Swallowing hydration and nutrition

Dysphagia51 and poor nutrition52-55 are common after stroke and may lead to further complications.56,57 All patients should have a bedside swallowing assessment58,59 as part of their initial assessment by a suitably trained member of the multidisciplinary team. The gag reflex is an unreliable indicator of swallowing ability and should not be used for this purpose.59 The bedside assessment should lead to a decision regarding whether or not the patient is safe to swallow and should be written down and clearly communicated to the nursing staff. For patients with an unsafe swallow, fluids should be prescribed (either intravenous or nasogastric) and arrangements made for further assessment by a speech and language therapist. The role of early enteral tube feeding, its timing, and whether this is best delivered via a nasogastric tube or percutaneous endoscopic gastrostomy remains unclear and is the subject of an ongoing multicentre trial.60,61 Percutaneous endoscopic gastrostomy (PEG) tube feeding is clearly the best option where prolonged tube feeding is necessary. However, in the early stages, where the advantages and disadvantages of early versus delayed tube feeding and the optimal type of tube are unclear, we randomise our patients in this trial.

Your Heart and Nutrition

Your Heart and Nutrition

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