Enteral Nutrition and Hydration in Patients with Acute Stroke: Efficacy of an Automatic Pump System for Water Administration and Flushes—A Pilot Study
Abstract
:1. Introduction
2. Materials and Methods
Statistical Analysis
3. Results
3.1. NGT Occlusions and Gastrointestinal Symptoms
3.2. Nutrition and Hydration Biomarkers
3.3. Nurses’ Satisfaction and Compliance
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Ojo, O.; Brooke, J. The use of enteral nutrition in the management of stroke. Nutrients 2016, 8, 827. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Dennis, M.; Lewis, S.; Cranswick, G.; Forbes, J. FOOD: A multicentre randomized trial evaluating feeding policies in patients admitted to hospital with a recent stroke. Health Technol. Assess. 2006, 10, 1. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Liu, C.-H.; Lin, S.-C.; Lin, J.-R.; Yang, J.-T.; Chang, Y.-J.; Chang, C.-H.; Chang, T.Y.; Huang, K.L.; Ryu, S.J.; Lee, T.H. Dehydration is an independent predictor of discharge outcome and admission cost in acute ischaemic stroke. Eur. J. Neurol. 2014, 21, 1184–1191. [Google Scholar] [CrossRef] [PubMed]
- Wu, F.-F.; Hung, Y.-C.; Tsai, Y.H.; Yang, J.-T.; Lee, T.-H.; Liow, C.-W.; Lee, J.D.; Lin, C.J.; Peng, T.I.; Lin, L.C. The influence of dehydration on the prognosis of acute ischemic stroke for patients treated with tissue plasminogen activator. BMC Cardiovasc. Disord. 2017, 17, 154. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Buoite Stella, A.; Gaio, M.; Furlanis, G.; Ridolfi, M.; Ajčević, M.; Sartori, A.; Caruso, P.; Morrison, S.A.; Naccarato, M.; Manganotti, P. Prevalence of hypohydration and its association with stroke severity and independence outcomes in acute ischemic stroke patients. J. Clin. Neurosci. 2020, 72, 281–286. [Google Scholar] [CrossRef] [PubMed]
- Buoite Stella, A.; Ajčević, M.; Furlanis, G.; Lugnan, C.; Gaio, M.; Cillotto, T.; Scali, I.; Caruso, P.; Cova, M.A.; Naccarato, M.; et al. A physiological perspective of the associations between hydration status and CTP neuroimaging parameters in hyper-acute ischaemic stroke patients. Clin. Physiol. Funct. Imaging 2021, 41, 235–244. [Google Scholar] [CrossRef]
- Crary, M.A.; Humphrey, J.L.; Carnaby-Mann, G.; Sambandam, R.; Miller, L.; Silliman, S. Dysphagia, nutrition, and hydration in ischemic stroke patients at admission and discharge from acute care. Dysphagia 2013, 28, 69–76. [Google Scholar] [CrossRef]
- Dziewas, R. Nutrition in acute stroke management: Food for thought. Lancet Neurol. 2022, 21, 296–297. [Google Scholar] [CrossRef]
- Powers, W.J.; Rabinstein, A.A.; Ackerson, T.; Adeoye, O.M.; Bambakidis, N.C.; Becker, K.; Biller, J.; Brown, M.; Demaerschalk, B.M.; Hoh, B.; et al. 2018 Guidelines for the Early Management of Patients with Acute Ischemic Stroke: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association. Stroke 2018, 49, e46–e110. [Google Scholar] [CrossRef]
- Burgos, R.; Bretón, I.; Cereda, E.; Desport, J.C.; Dziewas, R.; Genton, L.; Gomes, F.; Jésus, P.; Leischker, A.; Muscaritoli, M.; et al. ESPEN guideline clinical nutrition in neurology. Clin. Nutr. 2018, 37, 354–396. [Google Scholar] [CrossRef]
