Role of Swallowing Therapy in Preventing Aspiration Pneumonia in Patients with Stroke having Dysphagia

Bisma  Nauman; Naureen  Tassadaq

doi:10.51253/pafmj.v75i1.12508

Authors

Bisma Nauman Department of Rehab, Fauji Foundation Hospital, Rawalpindi Pakistan
Naureen Tassadaq Department of Rehab, Fauji Foundation Hospital, Rawalpindi Pakistan

DOI:

https://doi.org/10.51253/pafmj.v75i1.12508

Keywords:

Aspiration, dysphagia, Pneumonia, Swallowing, stroke, Therapy

Abstract

Objective: To compare the effectivity of swallowing therapy in prevention of aspiration pneumonia in patients with acute stroke with dysphagia admitted to the Intensive Care Unit.

Study Design: Prospective comparative study.

Place and Duration of Study: Department of Rehabilitation Medicine, Fauji Foundation Hospital, Rawalpindi Pakistan, from Jun-Dec 2023

Methodology: A total of 120 patients were recruited, patients were randomly divided into two groups. Group-S (n=60) receivied swallowing therapy and Group-N (n=60) received standard nursing care for oral feed according to institutional protocol. Primary variables studied were median scores of the Functional Oral Intake Scale (FOIS) (Scored 1-7) and Swallow Function Score System (SFSS) (Scored 0-6) evaluated every day and complied after 10 days along with incidence of aspiration pneumonia and necessity to shift to NG feed in case of complete oral feed failure.

Results: Median functional oral intake scale was 4.00 (0.00) in Group-N versus 6.00 (0.00) in Group-S (p<0.001). Median swallow function score system was 4.00 (1.00) in Group-N versus 5.00 (0.00) in Group-S (p<0.001). The incidence of aspiration pneumonia was seen in 20(33.3%) patients in Group-N versus 05(8.3%) patients in Group-S (p=0.001). Patients shifted to nasogastric feed following oral intake failure were 20(33.3%) patients in Group-N versus 02(3.3%) patients in Group-S.

Conclusion: The swallowing therapy results in early and effective initiation of oral feed with decreased need for nasogastric feeding resulting in reduced duration of hospital stay in selected patients having stroke with dysphagia.

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References

Pilato F, Silva S, Valente I, Distefano M, Broccolini A, Brunetti V, et al. Predicting factors of functional outcome in patients with acute ischemic stroke admitted to neuro-intensive care unit—A prospective cohort study. Brain Sci. 2020; 10(12): 911.

https://doi.org/10.3390/brainsci10120911

Feigin VL, Stark BA, Johnson CO, Roth GA, Bisignano C, Abady GG, et al. Global, regional, and national burden of stroke and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet Neurol. 2021; 20(10): 795-820.

https://doi.org/10.1016/S1474-4422(21)00252-0

Pandian JD, Kalkonde Y, Sebastian IA, Felix C, Urimubenshi G, Bosch J, et al. Stroke systems of care in low-income and middle-income countries: challenges and opportunities. The Lancet. 2020; 396(10260): 1443-1451.

https://doi.org/10.1016/S0140-6736(20)31374-X

H. Buck B, Akhtar N, Alrohimi A, Khan K, Shuaib A. Stroke mimics: incidence, aetiology, clinical features and treatment. Annals Med 2021; 53(1): 420-436.

https://doi.org/10.1080/07853890.2021.1890205

Jones CA, Colletti CM, Ding M-C. Post-stroke dysphagia: recent insights and unanswered questions. Curr neurol neurosci rep 2020; 20: 1-12. https://doi.org/10.1007/s11910-020-01081-z

Chang MC, Choo YJ, Seo KC, Yang S. The relationship between dysphagia and pneumonia in acute stroke patients: a systematic review and meta-analysis. Frontiers Neurol 2022; 13: 834240.

https://doi.org/10.3389/fneur.2022.834240

Wu S-J. Preventive care for aspiration pneumonia in patients with an indwelling nasogastric tube. Hu Li Za Zhi. 2022; 69(1): 18-24. https://doi.org/10.6224/jn.202202_69(1).04

Huang J, Zhang D, Yao Y, Xia Q, Fan Q. Training in swallowing prevents aspiration pneumonia in stroke patients with dysphagia. J int med res 2006; 34(3): 303-306.

https://doi.org/10.1177/147323000603400310

Oguchi N, Yamamoto S, Terashima S, Arai R, Sato M, Ikegami S, et al. The modified water swallowing test score is the best predictor of postoperative pneumonia following extubation in cardiovascular surgery: A retrospective cohort study. Medicine 2021; 100(4): e24478.

https://doi.org/10.1097%2FMD.0000000000024478

Jongprasitkul H, Kitisomprayoonkul W. Effectiveness of conventional swallowing therapy in acute stroke patients with dysphagia. Rehabil res practice 2020; 2020: 2907293.

https://doi.org/10.1155/2020/2907293

Ninfa A, Pizzorni N, Eplite A, Moltisanti C, Schindler A. Validation of the Italian version of the functional oral intake scale (FOIS-It) against fiberoptic endoscopic evaluation of swallowing and nutritional status. Dysphagia. 2021: 1-11.

https://doi.org/10.1007/s00455-021-10257-9

Edzie E, Gorleku P, Dzefi-Tettey K, Idun E, Amankwa AT, Aidoo E, et al. Incidence rate and age of onset of first stroke from CT scan examinations in Cape Coast metropolis. Heliyon. 2021; 7(2): e06214.

https://doi.org/10.1016/j.heliyon.2021.e06214

Sultan MO, Farooque U, Javed R, Khan MI, Karimi S, Sattar RA, et al. Correlation of homocysteine level and age in patients with ischemic stroke. Cureus. 2020; 12(4): e7785.

https://doi.org/10.7759/cureus.7785

Rupasinghe C, Bokhari S, Lutfi I, Noureen M, Islam F, Khan M, et al. Frequency of Stroke and Factors Associated With It Among Old Age Hypertensive Patients in Karachi, Pakistan: A Cross-Sectional Study. Cureus. 2022; 14(3): e23123.

https://doi.org/10.7759/cureus.23123

Gasbarrino K, Di Iorio D, Daskalopoulou SS. Importance of sex and gender in ischaemic stroke and carotid atherosclerotic disease. Eur Heart J. 2022; 43(6): 460-473.

https://doi.org/10.1093/eurheartj/ehab756

Toyoda K, Yoshimura S, Nakai M, Koga M, Sasahara Y, Sonoda K, et al. Twenty-year change in severity and outcome of ischemic and hemorrhagic strokes. JAMA neurol 2022; 79(1): 61-69. https://doi.org/10.1001/jamaneurol.2021.4346

Shimonaga K, Hama S, Tsuji T, Yoshimura K, Nishino S, Yanagawa A, et al. The right hemisphere is important for driving-related cognitive function after stroke. Neurosurgical Review 2021; 44:977-985.

https://doi.org/10.1007/s10143-020-01272-9

Hamzic S, Braun T, Juenemann M, Butz M, Voswinckel R, Belly M, et al. Validation of the German version of functional oral intake scale (FOIS-G) for flexible endoscopic evaluation of swallowing (FEES). Dysphagia 2021; 36: 130-139.

https://doi.org/10.1007/s00455-020-10114-1

Carnaby G, LaGorio L, Silliman S, Crary M. Exercise‐based swallowing intervention (McNeill Dysphagia Therapy) with adjunctive NMES to treat dysphagia post‐stroke: A double‐blind placebo‐controlled trial. J Oral Rehabil 2020; 47(4): 501-510.

https://doi.org/10.1111/joor.12928