The Effect of Nasogastric Tubes on Swallowing Function in Persons With Dysphagia Following Stroke

Wang, Tyng-Guey; Wu, M C; Chang, Yeun‐Chung; Hsiao, Tzu‐Yu; Lien, I-Nan

doi:10.1016/j.apmr.2006.05.019

Cited by 35 publications

(41 citation statements)

References 13 publications

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“…The contribution of NGT to colonisation of the oropharynx cannot be distinguished in this study. The possibility that NGTs influence swallowing contributing to respiratory infection cannot be excluded; previous research suggested wide bore NGT may create iatrogenic dysphagia [21;] however, more recent studies have refuted this [22]. …”

Section: Discussionmentioning

confidence: 99%

Dysphagia and Factors Associated with Respiratory Infections in the First Week Post Stroke

et al. 2014

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Background: Dysphagia occurs in approximately half of the stroke patients and is associated with respiratory infections; however, it is unclear what other factors contribute to an increased risk. This study aimed to provide evidence on factors associated with respiratory infections in the very acute stroke period. Methods: Retrospective review of 536 stroke patients admitted to Australian Hospitals in 2010. Data were collected on 37 clinical and demographic parameters. Univariable and multivariable logistic regression was performed. Results: The overall incidence of respiratory infection was 11%. On admission, requiring full assistance with mobility [OR 6.48, 95% CI 1.35, 31.16] and urinary incontinence [OR 3.21, 95% CI 1.16, 8.87] were associated with respiratory infections. During the first week post stroke nasogastric tubes (NGT) [OR 3.91, 95% CI 1.73, 8.80] and Nil By Mouth (NBM) [OR 5.62, 95% CI 1.54, 20.46] were associated with respiratory infections. Impaired GCS, ischaemic stroke and significantly impaired mobility were associated with swallowing difficulties. Conclusion: This study of a large cohort of acute stroke patients supports research indicating aspiration pneumonia is multifactorial in nature. NGT were associated with increased risk of respiratory infections and may contribute to infections by promoting oropharyngeal colonisation. Patients with severely impaired mobility were also at very high risk of respiratory infection.

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Section: Discussionmentioning

confidence: 99%

Dysphagia and Factors Associated with Respiratory Infections in the First Week Post Stroke

et al. 2014

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“…5,10 Pyriform residue occurs more commonly in an older person due to changes in bolus acceleration through the hypopharynx 11 compounded by reduced relaxation and smaller opening of the UES, 19 therefore the presence of a NGT may increase residue by partially obstructing a UES already narrowed with age 27 with residual material in close proximity to the open and unprotected airway after the swallow. Higher in the pharynx, valleculae residue can result from reduced base of tongue contact against the posterior pharyngeal wall, along which path the NGT traverses, and may reflect incomplete epiglottic deflection over the airway during the swallow.…”

Section: Discussionmentioning

confidence: 99%

“…Most other investigations were observational studies of clinical populations with dysphagia, 7-10 therefore different from the normative data presented in this RCT. Furthermore, prior studies used a binary, [8][9][10] modified 7 14 or condensed rating scale 4 of penetration-aspiration which is not as sensitive in capturing subtle changes in swallowing function as the validated 8 point PAS 15 which spans the continuum of penetration to aspiration. The only other study to analyse data using the 8 point scale 5 found no difference in penetration-aspiration, however the subjects were young healthy volunteers.…”

Section: Discussionmentioning

confidence: 99%

“…Other studies have suggested that the presence of a NGT does not increase aspiration risk 4,5,7-10 but these studies differ from the current study in population 5,7-10 and methodology. 4,[7][8][9][10] Methodological differences across studies relate to use of fibreoptic endoscopic evaluation of swallowing 4,7-9 as compared to modified barium swallow. [5][6]10 While both procedures are considered equivalent in detecting aspiration, 18 modified barium swallow allows additional information to be captured on swallowing duration hence its use in the current study.…”

Section: Discussionmentioning

confidence: 99%

“…To date evidence does not suggest that NGT presence increases aspiration risk [4][5][6][7][8][9][10] however the impact on swallowing physiology and function remains unclear. [4][5][6][7]10 Durational changes (i.e. a change in timing of swallowing events) associated with tube presence have been reported in two studies [5][6] with one (a randomized controlled trial [RCT] on young volunteers) documenting an effect associated with tube sizei.e.…”

Section: Introductionmentioning

confidence: 99%

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Impact of nasogastric tubes on swallowing physiology in older, healthy subjects: A randomized controlled crossover trial

et al. 2015

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Background & Aims:The presence of a nasogastric tube (NGT) affects swallowing physiology but not function in healthy young adults. The swallowing mechanism changes with increasing age, therefore the impact of a NGT on swallowing in elderly individuals is likely to be different but is not yet known. The aims of this study were to determine the effects of NGTs of different diameter on (1) airway penetration-aspiration, (2) pharyngeal residue, and (3) pharyngeal transit, in older healthy subjects. Methods:Randomized controlled crossover design. Healthy elderly volunteers underwent 3 modified barium swallow studies in which multiple diet and fluid consistencies were swallowed under the following conditions: (A) no NGT (control), (B) fine bore NGT, and (C) wide bore NGT. The control condition was assessed first to establish baseline swallowing function, then NGT order was randomly allocated. Results:Of the 15 volunteers (median age 65 years, range 60-81) complete data sets were obtained for 9 (4 with allocation order ABC; 5 with ACB). Wide bore NGT data could not be obtained for 6 volunteers mainly due to tube intolerance. The presence of a NGT was associated with: (i) an increase in airway penetration-aspiration (fine bore NGT with serial liquid swallows and puree) (p<0.01); (ii) increased pharyngeal residue (p<0.05) in the pyriform sinus (fine bore NGT with puree); and in the valleculae (both fine and wide bore NGT with soft solids); and (iii) an increase in pharyngeal transit duration regardless of consistency (p<0.01), with longest swallowing durations with the widest tube. Conclusions:NGT presence increases airway penetration-aspiration, pharyngeal residue and prolongs transit through the pharynx in older healthy individuals. Consideration of NGT impact on swallowing during concurrent oral and enteral feeding is recommended, with 4 further systematic investigation required in elderly patients recovering from critical illness.

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Dispelling Myths and Unfounded Practices About Enteral Nutrition

et al. 2020

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Many protocols and steps in the process of enteral nutrition (EN) use are not overly supported with strong research and have been done the same way over many years without questioning the use of best‐practices evidence. This article reports many of the myths and unfounded practices surrounding EN and attempts to refute those myths with current evidence. These practices include those about enteral access devices, formulas, enteral administration, and complications.

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The Effect of Nasogastric Tubes on Swallowing Function in Persons With Dysphagia Following Stroke

Cited by 35 publications

References 13 publications

Dysphagia and Factors Associated with Respiratory Infections in the First Week Post Stroke

Dysphagia and Factors Associated with Respiratory Infections in the First Week Post Stroke

Impact of nasogastric tubes on swallowing physiology in older, healthy subjects: A randomized controlled crossover trial

Dispelling Myths and Unfounded Practices About Enteral Nutrition

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