Impact of nasogastric tubes on swallowing physiology in older, healthy subjects: a randomized controlled crossover trial

Pryor, Lee N., Ward, Elizabeth C., Cornwell, Petrea L., O'Connor, Stephanie N., Finnis, Mark E. and Chapman, Marianne J. (2014) Impact of nasogastric tubes on swallowing physiology in older, healthy subjects: a randomized controlled crossover trial. Clinical Nutrition, 34 4: 572-578. doi:10.1016/j.clnu.2014.09.002

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Author Pryor, Lee N.
Ward, Elizabeth C.
Cornwell, Petrea L.
O'Connor, Stephanie N.
Finnis, Mark E.
Chapman, Marianne J.
Title Impact of nasogastric tubes on swallowing physiology in older, healthy subjects: a randomized controlled crossover trial
Journal name Clinical Nutrition   Check publisher's open access policy
ISSN 0261-5614
Publication date 2014-09-06
Year available 2014
Sub-type Article (original research)
DOI 10.1016/j.clnu.2014.09.002
Open Access Status
Volume 34
Issue 4
Start page 572
End page 578
Total pages 7
Place of publication Amsterdam, Netherlands
Publisher Elsevier
Collection year 2015
Language eng
Formatted abstract
Background & aims The presence of a nasogastric tube (NGT) affects swallowing physiology but not function in healthy young adults. The swallowing mechanism changes with increasing age, therefore the impact of a NGT on swallowing in elderly individuals is likely to be different but is not yet known. The aims of this study were to determine the effects of NGTs of different diameter on (1) airway penetration-aspiration, (2) pharyngeal residue, and (3) pharyngeal transit, in older healthy subjects.

Methods Randomized controlled crossover design. Healthy elderly volunteers underwent 3 modified barium swallow studies in which multiple diet and fluid consistencies were swallowed under the following conditions: (A) no NGT (control), (B) fine bore NGT, and (C) wide bore NGT. The control condition was assessed first to establish baseline swallowing function, then NGT order was randomly allocated.

Results Of the 15 volunteers (median age 65 years, range 60–81) complete data sets were obtained for 9 (4 with allocation order ABC; 5 with ACB). Wide bore NGT data could not be obtained for 6 volunteers mainly due to tube intolerance. The presence of a NGT was associated with: (i) an increase in airway penetration-aspiration (fine bore NGT with serial liquid swallows and puree) (p < 0.01); (ii) increased pharyngeal residue (p < 0.05) in the pyriform sinus (fine bore NGT with puree); and in the valleculae (both fine and wide bore NGT with soft solids); and (iii) an increase in pharyngeal transit duration regardless of consistency (p < 0.01), with longest swallowing durations with the widest tube.

Conclusions NGT presence increases airway penetration-aspiration, pharyngeal residue and prolongs transit through the pharynx in older healthy individuals. Consideration of NGT impact on swallowing during concurrent oral and enteral feeding is recommended, with further systematic investigation required in elderly patients recovering from critical illness.

Clinical trial registry Australia & New Zealand Clinical Trials Registry (ACTRN12613000577718).
Keyword Aspiration
Enteral nutrition
Nasogastric tube
Supplemental feeding
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Available online 6 September 2014.

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2015 Collection
School of Health and Rehabilitation Sciences Publications
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Created: Thu, 19 Mar 2015, 12:58:42 EST by Professor Elizabeth Ward on behalf of School of Health & Rehabilitation Sciences