with a gelatin-to-maltodextrin ratio of 4.35:3.64% w/w on day 17.4.

Feeding Tube Placement, Complications, and Treatment Responses in a Large Eosinophilic Esophagitis Patient Population.

Feeding tubes can provide a temporary or long-term solution for nutritional therapy. Little is known regarding the use of feeding tubes in patients with eosinophilic esophagitis (EoE). We sought to describe the characteristics and outcomes in EoE patients requiring tube feeding. This was a retrospective cohort study of EoE patients at a large tertiary care health system. Demographics, clinical characteristics, and endoscopic findings were extracted from medical records, and patients who had a feeding tube were identified. Patients with and without a feeding tube were compared. Details about the tube, complications, and treatment were extracted. Growth, global symptomatic, endoscopic, and histopathologic (<15 eos/hpf) responses were compared before and after the initiation of feeding tube therapy. We identified 39 of 1216 EoE patients who had a feeding tube (3%). Feeding tube patients were younger (mean age 6.3 years), reported more vomiting, and had a lower total endoscopic reference score than non-feeding tube patients ( P < 0.01 for all). Tubes were used for therapy for an average of 6.8 years, with most patients (95%) receiving both pharmacologic and formula treatment for EoE. An emergency department visit for a tube complication was required in 26%. Tube feeding improved body mass index z score ( P < 0.01), symptomatic response (42%), endoscopic response (53%), and histologic response (71%). Among EoE patients, only a small subset required a feeding tube and predominantly were young children with failure to thrive. Feeding tubes significantly improved growth and, when used in combination with other treatments, led to reduced esophageal eosinophilic inflammation.

Effect of prophylactic tube feeding in head and neck cancer patients with high Mallampati score undergoing definitive concurrent chemoradiotherapy.

There is no consensus on the selection of appropriate prophylactic tube feeding in patients with head and neck squamous cell carcinoma (HNSCC) undergoing concurrent chemoradiotherapy (CCRT). This study aimed to evaluate the effect of prophylactic tube feeding in patients with HNSCC who presented with a high Mallampati score and underwent CCRT. We prospectively enrolled 185 consecutive patients with stage II to IVa HNSCC and a pre-treatment Mallampati score of 3 or 4 who received CCRT between August 2017 and December 2018 with follow-up data collected retrospectively. Patients were divided to either with or without prophylactic tube feeding group for comparison of treatment tolerance, toxicities, and quality of life(QOL). Propensity score matching (PSM) was used to achieve balanced covariates across the two groups. Of the cohort, 52 (28.1%) and 133 (71.9%) patients were allocated to the prophylactic and non-prophylactic tube feeding groups, respectively. Before and after PSM, patients in the tube feeding group had a significantly lower incidence of incomplete radiotherapy, incompletion of chemotherapy, emergency room visits, and grade 3 or higher infection, and improved symptoms of quality of life after CCRT than those in the non-tube feeding group. Prophylactic tube feeding was associated with better treatment tolerance, safety profiles, and quality of life in patients with HNSCC and high Mallampati scores who underwent CCRT. Therefore, Mallampati score might serve as a clinical tool for proactive selection of patients receiving prophylactic tube feeding in HNSCC patients upon receiving CCRT.

P-418 Use of prophylactic and reactive feeding tubes in patients with esophageal cancer: A single-centre cohort study

P-418 Use of prophylactic and reactive feeding tubes in patients with esophageal cancer: A single-centre cohort study

Use of prophylactic and reactive feeding tubes in patients with esophageal cancer: A single-centre cohort study.

