Evaluating the clinical benefit of a trail of nasogastric feeding in patients with acute dysphagia secondary to delirium

Introduction:

The risk of acute oropharyngeal dysphagia is increased in delirium, and is associated with longer hospital admissions, malnutrition, dehydration and sarcopenia. To promote swallow rehabilitation and facilitate recovery from delirium, nasogastric tubes may be trialled for feeding and medication.

Methods:

This retrospective observational study of senior health wards in a London hospital identified 24 patients with delirium who had a nasogastric tube inserted for acute dysphagia. Data was collected on the swallow rehabilitation (based on recommended IDDSI levels following assessment by speech and language therapists) and associated complications of nasogastric feeding, including ionising radiation, treatment of aspiration pneumonias and mortality.

Results:

Primary outcomes showed that whilst 29% (n=7) patients sustained clinical benefit from the nasogastric feeding trial (i.e. were rehabilitated to a safe swallow), 58% (n=14) did not and were classified as Eating and Drinking with Acknowledged Risk post-trial. The clinical benefit was more prevalent in patients with Parkinson’s Disease (50%, n=2) and in those who did not have pre-existing dysphagia (46%, n=6). Patients who regained a safe swallow after nasogastric feeding had a longer length of stay, but lower 30-day mortality and fewer treatments for aspiration pneumonias.

Conclusion:

Although small, this study suggests that trials of nasogastric feeding do not always facilitate complete recovery of swallow function in patients with acute dysphagia in the context of delirium, but that in successful cases there is reduced 30-day mortality and no increased risk of associated complications. The authors highlight the complexity of predicting outcomes for patients with delirium and acute dysphagia and the need for further research to help clinicians make informed decisions.