- National Institute of Health and Care Excellence. Nutrition Support for Adults: Oral Nutrition Support, Enteral Tube Feeding and Parenteral Nutrition; NICE Guidel: London, UK, 2006. [Google Scholar]
- Buoite Stella, A.; Gaio, M.; Furlanis, G.; Douglas, P.; Naccarato, M.; Manganotti, P. Fluid and energy intake in stroke patients during acute hospitalization in a stroke unit. J. Clin. Neurosci. 2019, 62, 27–32. [Google Scholar] [CrossRef] [PubMed]
- Pearce, C.B.; Duncan, H.D. Enteral feeding. Nasogastric, nasojejunal, percutaneous endoscopic gastrostomy, or jejunostomy: Its indications and limitations. Postgrad Med. J. 2002, 78, 198–204. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- National Institute of Health and Care Excellence. Intravenous fluid therapy in adults in hospital. In NICE Guidelines; National Institute of Health and Care Excellence: London, UK, 2013. [Google Scholar]
- Ajčević, M.; Furlanis, G.; Buoite Stella, A.; Cillotto, T.; Caruso, P.; Ridolfi, M.; Lugnan, C.; Miladinović, A.; Ukmar, M.; Cova, M.A.; et al. A CT perfusion based model predicts outcome in wake-up stroke patients treated with recombinant tissue plasminogen activator. Physiol. Meas. 2020, 41, 075011. [Google Scholar] [CrossRef]
- Caruso, P.; Ridolfi, M.; Lugnan, C.; Ajčević, M.; Furlanis, G.; Bellavita, G.; Mucelli, R.A.P.; Zdjelar, A.; Ukmar, M.; Naccarato, M.; et al. Multimodal CT pc-ASPECTS in infratentorial stroke: Diagnostic and prognostic value. Neurol. Sci. 2021, 42, 4231–4240. [Google Scholar] [CrossRef] [PubMed]
- Vellas, B.; Villars, H.; Abellan, G.; Soto, M.E.; Rolland, Y.; Guigoz, Y.; Morley, J.E.; Chumlea, W.; Salva, A.; Rubenstein, L.Z.; et al. Overview of the MNA—Its history and challenges. J. Nutr. Health Aging 2006, 10, 455–456. [Google Scholar]
- Lee, N.; White, L.V.; Marin, F.P.; Saludar, N.R.; Solante, M.B.; Tactacan-Abrenica, R.J.; Calapis, R.W.; Suzuki, M.; Saito, N.; Ariyoshi, K.; et al. Mid-upper arm circumference predicts death in adult patients admitted to a TB ward in the Philippines: A prospective cohort study. PLoS ONE 2019, 14, e0218193. [Google Scholar] [CrossRef] [PubMed]
- Martino, R.; Foley, N.; Bhogal, S.; Diamant, N.; Speechley, M.; Teasell, R. Dysphagia after stroke: Incidence, diagnosis, and pulmonary complications. Stroke 2005, 36, 2756–2763. [Google Scholar] [CrossRef] [Green Version]
- Arnold, M.; Liesirova, K.; Broeg-Morvay, A.; Meisterernst, J.; Schlager, M.; Mono, M.-L.; Kägi, G.; Jung, S.; Sarikaya, H. Dysphagia in Acute Stroke: Incidence, Burden and Impact on Clinical Outcome. PLoS ONE 2016, 11, e0148424. [Google Scholar] [CrossRef] [Green Version]
- White, H.; King, L. Enteral feeding pumps: Efficacy, safety, and patient acceptability. Med. Devices 2014, 7, 291–298. [Google Scholar] [CrossRef] [Green Version]
- Garrison, C.M. Enteral Feeding Tube Clogging: What Are the Causes and What Are the Answers? A Bench Top Analysis. Nutr. Clin. Pract. 2018, 33, 147–150. [Google Scholar] [CrossRef]
- Jones, S.A.; Guenter, P. Automatic flush feeding pumps. Nursing 1997, 27, 56–58. [Google Scholar] [CrossRef] [PubMed]