e18694 Background: Esophageal cancer (EC) patients suffer from significant cachexia prior to and during treatment with chemotherapy and radiation (CRT). Feeding tubes can become the primary form of nutritional support for these patients during and after completion of treatment. Our primary objective was to identify factors that can predict EC patients at high risk of requiring feeding tube insertion. Methods: A retrospective cohort review was completed. All patients with an EC diagnosis made from January 1, 2013 to December 31, 2018 were included. Baseline characteristics of all patients and those receiving feeding tubes were collected. A multivariate logistic regression was performed comparing the group that required a reactive feeding tube insertion to those who did not require any feeding tube insertion to identify risk factors. Results: A total of 350 patients were included in the study, and 132/350 (38%) patients received a feeding tube, with gastrostomy tube being the most common type inserted (72%). 82 out of 132 (62%) patients had feeding tube inserted prophylactically, while 50/132 (38%) patients had feeding tube inserted reactively. Amongst patients who had a feeding tube inserted, median age was 67 years old, with 74% being male. Fifty-one out of 132 (39%) were adenocarcinoma, 75/132 (57%) were squamous cell carcinoma, 5/132 (4%) were neuroendocrine, and 1/132 (1%) was lymphoma. Severe dysphagia (OR 19.9, 95% CI 2.6-151.2, p &lt; 0.001) at diagnosis and decision to undergo chemotherapy (OR 2.8, 95% CI 1.3-5.8, p = 0.008) appeared to be predictors for reactive feeding tube insertion. Complications relating to feeding tubes were seen in 24/50 (48%) of the reactive insertion group and 34/82 (41%) of the prophylactic insertion group (p = 0.48). Conclusions: In this single-centre cohort study, severe dysphagia and undergoing chemotherapy were identified as risk factors for requiring a feeding tube later on. Future prospective studies can further explore other risk factors that may predict those at high risk of requiring a feeding tube, especially as it appears that those who have feeding tubes inserted reactively may have more complications than those who have feeding tube inserted prophylactically.

Detection of Complications Associated With Nasogastric Tube Feeding in Patients With Haemorrhagic Stroke in a Tertiary Hospital

Background: Stroke poses the greatest disease burden in hospital admission among the non communicable diseases (NCD’s). In majority of cases haemorrhagic stroke is the common neurological problem. Many of the patients develop swallowing difficulty and require nasogastric feeding for maintenance of nutrition. But this feeding can be a double-edged sword as it can lead to many complications due to various factors including errors in the feeding method, dislodgement of the tube and many other causes. Our intention was to look into this neglected part of clinical practice as this is mostly handled by internists. Objectives: To evaluate the complications of nasogastric tube feeding practice on haemorrhagic stroke patients. Materials and methods: One hundred (100) adult patients aged between 18- 70 years with haemorrhagic strokeas enrolled in the study. Haemorrhagic stroke was diagnosed by the clinical presentation, neuroimaging (CT scan/ MRI). Patients requiring nasogastric tube feeding were included in the study. They were systematically examined for any complications related to use of nasogastric tube. Their caregivers were also thoroughly interviewed using a standard pre formed questionnaire regarding any complications as well. All data were be collected by using a preformed data sheet and results were presented in standard method after statistical analysis. Results: Of the 100 patients studied, most common age group for stroke was 51-60 years (53%). Male to female ratio was 2.22:1. In this study population, 70% had intracerebral haemorrhage, 24% had Sub arachnoid haemorrhage and 6% had aneurysmal haemorrhage. The most common indication for NG feeding was difficulty in swallowing (39%). Other common indications were semi consciousness (26%), unconsciousness (22%), inability to maintain feed (10%). Around 71 % of the patients had complications from NG tube feeding. Out of them, 53% of the patients had nasal irritation where 63.15%was suffering from intracerebral haemorrhage, 31.57% and 5.26% were suffering from subarachnoid haemorrhagic and aneurysmal haemorrhage respectively. 40 % patients developed aspiration pneumonia, out of them 65.51%wasintracerebral haemorrhage, 31.03% was subarachnoid haemorrhagie ,3.44% was aneurysmal haemorrhage. 38% of the patients were developed diarrhea. Diarrhoea was reported by 66.66%, 29.62%, 3.70% in intracerebral haemorrhage, subarachnoid haemorrhagic and aneurysmal haemorrhage respectively. 53% had tube blockage, out of them intracerebral haemorrhage 71.05%, subarachnoid haemorrhage 23.68%, aneurysmal haemorrhage 2.63%. 43% of the patients had electrolyte imbalance, among them intracerebral haemorrhage 67.74% and subarachnoid haemorrhage 32.25%. Tube displacement was experienced by intracerebral haemorrhage 74.16%, subarachnoid haemorrhage 25.80% and 18% of the patients were malnourished. Conclusion: NG tube feeding is an integral part of management of stroke patients with feeding difficulties. But often it is associated with various complications which can increase the morbidities in stroke patients. J Dhaka Med Coll. 2022; 31(1) : 77-85

