Do nasogastric tubes worsen dysphagia in patients with acute stroke?
BACKGROUND
Early feeding via a nasogastric tube (NGT) is recommended as safe way of supplying nutrition in patients with acute dysphagic stroke. However, preliminary evidence suggests that NGTs themselves may interfere with swallowing physiology. In the present study we therefore investigated the impact of NGTs on swallowing function in acute stroke patients.


METHODS
In the first part of the study the incidence and consequences of pharyngeal misplacement of NGTs were examined in 100 stroke patients by fiberoptic endoscopic evaluation of swallowing (FEES). In the second part, the effect of correctly placed NGTs on swallowing function was evaluated by serially examining 25 individual patients with and without a NGT in place.


RESULTS
A correctly placed NGT did not cause a worsening of stroke-related dysphagia. Except for two cases, in which swallowing material got stuck to the NGT and penetrated into the laryngeal vestibule after the swallow, no changes of the amount of penetration and aspiration were noted with the NGT in place as compared to the no-tube condition. Pharyngeal misplacement of the NGT was identified in 5 of 100 patients. All these patients showed worsening of dysphagia caused by the malpositioned NGT with an increase of pre-, intra-, and postdeglutitive penetration.


CONCLUSIONS
Based on these findings, there are no principle obstacles to start limited and supervised oral feeding in stroke patients with a NGT in place.
Dziewas
Rainer
R
Department of Neurology, University Hospital of Münster, Albert-Schweitzer-Strasse 33, 48129 Münster, Germany. dziewas@uni-muenster.de
Warnecke
Tobias
T
Hamacher
Christina
C
Oelenberg
Stefan
S
Teismann
Inga
I
Kraemer
Christopher
C
Ritter
Martin
M
Ringelstein
Erich B
EB
Schaebitz
Wolf R
WR
D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003679:Deglutition / Q000502:physiology; D003680:Deglutition Disorders / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D016099:Endoscopy, Gastrointestinal / Q000379:methods; D004750:Enteral Nutrition / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007441:Intubation, Gastrointestinal / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020521:Stroke / Q000150:complications* / Q000453:epidemiology / Q000628:therapy; D016896:Treatment Outcome