- Boullata, J.I.; Carrera, A.L.; Harvey, L.; Escuro, A.A.; Hudson, L.; Mays, A.; McGinnis, C.; Wessel, J.J.; Bajpai, S.; Beebe, M.L.; et al. ASPEN Safe Practices for Enteral Nutrition Therapy. JPEN J. Parenter. Enter. Nutr. 2017, 41, 15–103. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Blumenstein, I.; Shastri, Y.M.; Stein, J. Gastroenteric tube feeding: Techniques, problems and solutions. World J. Gastroenterol. 2014, 20, 8505–8524. [Google Scholar] [CrossRef] [PubMed]
- Dandeles, L.M.; Lodolce, A.E. Efficacy of agents to prevent and treat enteral feeding tube clogs. Ann. Pharmacother. 2011, 45, 676–680. [Google Scholar] [CrossRef]
- Pash, E.; Nadeau, B.; Parikh, N. M-25 Attainment of Enteral Nutrition Water Flush Orders Using Manual Syringe versus Automated Pump Delivery. In Proceedings of the Clinical Nutrition Week, Austin, TX, USA, 16–19 January 2016. [Google Scholar]
- Nadeau, B.; Weissbrod, R.; Trierweiler-Hauke, B. MON-P234: Flush now: The Use of Technology to Prevent Occlusions in Jejunal Feeding Tubes—A Pilot Evaluation. Clin. Nutr. 2017, 36, S64. [Google Scholar] [CrossRef]
- Arevalo-Manso, J.J.; Martinez-Sanchez, P.; Juarez-Martin, B.; Fuentes, B.; Ruiz-Ares, G.; Sanz-Cuesta, B.E.; Parrilla-Novo, P.; Diez-Tejedor, E. Enteral tube feeding of patients with acute stroke: When does the risk of diarrhoea increase? Intern. Med. J. 2014, 44, 1199–1204. [Google Scholar] [CrossRef]
- Jack, L.; Coyer, F.; Courtney, M.; Venkatesh, B. Diarrhoea risk factors in enterally tube fed critically ill patients: A retrospective audit. Intensive Crit. Care Nurs. 2010, 26, 327–334. [Google Scholar] [CrossRef] [Green Version]
- Lin, S.-C.; Lin, K.-H.; Lee, Y.-C.; Peng, H.-Y.; Chiu, E.-C. Test-retest reliability of the Mini Nutritional Assessment and its relationship with quality of life in patients with stroke. PLoS ONE 2019, 14, e0218749. [Google Scholar] [CrossRef] [Green Version]
- Ha, L.; Hauge, T.; Iversen, P.O. Body composition in older acute stroke patients after treatment with individualized, nutritional supplementation while in hospital. BMC Geriatr. 2010, 10, 75. [Google Scholar] [CrossRef] [Green Version]
- Kim, E.J.; Yoon, Y.H.; Kim, W.H.; Lee, K.L.; Park, J.M. The clinical significance of the mini-nutritional assessment and the scored patient-generated subjective global assessment in elderly patients with stroke. Ann. Rehabil. Med. 2013, 37, 66–71. [Google Scholar] [CrossRef]
- Bahouth, M.N.; Gottesman, R.F.; Szanton, S.L. Primary “dehydration” and acute stroke: A systematic research review. J. Neurol. 2018, 265, 2167–2181. [Google Scholar] [CrossRef] [PubMed]
- Bahouth, M.N.; Gaddis, A.; Hillis, A.E.; Gottesman, R.F. Pilot study of volume contracted state and hospital outcome after stroke. Neurol Clin. Pract. 2018, 8, 21–26. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Manganotti, P.; Naccarato, M.; Scali, I.; Cappellari, M.; Bonetti, B.; Burlina, A.; Turinese, E.; Bogo, S.; Teatini, F.; Franchini, E.; et al. Stroke management during the coronavirus disease 2019 (COVID-19) pandemic: Experience from three regions of the north east of Italy (Veneto, Friuli-Venezia-Giulia, Trentino-Alto-Adige). Neurol. Sci. 2021, 42, 4599–4606. [Google Scholar] [CrossRef] [PubMed]