Effect of jejunal feeding tube placement on complications after laparoscopic radical surgery in patients with incomplete pyloric obstruction by gastric antrum cancer

Objective: To assess the effect of jejunal feeding tube placement on early complications of laparoscopic radical gastrectomy in patients with incomplete pyloric obstruction by gastric cancer. Methods: This was a retrospective cohort study. Perioperative clinical data of 151 patients with gastric antrum cancer complicated by incomplete pyloric obstruction who had undergone laparoscopic distal radical gastrectomy from May 2020 to May 2022 in the First Affiliated Hospital of Nanchang University were collected. Intraoperative jejunal feeding tubes had been inserted in 69 patients (nutrition tube group) and not in the remaining 82 patients (conventional group). There were no statistically significant differences in baseline characteristics between the two groups (all P>0.05). The operating time, intraoperative bleeding, time to first intake of solid food, time to passing first flatus, time to drainage tube removal, and postoperative hospital stay, and early postoperative complications (occurded within 30 days after surgery) were compared between the two groups. Results: Patients in both groups completed the surgery successfully and there were no deaths in the perioperative period. The operative time was longer in the nutritional tube group than in the conventional group [(209.2±4.7) minutes vs. (188.5±5.7) minutes, t=2.737, P=0.007], whereas the time to first postoperative intake of food [(2.7±0.1) days vs. (4.1±0.4) days, t=3.535, P<0.001], time to passing first flatus [(2.3±0.1) days vs. (2.8±0.1) days, t=3.999, P<0.001], time to drainage tube removal [(6.3±0.2) days vs. (6.9±0.2) days, t=2.123, P=0.035], and postoperative hospital stay [(7.8±0.2) days vs. (9.7±0.5) days, t=3.282, P=0.001] were shorter in the nutritional tube group than in the conventional group. There was no significant difference between the two groups in intraoperative bleeding [(101.1±9.0) mL vs. (111.4±8.7) mL, t=0.826, P=0.410]. The overall incidence of short-term postoperative complications was 16.6% (25/151). Postoperative complications did not differ significantly between the two groups (all P>0.05). Conclusion: It is safe and feasible to insert a jejunal feeding tube in patients with incomplete outlet obstruction by gastric antrum cancer during laparoscopic radical gastrectomy. Such tubes confer some advantages in postoperative recovery.

Medical choices regarding feeding tubes in patients with end-stage dementia in Israel: nasogastric vs. percutaneous endoscopic gastrostomy.

A previous study conducted more than 15years ago in Israel found a high overall use of tube-feeding for institutionalized end-stage dementia patients (52%) and a proportionally higher use (2:1) of naso-gastric tube (NG) over Percutaneous Endoscopic Gastrostomy (PEG) tubes for enteral feeding. This rate was markedly higher than that observed in other western countries (4.9-34%), and did not conform with clinical guidelines preferring spoon-feeding over tube-feeding for these patients, and PEG over NG for those in whom tube-feeding was initiated in long-term care. Over the past decade, the Israeli Ministry of Health conducted a policy reform to neutralize the administrative incentives presumed to be responsible for this situation. Further administrative and legislative developments followed suit. Despite these, we found no significant reduction in the prevalence of tube-feeding over spoon-feeding. However, we did observe a reduction in the proportional use of NG over PEG.

Comparison of nutritional effectiveness and complication rate between early nasojejunal and nasogastric tube feeding in patients with an intracerebral hemorrhage

BackgroundThis study aimed to compare nutritional effectiveness and complication rate between early nasojejunal and nasogastric tube feeding in patients with an intracerebral hemorrhage. MethodsThis was a retrospective study. Eighty patients with an intracerebral hemorrhage were divided into a nasojejunal and a nasogastric tube feeding group. Feeding tubes were placed within 6 h after admission, and enteral feeding began within 2 h after tube placement. The nutritional status and complication rate of the 2 groups were compared before and 2 and 4 weeks after beginning feeding. ResultsSerum prealbumin, serum albumin, and hemoglobin levels were significantly higher in the nasojejunal tube feeding group than in the nasogastric tube feeding group at 2 and 4 weeks after beginning feeding (all, p < 0.05). The incidence of gastric retention, pulmonary aspiration, and pneumonia were lower in the early nasojejunal tube feeding group than in the early nasogastric tube feeding group (all, p < 0.05). There was no significant difference in the incidence of diarrhea between the 2 groups. ConclusionCompared with early nasogastric feeding, early nasojejunal feeding provides better nutritional effectiveness and a lower incidence of gastric retention, pulmonary aspiration, and pneumonia in patients with an intracerebral hemorrhage.

Tube feeding in patients with head and neck cancer undergoing chemoradiotherapy: A systematic review.

Patients with head and neck cancer (HNC) are frequently malnourished at the time of diagnosis and before beginning treatment. In addition, chemoradiotherapy causes or exacerbates symptoms such as alteration or loss of taste, mucositis, xerostomia, fatigue, nausea, and vomiting, with consequent worsening of malnutrition. If obstructing cancer and/or mucositis interferes with swallowing, enteral nutrition should be delivered by a nasogastric tube (NGT) or percutaneous endoscopic gastrostomy (PEG). To review studies comparing NGT's and PEG's nutrition outcomes, survival, hospitalizations, radiotherapy interruptions, quality of life, and swallowing function. Two hundred fifty publications were identified via electronic databases. 26 manuscripts that met the inclusion criteria were included for analysis. We divided the analysis in two sections: (1) comparison of enteral nutrition through NGT or PEG and (2) comparison of reactive PEG (R-PEG) and prophylactic PEG (P-PEG). They have comparable nutrition outcomes, number of radiotherapy interruptions, survival, and quality of life, whereas swallow function seems better with NGT. PEG may be associated with major complications such as exit-site infection, malfunction, leakage, pain, pulmonary infection, and higher costs. Nevertheless, NGTs dislodged more often; patients find NGTs more inconvenient; NGTs may cause aspiration pneumonia; P-PEG and R-PEG have similar nutrition outcomes, number of radiotherapy interruptions, and survival. PEG does not have better nutrition, oncologic, and quality-of-life outcomes than NGT. Prophylactic feeding through NGT or PEG, compared with reactive feeding, does not offer significant advantages in nutrition outcomes, radiotherapy interruptions, and survival. However, the number of prospective randomized studies on this topic is limited; consequently, definitive conclusions cannot be drawn. Further adequate, prospective randomized studies are needed.

Evaluation of Oropharyngeal Dysphagia in Older Patients for Risk Stratification of Pneumonia.

ObjectiveNasogastric 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.MethodsWe 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.ResultsMultivariate 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).ConclusionsFor 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.

Abstract WMP34: Early Oral Feeding Following Removal Of Feeding Tube In Stroke Patients Based On The Modified Volume-viscosity Swallow Test

Objective: Dysphagia is common in patients with acute ischemic stroke patients (AIS). Feeding tubes are often placed to prevent aspiration pneumonia and supply nutrition when swallow function impaired are detected. However, little is known about when and how to start oral feeding in AIS. The purpose of this study is to establish a feasibility and effective intervention for early oral feeding following removal of feeding tube in patients with AIS. Methods: A total of 37 patients with AIS who were removed feeding tubes and start oral feeding in our hospital from 2017 to 2021 were retrospectively analyzed. An intervention program for early oral feeding, which consisted of the modified volume-viscosity swallow test (V-VST) and mechanical soft diet, was fully operationalized from October 2020 to July 2021. Outcomes were compared between an early oral feeding intervention group of 17 patients and a historical control group of 20 patients from July 2017 to September 2020. We compared the baseline characteristics between the groups. To analyze aspiration pneumonia probability, the Kaplan-Meier method were used. Results: The length of stay in hospital was significantly longer in the control group compared with the early oral feeding group (16.70±5.24 vs 12.88±4.46; P=0.024). Patients in the control group tolerated tube feeding longer days ( 9.45±2.93 vs 6.59±3.57; P=0.011 ). A log-rank test found no significant difference in aspiration pneumonia between the two groups ( P =0.111). Conclusions: Our data suggest that the intervention for early oral feeding can be used safely and possibly.