J Korean Acad Nurs.  2014 Jun;44(3):280-293. 10.4040/jkan.2014.44.3.280.

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

• Yoo SH
• Kim SS

• KMID: 1796153
• DOI: http://doi.org/10.4040/jkan.2014.44.3.280

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.

Keyword

Enteral nutrition; Stroke; Swallowing disorder

MeSH Terms

Aged
Aged, 80 and over
Body Weight
Deglutition Disorders/complications/*diagnosis
Energy Intake
Enteral Nutrition/*methods
Evidence-Based Nursing
Female
Gastrointestinal Diseases/complications
Humans
Intensive Care Units
Male
Middle Aged
Pneumonia/diagnosis
*Program Development
*Program Evaluation
Questionnaires
Stroke/complications/*diagnosis

Figure

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  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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