Recommendation of Nasogastric Tube Removal in Acute Stroke Patients Based on Videofluoroscopic Swallow Study

OBJECTIVE: To evaluate the safety of nasogastric tube (NGT) removal and change to oral feeding with a food thickener for acute stroke patients in whom a videofluoroscopic swallow study (VFSS) confirmed thin liquid aspiration. METHODS: We retrospectively examined data of 199 patients with first stroke who were diagnosed with dysphagia from 2011 to 2015. Swallowing function was evaluated using VFSS. Patients included in this study were monitored for 4 weeks to identify the occurrence of aspiration pneumonia. The penetration-aspiration scale (PAS) was used to assess VFSS findings. The patients were divided into thin-liquid aspiration group (group 1, n=104) and no thin-liquid aspiration group (group 2, n=95). RESULTS: The feeding method was changed from NGT feeding to oral feeding with food thickener (group 1) and without food thickener (group 2). The PAS scores of thin and thick liquids were 6.46±0.65 and 1.92±0.73, respectively, in group 1 and 2.65±0.74 and 1.53±0.58, respectively, in group 2. Aspiration pneumonia developed in 1.9% of group 1 and 3.2% of group 2 (p=0.578), with no significant difference between the groups. CONCLUSION: We concluded that removing the NGT and changing to oral feeding with a food thickener is a safe food modification for acute stroke patients with thin liquid aspiration. Therefore, we recommend that VFSS should be conducted promptly in acute stroke patients to avoid unnecessary prolonged NGT feeding.

Effect of Salivary Reaction Time on Flow Properties of Commercial Food Thickeners Used for Dysphagic Patients

The effect of human saliva on the flow properties of pudding-like thickened water prepared with commercial food thickeners was investigated, and their viscosity differences were also compared as a function of salivary reaction time (0-60 min after the addition of saliva). Food thickeners used in this study were starch-based (SB), gum-containing starch-based (GSB), and gumbased (GB) commercial thickeners marketed in Korea. GB showed no significant reduction in viscosity upon contact with human saliva during the salivary reaction. In contrast, SB almost completely lost its viscosity shortly after the addition of saliva, and GSB significantly reduced its viscosity after 20 min of reaction time but retained its viscosity. The results of this study indicate that GB can enhance the swallowing safety of dysphagic patients by retaining a stable viscosity level without the reduction of viscosity during consumption of thickened fluids, whereas SB may increase the possibility of aspiration owing to a rapid decrease of viscosity upon contact with human saliva.

Desenvolvimento de espessante alimentar com valor nutricional agregado, destinado ao manejo da disfagia / Development of food thickener with aggregated nutritional value, for the management of dysphagia

A disfagia se caracteriza por uma disfunção no processo de deglutição, sinal prevalente de doenças degenerativas como esclerose múltipla e doença de Parkinson. Alimentos de textura modificada e bebidas espessadas são tradicionalmente utilizados no auxílio para o tratamento clínico da disfagia. Assim, este trabalho objetivou desenvolver uma formulação de espessante alimentar com valor nutricional agregado, e avaliar sua eficiência em diferentes alimentos líquidos (leite integral, sucos de maçã, uva e laranja), sob diferentes condições de tempo de preparo (10 e 120 minutos e 24 horas) e temperatura ambiente (25°C) e refrigerada (10°C). A formulação foi composta de concentrado proteico de soro, mix de vitaminas e minerais e goma guar como agente espessante. Os valores obtidos para a viscosidade mostraram diferença estatisticamente significativa (P<0,05) entre os tempos de espessamento, sendo que as viscosidades no tempo de 10 minutos e após 24 horas variaram, respectivamente, 58±3cP a 180±2cP na consistência de néctar; de 310±4Cp a 1084±3cP na consistência de mel e 844±14 a 2848±22cP na consistência de pudim. No entanto, a maioria das bebidas permaneceu dentro dos padrões internacionais sugeridos pela National Dysphagia Diet (NDD), para a consistência de alimentos destinados a pacientes disfágicos.

Dysphagia is characterized by a dysfunction of the swallowing process, being a prevalent symptom of degenerative diseases such as multiple sclerosis and Parkinson's disease. Foods with modified texture and thickened beverages are traditionally used in the clinical treatment of dysphagia. This study aims to develop a formulation of food thickener with value nutritional aggregate, as well as evaluate its action on various liquid food , under different conditions of preparation time (10 and 120 minutes and 24 hours) temperature (25°C) and refrigeration (10°C). The formulation was composed of whey protein concentrate (WPC), mix of vitamins and minerals and guar gum as a thickening agent. The values obtained for the viscosity showed a difference statistically significant at the 5% level, between the times of thickening, ranging from 58±3CP to 2848±3CP, as well as between different samples tested when compared to each other for the same time. However, viscosity measurements showed that the most beverages are in international standards suggested by the National Dysphagia Diet (NDD), for consistency of food for dysphagia patients.