Please use this identifier to cite or link to this item: http://ahro.austin.org.au/austinjspui/handle/1/18478
Title: Route of Feeding as a Proxy for Dysphagia After Stroke and the Effect of Transdermal Glyceryl Trinitrate: Data from the Efficacy of Nitric Oxide in Stroke Randomised Controlled Trial.
Authors: Woodhouse, Lisa J;Scutt, Polly;Hamdy, Shaheen;Smithard, David G;Cohen, David L;Roffe, Christine;Bereczki, Daniel;Berge, Eivind;Bladin, Christopher F;Caso, Valeria;Christensen, Hanne K;Collins, Rónán;Czlonkowska, Anna;de Silva, Asita;Etribi, Anwar;Laska, Ann-Charlotte;Ntaios, George;Ozturk, Serefnur;Phillips, Stephen J;Prasad, Kameshwar;Szatmari, Szabolcs;Sprigg, Nikola;Bath, Philip M
Affiliation: Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, City Hospital Campus, Hucknall Road, Nottingham, NG5 1PB, UK
Stroke, Nottingham University Hospitals NHS Trust, Nottingham, UK
Centre for Gastrointestinal Sciences, University of Manchester, Salford, UK
Elderly Medicine, Princess Royal University Hospital, Orpington, UK
Institute for Science and Technology in Medicine, Keele University, Stoke-on-Trent, UK
Neurology, Semmelweis University, Balassu, Budapest, Hungary
Oslo University Hospital, Oslo, Norway
The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
Stroke Unit, Ospedale Santa Maria della Misericordia di Perugia, Perugia, Italy
Neurology, Bispebjerg Hospital & University of Copenhagen, Copenhagen, Denmark
Stroke Service, Tallaght Hospital, Tallaght Dublin, Ireland
Neurology 2, Institute of Psychiatry and Neurology, Warsaw, Poland
Clinical Trials Unit, University of Kelaniya, Ragama, Sri Lanka
Neurology, Ainshams University, Cairo, Egypt
Clinical Sciences, Karolinska Institute, Stockholm, Sweden
Medicine, University of Thessaly, Larissa, Greece
Neurology, Selcuk University, Konya, Turkey
Division of Neurology, Halifax Infirmary, Halifax, Canada
Neurology, All India Institute of Medical Sciences, New Delhi, India
Neurology, Clinical County Emergency Hospital, Targu Mures, Romania
Issue Date: Apr-2018
EDate: 2017-08-02
Citation: Translational stroke research 2018; 9(2): 120-129
Abstract: Post-stroke dysphagia is common, associated with poor outcome and often requires non-oral feeding/fluids. The relationship between route of feeding and outcome, as well as treatment with glyceryl trinitrate (GTN), was studied prospectively. The Efficacy of Nitric Oxide in Stroke (ENOS) trial assessed transdermal GTN (5 mg versus none for 7 days) in 4011 patients with acute stroke and high blood pressure. Feeding route (oral = normal or soft diet; non-oral = nasogastric tube, percutaneous endoscopic gastrostomy tube, parenteral fluids, no fluids) was assessed at baseline and day 7. The primary outcome was the modified Rankin Scale (mRS) measured at day 90. At baseline, 1331 (33.2%) patients had non-oral feeding, were older, had more severe stroke and more were female, than 2680 (66.8%) patients with oral feeding. By day 7, 756 patients had improved from non-oral to oral feeding, and 119 had deteriorated. Non-oral feeding at baseline was associated with more impairment at day 7 (Scandinavian Stroke Scale 29.0 versus 43.7; 2p < 0.001), and worse mRS (4.0 versus 2.7; 2p < 0.001) and death (23.6 versus 6.8%; 2p = 0.014) at day 90. Although GTN did not modify route of feeding overall, randomisation ≤6 h of stroke was associated with a move to more oral feeding at day 7 (odds ratio = 0.61, 95% confidence intervals 0.38, 0.98; 2p = 0.040). As a proxy for dysphagia, non-oral feeding is present in 33% of patients with acute stroke and associated with more impairment, dependency and death. GTN moved feeding route towards oral intake if given very early after stroke. Clinical Trial Registration Clinical Trial Registration-URL: http://www.controlled-trials.com . Unique identifier: ISRCTN99414122.
URI: http://ahro.austin.org.au/austinjspui/handle/1/18478
DOI: 10.1007/s12975-017-0548-0
PubMed URL: 28770403
Type: Journal Article
Research Support, Non-U.S. Gov't
Subjects: Vasodilator Agents
Dysphagia
Deglutition Disorders
Nitric Oxide
Nitroglycerin
Glyceryl trinitrate
Outcome
Randomised controlled trial
Stroke
Appears in Collections:Journal articles

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