Effect of Intermittent Oro-Esophageal Tube Feeding in Bulbar Palsy After Ischemic Stroke: A Randomized Controlled Study

Abstract

BACKGROUND: Nasogastric tube feeding (NG) has been widely used in patients with bulbar palsy after ischemic stroke but is associated with a significant risk of complications including malnutrition and pneumonia. Intermittent oro-esophageal tube feeding (IOE) can help alleviate these concerns. This study explored the clinical effect of IOE versus NG on nutritional status, swallowing function, stroke-associated pneumonia, and depression in patients with bulbar palsy after ischemic stroke. METHODS: This randomized controlled study included 148 patients with bulbar palsy after ischemic stroke who underwent routine treatment and swallowing rehabilitation training in the Department of Rehabilitation Medicine between July 2017 and July 2019 in China. The participants were randomly divided into the IOE group (n=74) and NG group (n=74) with IOE and NG as nutritional supports, respectively. The primary outcome was nutritional status including (1) body mass index (kg/m 2 ), (2) serum ALB (albumin, g/L), and (3) PA (prealbumin, mg/L). The secondary outcomes were (1) swallowing function including (i) Functional Oral Intake Scale (FOIS) and (ii) Penetration-Aspiration Scale, (2) pneumonia, (3) depression, and (4) adverse events. Statistical analyses for continuous outcomes were performed using t test, Mann-Whitney U test and Wilcoxon signed-rank test and categorical variables using χ 2 test. SPSS 21.0 was used for all analysis. RESULTS: There were no significant baseline differences between the 2 groups. After the treatment, the IOE group demonstrated significantly better results compared with the NG group in ALB ([32.71±0.94] versus [32.28±0.81] g/L; P =0.003), PA ([278.15±13.81] versus [270.31±15.08] mg/L; P =0.001], body mass index ([19.77±1.03] versus [19.41±0.98] kg/m 2 ; P =0.002], FOIS ( P <0.001), Penetration-Aspiration Scale ( P <0.001), stroke-associated pneumonia ([1, 4.05%] versus [26, 35.14%]; P <0.001), depression ([1, 1.35%] versus [44, 59.46%]; P <0.001) and overall less adverse events (reflux, fever, discomfort in the throat; P <0.001). CONCLUSIONS: In patients with dysphagia with bulbar palsy after ischemic stroke who received routine treatment and swallowing rehabilitation training, IOE is safer and more conducive to the improvement of nutritional status, swallowing function, stroke-associated pneumonia, and depression than NG. REGISTRATION: URL: https://www.chictr.org.cn ; Unique identifier: ChiCTR-INC-17011741.

Prevalence and influencing factors of malnutrition in stroke patients with bulbar paralysis: a cross-sectional study in China

“…Therefore, this study investigated the risk factors for malnutrition in SPBP to help identify high-risk patients at an early stage. This study demonstrated a pneumonia prevalence of 60% in SPBP, consistent with a clinical study conducted in China ( 27 ). Logistic regression analysis revealed that pulmonary infection is an independent risk factor.…”

“…The current study showed that the prevalence of malnutrition in SPBP was 60.59%, significantly higher than the overall prevalence of malnutrition in the stroke survivors enrolled (51.01%, p < 0.05). Possible reasons for this include the fact that the lesions in patients with true bulbar palsy are located in the medulla oblongata, which is the most basic center for regulating swallowing function ( 27 ). Therefore, SPBP typically experience severe dysphagia, manifested as difficulty in eating, inability to swallow food after chewing, choking on liquids, and in severe cases, inability to conduct oral intake, which can potentially lead to malnutrition.…”

“…It can also cause patients to experience problems such as coughing and aspiration pneumonia during meals, which can lead to fear of eating and thus reduce their willingness to eat ( 47 ). Studies have shown a significant correlation between dysphagia and complications such as pneumonia ( 27 ). In clinical practice, various feeding tubes are routinely used to alleviate the impact of dysphagia.…”

“…Compared to NGT, IOE does not affect the nasal, pharyngeal, and lower esophageal sphincter functions. This can not only reduce the risk of pneumonia and reflux but also provide a higher daily feeding volume, thus having advantages in improving nutritional status ( 27 ). However, in patients with FOIS >3, the nutrition support mode is no longer a significant influencing factor, which may be because the tube feeding dependence is low in these patients, and oral intake can partially facilitate nutritional status.…”