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Yoo and Kim: Development and Evaluation of an Enteral Nutrition Protocol for Dysphagia in Patients with Acute Stroke
Original Article

Journal of Korean Academy of Nursing 2014; 44(3): 280-293.

Published online: 30 June 2014

DOI: https://doi.org/10.4040/jkan.2014.44.3.280

Development and Evaluation of an Enteral Nutrition Protocol for Dysphagia in Patients with Acute Stroke

Sung-Hee Yoo1, So-Sun Kim2

1College of Nursing, Chonnam National University, Gwangju, Korea.

2College of Nursing, Yonsei University, Seoul, Korea.

Address reprint requests to: Yoo, Sung-Hee. College of Nursing, Chonnam National University, 160 Baekseo-ro, Dong-gu, Gwangju 501-746, Korea. Tel: +82-62-530-4941, Fax: +82-62-220-4544, shyoo@jnu.ac.kr

Received 13 February 2014       Revised 28 February 2014       Accepted 9 May 2014

© 2014 Korean Society of Nursing Science

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. (http://creativecommons.org/licenses/by-nd/4.0/) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium.

Abstract

Purpose

The study was done to develop an evidence-based enteral nutrition (EN) protocol for effective nutritional support for dysphagia in patients with acute stroke, and to evaluate effects of this protocol on clinical outcomes.

Methods

A methodological study was used to develop the EN protocol and a quasi-experimental study to verify the effectiveness of the protocol. The preliminary EN protocol was drawn by selecting recommendations from previous well-designed EN guidelines, and then developing additional recommendations based on high-quality evidence. Content validation was assessed by an expert group, and clinical applicability by care providers and patients. The scale-level content validity index of the final EN protocol was 0.99. Assessment was done of differences in percentage of caloric goals achieved and presence of undernutrition, aspiration pneumonia, and gastrointestinal (GI) complications after application of the EN protocol.

Results

In the EN protocol group, the percentage of caloric goals achieved (R2=.24, p=.001) and the reduction of GI complications (p=.045) were significantly improved, but the presence of undernutrition (p=.296) and aspiration pneumonia (p=.601) did not differ from the usual care group.

Conclusion

Results indicate that the new EN protocol for dysphagia in patients with acute stroke significantly increased their nutritional intake and reduced GI complications.

Keywords: Enteral nutrition, Stroke, Swallowing disorder

Figures and Tables

Figure 1
The development process of new enteral nutrition protocol for dysphagia in patients with acute stroke.
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Figure 2
Enteral feeding algorithms in acute stroke patients for (a) formula selection, (b) diarrhea management, and (c) the initiation and progression of enteral feeding.
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Table 1
Final Enteral Nutrition Protocol
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*The algorithm for formula selection (Figure 2a); †The algorithm for diarrhea management (Figure 2b); ‡The algorithm for the initiation and progression of enteral feeding (Figure 2c).

Table 2
General, Disease, and Nutritional Characteristics (N=33)
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p values were calculated using Fisher's exact test or Mann-Whitney U test, where appropriate; EN=Enteral nutrition; IQR=Interquartile range; mRS=modified Rankin Scale; TOAST=the Trial of ORG 10172 in Acute Stroke Treatment; LAA=Large artery atherosclerosis; SVO=Small vessel occlusion; CE=Cardiac embolism; NIHSS=National Institutes of Health stroke scale; GNRI=Geriatric nutritional risk index.

Table 3
Clinical Outcomes between Usual Care Group and EN Protocol Group (N=33)
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p values were calculated using Fisher's exact test or Mann-Whitney U test, where appropriate; EN=Enteral nutrition; IQR=Interquartile range; GRV=Gastric residual volume; GNRI=Geriatric nutritional risk index.

Notes

This manuscript is based on a part of the first author's doctoral dissertation from Yonsei University

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