Gastrostomy feeding in the elderly after acute dysphasgic stroke

Recent studies have shown that 45-50% of patients with stroke (stroke) were admitted to hospital swallowing difficulties. In addition, 1/4 to 1/3 of stroke patients had dysphagia; approximately 20% of patients with dysphagia develop an infection of the respiratory tract versus 8% of stroke patients without dysphagia. Strokes associated with dysphagia are also associated with a higher incidence of impaired nutritional status, and increased disability, institutionalization and death. Elderly patients with stroke do not always tolerate nasogastric feeding and it is common that these patients snapped the probe. In addition, this tube feeding increases the risk of inhalation and pneumonia. Frequent extubations also will result in the interruption of the power supply. Failure to re-intubate these patients may impose additional stress and care; more this type of diet can interfere with the long-term reeducation programs if done during the day. Unfortunately, if the power supply is made at night, you run a greater risk of inhalation. Power over nasogatrique probe is also unsightly and the effect on morale is often underestimated. Food percutaneous gastrostomy after stroke has now become commonplace; is credited with a low prevalence in terms of mortality (0-1%), serious complications (3%), and minor complications. (13-14%). We, in our unit, compared nasogastric feeding and percutaneous gastrostomy feeding in a group of 30 elderly patients (19 women and 11 men) followed after a stroke over a year. These patients had persistent dysphagia 14 days after the stroke; 16 patients were fed via a gastrostomy and 24 patients through a nasogastric tube. All patients underwent a brain scan to confirm the diagnosis of stroke. All patients were assessed by the speech therapist and the presence or absence of a yawn reflex were noted. Patients with a history of serious gastrointestinal disease were excluded from the protocol. The supply passage was 50 ml / hr for 24 hours and was gradually increased to 100 ml / h. The primary endpoints studied were mortality and changes in nutritional status, including weight, skinfold thickness in the arm, arm circumference, serum albumin, total protein and hemoglobin. Results at 6 weeks showed that mortality was significantly lower in the group with gastrostomy with 2 deaths (12.5%) compared with 8 deaths (57%) in patients with a nasogastric tube. Patients with a gastrostomy received 100% of the prescribed diet while patients of the group with a nasogastric tube will have received 71%. Each patient group with gastrostomy needed only one installation of tubing versus 6 in the group with nasogastric tube. 77% of patients with gastrostomy group gained weight (mean increase of 2.2 kg) versus 12% of patients with a nasogastric tube (P = 0.004).