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In-Hospital Management of AIS:
General Supportive Care
5.2. Dysphagia
COR LOE
Recommendations
1 C-EO
1. In patients with AIS, performing a bedside swallow screening
prior to initiation of liquid or food intake is recommended to
screen for patients at increased risk for aspiration.
2a C-LD
2. In patients with AIS, it is reasonable for dysphagia screening
to be performed by speech pathologists or other trained
health care professionals.
2a B-NR
3. In patients with AIS who have failed or are unable to
participate in a bedside swallow screening due to neurological
disabilities, it is reasonable to perform an endoscopic
examination of swallowing function to aid in determination
of dysphagia severity and aspiration risk.
2b B-NR
4. In patients with AIS, an oral hygiene protocol may be
reasonable to reduce the risk for pneumonia.
2a B-R
5. (New and of High Impact) In patients with stroke with
dysphagia, treatment with pharyngeal electrical stimulation
(PES), can be beneficial to reduce dysphagia severity and
decrease the risk of aspiration.
2a B-R
6. In patients with severe stroke with dysphagia requiring
tracheotomy and mechanical ventilation, treatment with
PES, after ventilator weaning can be beneficial to decrease
dysphagia severity, reduce the risk of aspiration, and
expedite decannulation.
5.3. Nutrition
COR LOE
Recommendations
1 B-R
1. In patients with AIS, enteral diet should be started within 7
days of admission after an AIS.
1 B-NR
2. In patients with AIS, nutritional screening is recommended
to direct nutritional management early into hospitalization,
preferably within 48 hours of admission, with a nutritional
screening or assessment tool that has been validated in
patients with acute stroke.
2a B-NR
3. In patients with AIS with dysphagia, it is reasonable to use
nasogastric tubes initially for feeding within the first 7 days and
to place percutaneous gastrostomy tubes in patients with longer
anticipated persistent inability to swallow safely (>2–3 weeks).
