Quantifying fluid intake in dysphagic stroke patients: A preliminary comparison of oral and nonoral strategies

Finestone, Hillel M.; Foley, Norine; Woodbury, M. Gail; Greene-Finestone, Linda S.

doi:10.1053/apmr.2001.27379

Cited by 109 publications

(95 citation statements)

References 12 publications

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“…The literature has demonstrated that, especially if reliant on oral intake alone, individuals with dysphagia following stroke often present with inadequate fluid intake [6][7][8] and dehydration [9].Therefore much of the research regarding fluid intake and hydration in the stroke population has involved patients presenting with dysphagia. One study comparing the fluid intake of hospitalized patients post-stroke with and without dysphagia found those without dysphagia permitted thin liquids drank significantly more than those with dysphagia prescribed thickened liquids (mean of 1237ml and 947ml, respectively), although only one patient from the total sample of patients met the minimum standard of fluid intake set at 1500ml [10].…”

Section: Introductionmentioning

confidence: 99%

“…Dehydration, based on biochemical analysis, has been demonstrated by 36 -66% of patients presenting with or without dysphagia in the acute phase following stroke [11,4], although patients with dysphagia had significantly worse hydration at discharge compared to their non-dysphagic counterparts [11]. Evaluating a control group of patients without dysphagia following stroke is warranted to determine whether sub-optimal oral fluid intake of the patients with dysphagia [6][7][8] is solely related to their swallowing impairment or other factors. Whilst fluid intake was not related to any dependency factors in a study of 121 residents in a long-term care facility [12], it is unknown whether stroke-related deficits in mobility, self-care, communication, cognition, toileting and fear of incontinence may play a role in sub-optimal fluid intake of patients in rehabilitation settings.…”

Section: Introductionmentioning

confidence: 99%

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A Descriptive Study of the Fluid Intake, Hydration, and Health Status of Rehabilitation Inpatients without Dysphagia Following Stroke

Murray

Doeltgen

Miller

et al. 2015

Journal of Nutrition in Gerontology and Geriatrics

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Abstract:Adequate hydration is important for all people particularly when hospitalized with illness.Individuals with dysphagia following stroke are considered to be at risk of inadequate fluid intake and, therefore, dehydration but there is little information about the fluid intake or hydration of individuals without dysphagia post-stroke. This cohort study measured the average beverage intake, calculated the urea/creatinine ratio as a measure of hydration, and documented specific health outcomes of 86 people without dysphagia post-stroke who were inpatients in rehabilitation centres. Participants drank on average 1504ml per day (SD 359ml) which typically represented 67% of their estimated daily requirement. Approximately 44% of the participants in the sample were dehydrated based on a Blood Urea Nitrogen/Creatinine ratio >20:1. Sixteen percent of participants were diagnosed with one or more of the health outcomes of dehydration/hypernatremia, urinary tract infection or constipation. A greater level of dependence was associated with poorer beverage intake and higher risk of an adverse health outcome. Those in the older/elderly age range (particularly older women) and those with poor mobility were most at risk of poor hydration. This study highlights that patients in rehabilitation facilities post-stroke, even without dysphagia, may be at risk of sub-optimal fluid intake and hydration.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A Descriptive Study of the Fluid Intake, Hydration, and Health Status of Rehabilitation Inpatients without Dysphagia Following Stroke

Murray

Doeltgen

Miller

et al. 2015

Journal of Nutrition in Gerontology and Geriatrics

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“…Notably, food was found to be the greatest contributor to oral fluid intake in a cohort of patients with dysphagia in acute settings [25]. However, total fluid intake has consistently been found to be inadequate for individuals with dysphagia on modified diet and liquids, especially if reliant of oral intake alone [25][26][27][28][29]. …”

