title: Does looped nasogastric tube feeding improve nutritional delivery for patients with dysphagia after acute stroke? A randomised controlled trial.
abstract: BACKGROUND
  nasogastric tube (NGT) feeding is commonly used after stroke, but its effectiveness is limited by frequent dislodgement.
  
  
  OBJECTIVE
  the objective of the study was to evaluate looped NGT feeding in acute stroke patients with dysphagia.
  
  
  METHODS
  this was a randomised controlled trial of 104 patients with acute stroke fed by NGT in three UK stroke units. NGT was secured using either a nasal loop (n = 51) or a conventional adhesive dressing (n = 53). The main outcome measure was the proportion of prescribed feed and fluids delivered via NGT in 2 weeks post-randomisation. Secondary outcomes were frequency of NGT insertions, treatment failure, tolerability, adverse events and costs at 2 weeks; mortality; length of hospital stay; residential status; and Barthel Index at 3 months.
  
  
  RESULTS
  participants assigned to looped NGT feeding received a mean 17% (95% confidence interval 5-28%) more volume of feed and fluids, required fewer NGTs (median 1 vs 4), and had fewer electrolyte abnormalities than controls. There was more minor nasal trauma in the loop group. There were no differences in outcomes at 3 months. Looped NGT feeding cost 88 pounds sterling more per patient over 2 weeks than controls.
  
  
  CONCLUSIONS
  looped NGT feeding improves delivery of feed and fluids and reduces NGT reinsertion with little additional cost.
authors.affiliation: Department of Stroke, Derby Royal Hospital, Derby, UK. jess.beavan@gmail.com
authors.forename: Jessica
authors.initials: J
authors.lastname: Beavan
authors.forename: Simon Paul
authors.initials: SP
authors.lastname: Conroy
authors.forename: Rowan
authors.initials: R
authors.lastname: Harwood
authors.forename: John R F
authors.initials: JR
authors.lastname: Gladman
authors.forename: Jo
authors.initials: J
authors.lastname: Leonardi-Bee
authors.forename: Tracey
authors.initials: T
authors.lastname: Sach
authors.forename: Tim
authors.initials: T
authors.lastname: Bowling
authors.forename: Wayne
authors.initials: W
authors.lastname: Sunman
authors.forename: Catherine
authors.initials: C
authors.lastname: Gaynor
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D001458:Bandages; D003680:Deglutition Disorders / Q000191:economics / Q000401:mortality / Q000534:rehabilitation*; D004750:Enteral Nutrition / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000191:economics / Q000379:methods* / Q000592:standards; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009748:Nutrition Disorders / Q000191:economics / Q000401:mortality / Q000517:prevention & control*; D020521:Stroke / Q000191:economics / Q000401:mortality; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome