Interventions for dysphagia in acute stroke (Review)

Bath, Philip M.W. and Bath-Hextall, F.J. and Smithard, D.G. (2008) Interventions for dysphagia in acute stroke (Review). Cochrane Library, 2008 (3).

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Abstract

Background

It is unclear how dysphagic patients should be fed and treated after acute stroke.

Objectives

The objective of this review was to assess the effect of different management strategies for dysphagic stroke patients, in particular how

and when to feed, whether to supplement nutritional intake, and how and whether to treat dysphagia.

Search strategy

We searched the Cochrane Stroke Group trials register, Medline, Embase, ISI, and existing review articles.We contacted researchers in

the field and equipment manufacturers. Date of the most recent searches: March 1999.

Selection criteria

Unconfounded truly or quasi randomised controlled trials in dysphagic patients with acute/subacute (within 3 months) stroke.

Data collection and analysis

Three reviewers independently applied the trial inclusion criteria. Two reviewers assessed trial quality and extracted the data.

Main results

Percutaneous endoscopic gastrostomy (PEG) versus nasogastric tube (NGT) feeding: two trials (49 patients) suggest that PEG reduces

end-of-trial case fatality (Peto Odds Ratio, OR 0.28, 95% CI 0.09 to 0.89) and treatment failures (OR 0.10, 95% CI 0.02 to 0.52),

and improves nutritional status, assessed as weight (Weighted Men Difference, WMD +4.1 kg, 95% CI -4.3 to +12.5), mid-arm

circumference (WMD +2.2 cm, 95% CI -0.5 to +4.9) or serum albumin (WMD + 7.0 g/l, 95% CI +4.9 to +9.1) as compared with

NGT feeding; two larger studies are ongoing. Timing of feeding: no completed trials; one large study is ongoing. Swallowing therapy

for dysphagia: two trials (85 patients) suggest that formal swallowing therapy does not significantly reduce end-of-trial dysphagia rates

(OR 0.55, 95%CI 0.18 to 1.66). Drug therapy for dysphagia: one trial (17 patients); nifedipine did not alter end-of-trial case fatality or

the frequency of dysphagia. Nutritional supplementation: one trial (42 patients) found a non-significant trend to a lower case fatality,

and significantly increased energy and protein intake; one large trial is ongoing and data is awaited from two other studies. Fluid

supplementation: one trial (20 patients) found that supplementation did not alter the time to resolution of dysphagia.

Authors’ conclusions

Too few studies have been performed, and these have involved too few patients. PEG feeding may improve outcome and nutrition as

compared with NGT feeding. Further research is required to assess how and when patients are fed, and the effect of swallowing or drug

therapy on dysphagia.

Item Type: Article
Additional Information: Originally published: Bath PMW, Bath-Hextall FJ, Smithard D. Interventions for dysphagia in acute stroke. Cochrane Database of Systematic Reviews 1999, Issue 4. Art. No.: CD000323. doi: 10.1002/14651858.CD000323. URL: http://dx.doi.org/10.1002/14651858.CD000323 This review is published as a Cochrane Review in the Cochrane Database of Systematic Reviews 1999, Issue 4. Cochrane Reviews are regularly updated as new evidence emerges and in response to comments and criticisms, and the Cochrane Database of Systematic Reviews should be consulted for the most recent version of the Review. Reprinted in the Cochrane Library, 2008, issue 3.
Schools/Departments: University of Nottingham UK Campus > Faculty of Medicine and Health Sciences > School of Health Sciences
Depositing User: Sayers, Hazel
Date Deposited: 08 Jun 2012 12:07
Last Modified: 14 Aug 2013 13:41
URI: http://eprints.nottingham.ac.uk/id/eprint/963

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