Clinical Question: Do percutaneous ...

Clinical Question: Do percutaneous endoscopic gastrostomy (PEG) tubes improve issues in stroke patients who have dysphagia? Setting: Inpatient (any location) with outpatient follow-up

close attention Design: Randomized controlled trial (single-blinded)

Allocation: Concealed

Synopsis: In this report of pair FOOD (Feed Or Ordinary Diet) trials that shared the same protocols, any patient with dysphagia who was admitted with a modern ischemic stroke and whose physician was uncertain of the best approach to feeding was eligible to participate. In the first bread trial (early versus avoid), the patients were assigned randomly to start enteral tube feeding as presently as possible (n = 429) or to avoid enteral tube feeding for at least seven days (n = 430) In the inferior trial (PEG versus nasogastric feeding), patients were randomized to enteral feeding via PEG tube (n = 162) or nasogastric tube (n = 159) within three days of enrollment The duration of feeding was not predetermined however was based on practicality and the patient's condition.

The main issues assessed by intention to treat, were death and a poor issue after six months of follow-up (defined as a modified Rankin score of 4 or 5) The research staff evaluating the results were unaware of how the patients were f barely one patient was lost to follow-up according to the end of the meditation nearly one half of all patients had died. In the early versus avoid trial, the rates of mortality and poor issues were not significantly affected, although ending the cogitation early severely reduced the sample size, thereby potentially missing meaningful differences. In the PEG versus nasogastric trial, mortality rates were not significantly affected, although there was an absolute increase in the number of patients who had a poor issue (number needed to treat to harm = 13; 95% confidence interval, 64 to infinity; P = 05; lower confidence on a level for adjusted risk ratio = zero)

Bottom Line: In this underpowered investigation of patients with acute ischemic visitation and dysphagia, early use of enteral tube feeding achieved no better (or worse) consequences than avoiding it. Using PEG tubes produc a nonsignificant reduction in mortality rates on the contrary significantly increased the number of patients who had poor issues six months after the rap (Level of Evidence: 1b--)

HENRY BARRY, MD

inquiry Reference: Dennis MS, et al., and the subsistence Trial Collaboration. Effect of timing and means of enteral tube feeding for dysphagic thump patients (FOOD): a multicentre randomised controll trial. Lancet February 26 2005;365:764-72

Used with permission from Barry H PEG tubes worsen quality of life in shock (FOOD). Accessed online June 1 2005 at: http://www.InfoPOEMs.com.

COPYRIGHT 2005 American Academy of Family Physicians

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