Manual n = 31 | Automatic n = 31 | Significance | |
---|---|---|---|
Age (y) | 72 ± 8 | 71 ± 7 | 0.546 |
Males/Females [n (%)] | 16/15 (52/48) | 18/13 (58/42) | 0.609 |
Body Mass (kg) | 75.1 ± 10.2 | 74.1 ± 7.6 | 0.673 |
BMI (kg/m2) | 25.9 ± 2.3 | 25.5 ± 2.0 | 0.497 |
Ischemic/Hemorrhagic [n (%)] | 29/2 (94/6) | 28/3 (90/10) | 0.640 |
tPA [n (%)] | 20 (65) | 21 (68) | 0.788 |
NIHSS | 10 ± 3 | 11 ± 3 | 0.209 |
HTN [n (%)] | 17 (55) | 19 (61) | 0.606 |
DM [n (%)] | 9 (29) | 10 (32) | 0.782 |
Dyslipidemia [n (%)] | 3 (10) | 4 (13) | 0.688 |
AF [n (%)] | 3 (10) | 3 (10) | 1.000 |
Days on enteral nutrition (days) | 6 ± 2 | 7 ± 2 | 0.053 |
Manual n = 31 | Automatic n = 31 | Significance | |
---|---|---|---|
NGT occlusions [n (%)] | 7 (22.6) | 1 (3.2) | 0.023 |
More than 1 occlusion [n (%)] | 0 (0) | 0 (0) | 1.000 |
Constipation [n (%)] | 0 (0) | 0 (0) | 1.000 |
Diarrhea [n (%)] | 12 (38.7) | 10 (32.3) | 0.596 |
Duration of diarrhea (days) | 2 ± 1 | 2 ± 1 | 1.000 |
Manual n = 31 | Automatic n = 31 | Significance | |
---|---|---|---|
Nutritional status | |||
MNA at admission [n (%)] | 0.863 | ||
Malnutrition | 13 (41.9) | 14 (45.2) | |
At risk | 13 (41.9) | 11 (35.5) | |
Well-nourished | 5 (15.8) | 7 (19.3) | |
MNA at discharge [n (%)] | 0.673 | ||
Worsened | 6 (18.9) | 4 (12.9) | |
Remained stable | 22 (71.1) | 25 (80.6) | |
Improved | 3 (10.0) | 2 (6.5) | |
MUAC at admission (cm) | 28.3 ± 1.3 | 28.4 ± 1.4 | 0.925 |
MUAC at discharge (cm) | 28.2 ± 1.2 | 28.1 ± 1.4 | 0.981 |
Hydration | |||
Total fluid intake (mL/day) | 1934 ± 412 | 1921 ± 387 | 0.898 |
uOsm at admission (mOsm) | 580 ± 131 | 559 ± 127 | 0.522 |
uOsm at discharge (mOsm) | 610 ± 113 | 586 ± 120 | 0.423 |
sOsm at admission (mOsm) | 296 ± 5 | 298 ± 5 | 0.229 |
sOsm at discharge (mOsm) | 296 ± 5 | 297 ± 5 | 0.261 |
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. |
© 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Buoite Stella, A.; Manganotti, P. Enteral Nutrition and Hydration in Patients with Acute Stroke: Efficacy of an Automatic Pump System for Water Administration and Flushes—A Pilot Study. Sensors 2022, 22, 8029. https://doi.org/10.3390/s22208029
Buoite Stella A, Manganotti P. Enteral Nutrition and Hydration in Patients with Acute Stroke: Efficacy of an Automatic Pump System for Water Administration and Flushes—A Pilot Study. Sensors. 2022; 22(20):8029. https://doi.org/10.3390/s22208029
Chicago/Turabian StyleBuoite Stella, Alex, and Paolo Manganotti. 2022. "Enteral Nutrition and Hydration in Patients with Acute Stroke: Efficacy of an Automatic Pump System for Water Administration and Flushes—A Pilot Study" Sensors 22, no. 20: 8029. https://doi.org/10.3390/s22208029
APA StyleBuoite Stella, A., & Manganotti, P. (2022). Enteral Nutrition and Hydration in Patients with Acute Stroke: Efficacy of an Automatic Pump System for Water Administration and Flushes—A Pilot Study. Sensors, 22(20), 8029. https://doi.org/10.3390/s22208029