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confidence: 99%

Does a Water Protocol Improve the Hydration and Health Status of Individuals with Thin Liquid Aspiration Following Stroke? A Randomized Controlled Trial

et al. 2016

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The benefit of water protocols for individuals with thin-liquid aspiration remains controversial, with mixed findings from a small number of randomized controlled trials (RCTs). This study aimed to contribute to the evidence of the effectiveness of water protocols with a particular emphasis on health outcomes, especiallyhydration. An RCT was conducted with patients with known thin-liquid aspiration post-stroke randomized to receiving thickened liquids only or a water protocol. For the 14 participants in rehabilitation facilities whose data proceeded to analysis, there was no difference in the total amount of beverages consumed between the water protocol group (mean=1103ml per day, SD=215ml) and the thickened liquids only group (mean=1103ml, SD=247ml). Participants in the water protocol group drank on average 299ml (SD 274) of water but offset this by drinking less of the thickened liquids. Their hydration improved over time compared with participants in the thickened liquids only group, but differences between groups were not significant. Twenty-one percent of the total sample was diagnosed with dehydration and no participants in either group were diagnosed with pneumonia. There were significantly more diagnoses of urinary tract infection in the thickened liquids only group compared to the water protocol group (χ 2 =5.091, p=0.024), but no differences between groups with regard to diagnoses of dehydration (χ 2 = 0.884, p=0.347) or constipation (χ 2 =0.117, p=0.733). The findings reinforce evidence about the relative safety of water protocols for patients in rehabilitation post-stroke and provide impetus for future research into the potential benefits for hydration status and minimizing adverse health outcomes.Drinking, deglutition, deglutition disorders, stroke, water, water-electrolyte imbalance [6]. The premise is that thickening a liquid makes it more cohesive and dense, reducing its flow rate. This enables many patients to better control the bolus intra-orally, thereby reducing aspiration risk before and during swallowing [7,8].There has been growing concern, however, about the blanket prescription of thickened liquids for a number of [14,18,19]. By far the greatest concern about thickened liquid prescription is that individuals with dysphagia do not consume enough fluids. Researchers have demonstrated that the bioavailability of water from a quantity of thickened liquids is equivalent to that from the same quantity of thin liquid [20][21][22] confirming that thickened liquids themselves are not the cause of dehydration. Furthermore, it is recognised that, in addition to beverages, food contributes to approximately 20% of overall fluid intake with an even greater percentage if individuals are on pureed food [23,24]. Notably, food was found to be the greatest contributor to oral fluid intake in a cohort of patients with dysphagia in acute settings [25]. However, total fluid intake has consistently been found to be inadequate for individuals with dysphagia on modified diet and liquids, especially if reliant o...

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“…Stroke severity may be difficult to assess and comorbidities such as chronic obstructive pulmonary disease may complicate the case (1). Dysphagia in stroke patients may lead to complications such as aspiration pneumonia, which increases the length of acute stay and leads to persistence and perhaps even worsening of dysphagia during the first month after stroke (2)(3)(4). It is important to maintain or restore oral intake to improve the quality of life and nutritional status of these patients.…”

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confidence: 99%

Videofluoroscopy-guided balloon dilatation for treatment of severe pharyngeal dysphagia

Yabunaka

Konishi

Nakagami³

et al. 2015

Diagn Interv Radiol

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Balloon dilatation is a widely accepted technique in the management of esophageal and other types of gastrointestinal strictures, but it is rarely used for the treatment of pharyngeal dysphagia. Therefore, the aim of our prospective study was to evaluate the use of videofluoroscopy-guided balloon dilatation (VGBD) for the treatment of severe pharyngeal dysphagia. The study included 32 stroke patients who had been diagnosed with oral and/or pharyngeal dysphagia. All patients underwent dilatation of the esophageal inlet using a balloon catheter under videofluoroscopic guidance during one or more sessions. Following esophageal dilatation, manual feeding was provided twice weekly. VGBD was effective in 10 out of 32 patients; however, the remaining 22 patients were unable to attempt oral food consumption because aspiration was not completely resolved on videofluoroscopy. According to this case series, VGBD may provide treatment for patients with severe pharyngeal dysphagia, who have not consumed food orally for a long period of time.

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Quantifying fluid intake in dysphagic stroke patients: A preliminary comparison of oral and nonoral strategies

Cited by 109 publications

References 12 publications

A Descriptive Study of the Fluid Intake, Hydration, and Health Status of Rehabilitation Inpatients without Dysphagia Following Stroke

A Descriptive Study of the Fluid Intake, Hydration, and Health Status of Rehabilitation Inpatients without Dysphagia Following Stroke

Does a Water Protocol Improve the Hydration and Health Status of Individuals with Thin Liquid Aspiration Following Stroke? A Randomized Controlled Trial

Videofluoroscopy-guided balloon dilatation for treatment of severe pharyngeal dysphagia

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