Predictive Factors Associated with Achieving Oral Intake in Patients with Dysphagia

Abstract

Objective: The purpose of this study was to determine oral intake predictors, including videofluoroscopic swallow study (VFSS) and Charlson Comorbidity Index (CCI), in patients with diseases/conditions requiring nasogastric (NG) tube feeding for dysphagia. Methods: We retrospectively extracted the clinical or radiological medical records of 501 patients with internal medicine diseases who were referred for VFSS to evaluate dysphagia between January 2012 and August 2021. Our study analyzed 310 (61.9%) subjects using the NG tube out of 501 patients surveyed. The demographic features of the subjects, comorbidities, including CCI, and the VFSS results were extracted. Immediately after the VFSS test, the subjects were categorized into two groups: 153 who removed the NG tube and 157 who retained it. The chi-square test, Fisher's exact test, and the independent t-test were used to analyze the data. We used the logistic regression analysis to determine the independent predictors of NG tube removal. The receiver operating characteristic (ROC) curve analysis was used to determine the best cut-off value of the Functional Dysphagia Scale (FDS) score for NG tube removal. Results: The FDS score, the Penetration-Aspiration Scale (PAS) score, the diagnosis of aspiration pneumonia, and the presence of hemiplegia affected the NG tube removal. The optimal cut-off value for the NG tube removal was a score of 36.5 based on the FDS. Conclusion: We clarified factors that may affect the NG tube removal in patients hospitalized for internal medicine disease. This study will assist in the future development of an oral intake strategy for patients with medical conditions receiving NG tube feeding. (JKDS 2022;12:35-44

Association between successful weaning from nasogastric tube feeding and thoracic muscle mass in patients with aspiration pneumonia

“…[19] Stroke and aspiration pneumonia are known as important clinical factors that make the removal of NG tubes difficult. [20] In patients with stroke and dysphagia, functional status was a significant clinical factor in nasogastric tube removal. [16] In a large-scale study that aimed to identify factors predicting oral intake in elderly patients with aspiration pneumonia, it was found that not only functional status but also underweight was an important factor in the delayed initiation of oral intake.…”

“…[10][11][12] Several studies have investigated various approaches to identify clinical factors related with successful transition from tube feedings to oral feedings. [13][14][15][16][17][18][19][20][21] Younger age was associated with a successful transition to oral nutrition from gastrostomy tube feeding in adults diagnosed with cancer. [19] Stroke and aspiration pneumonia are known as important clinical factors that make the removal of NG tubes difficult.…”

“…Several clinical and functional parameters have been evaluated as a predictor for successful weaning from tube feeding in adults. [13][14][15][16][17][18][19][20][21][22][23] However, little is known about useful radiologic indicators for predicting successful weaning from nasogastric tube feeding in adults.…”