Is looped nasogastric tube feeding more effective than conventional nasogastric tube feeding for dysphagia in acute stroke?

Three centre, two arm randomised controlled trial, with 50 participants in each arm comparing loop (the intervention) versus conventional nasogastric tube feeding. The primary outcome measure is proportion of intended feed delivered in the first 2 weeks. The study is designed to show a mean increase of feed delivery of 16% in the intervention group as compared with the control group, with 90% power at a 5% significance level. Secondary outcomes are treatment failures, mean volume of feed received, adverse events, cost-effectiveness, number of chest x-rays, number of nasogastric tubes and tolerability.ISRCTN Number: ISRCTN61174381Dysphagia occurs in up to 50% of patients admitted to hospital with hemispheric stroke [1-4]; up to 27% remain at risk of aspiration by seven days, and up to 8% have swallowing problems six months after their stroke [5] with 1.7% still requiring tube feeding [6]. Nutritional supplementation can reduce mortality in older people at risk of malnutrition, although this has not been shown specifically in the context of stroke [7]. During the period when patients with stroke are unable to take their full dietary requirements normally, the delivery of a liquid feed through a fine bore nasogastric tube is commonly used. The tube is usually secured with adhesive tape around the tube and to the patients face, and is often hooked behind the ear, where more adhesive tape may be used.Unfortunately nasogastric tubes are frequently inadvertently dislodged, due to confusion, restlessness, communication and attention disorders during handling or normal movement. Partial dislodgement may leave the tube misplaced in the lungs, leading to a risk of aspiration. Dislodgement means that the tube needs to be re-sited, possibly causing distress and discomfort to the patient. Re-siting takes up nursing staff time, and may require a chest x-ray to confirm that the tip of the tube is in the stomach (especially in light of recent guidance [8]), adding further costs and