Small technology solves big "food" problems! IOE technology allows patients with swallowing disorders to become "foodies"

Eating is both a physiological need and a kind of enjoyment, but for patients with swallowing dysfunction and nasogastric feeding tubes, enjoying delicious food becomes an unattainable thing.

In order to solve this clinical problem, the Rehabilitation Department of Shimen County Traditional Chinese Medicine Hospital sent personnel to the First Affiliated Hospital of Zhengzhou University to study the "intermittent oral to esophageal feeding technique" (IOE technique for short), and obtained the corresponding qualifications. It has been gradually promoted and applied in the hospital. So far, 13 cases of IOE technique have been carried out, and 11 patients have successfully removed the indwelling nasogastric tubes and have been able to eat normally through the mouth.

This technology can effectively solve patients' nutritional problems, promote the recovery of swallowing function, reduce the occurrence of complications such as aspiration pneumonia, save medical resources, and at the same time maintain patients' dignity, bringing good news to patients with swallowing disorders.

Case Study

On July 25, 2024, the patient fell to the ground after suffering from heatstroke while working outdoors. He developed impaired consciousness and was admitted to a hospital in another place for treatment. He was diagnosed with "heat stroke, cerebral hemorrhage, right clavicle fracture, and right rib fracture." After active treatment, the patient regained consciousness.

However, the patient was malnourished and had severe hypoproteinemia. He weighed only 80 catties, a 20 catties drop from before he became ill. The cannula was not removed after the tracheotomy. He coughed and expectorated significantly. He wore a nasogastric tube, drooled involuntarily, spoke unclearly, and gestured randomly with his fingers. He could not stand or walk, and needed help from others to urinate and defecate.

Because he could not accept the reality and could not communicate with the medical staff and relatives, the patient was very anxious. In the end, he refused all treatment and went on a hunger strike, which made his relatives very anxious. On September 10, he was admitted to the Rehabilitation Department of Shimen County Traditional Chinese Medicine Hospital through the recommendation of others.

Develop a recovery plan

The Rehabilitation Department of Shimen County Traditional Chinese Medicine Hospital has established a rehabilitation team consisting of department director Cui Haibo, chief physician, rehabilitation physician Xia Weiwei, deputy chief physician, critical care rehabilitation therapist Chen Linchuan, swallowing rehabilitation therapist Zhang Ling, and rehabilitation specialist nurse Deng Yada to discuss and determine the rehabilitation plan.

Implement rehabilitation treatment

1. IOE eating training

Rehabilitation specialist nurse Deng Yadan performs feeding through an IOE tube (intermittent oral esophageal feeding). When food or water is needed, the IOE tube is inserted into the esophagus through the mouth and can be removed after eating.

You can eat 500-600ml each time. Rationally match food, stop using protein powder and other nutritional products, and use 12 egg whites, vegetables and other foods instead, and formulate a three-meal-a-day recipe.

2. Swallowing function training

Swallowing rehabilitation therapist Zhang Ling performs swallowing rehabilitation treatment, providing swallowing function training, oral sensory stimulation, Mendelssohn stimulation, and combined with swallowing muscle electrical stimulation, acupuncture and other treatments.

3. Pulmonary rehabilitation and exercise rehabilitation training

Critical care rehabilitation therapist Chen Linchuan performs pulmonary rehabilitation and sports rehabilitation treatments to improve airway clearance and coughing abilities, perform resistance breathing training, improve exercise endurance and physical strength, and improve overall muscle strength and balance and coordination abilities.

After two weeks of comprehensive rehabilitation treatment, the patient's sputum was significantly reduced, drooling was significantly improved, he occasionally choked when drinking water, and his weight increased by 5 catties. On September 25, the tracheotomy tube was successfully removed. After 20 days of swallowing rehabilitation, the swallowing function was re-evaluated and the patient switched to oral intake of solid and paste food.

After 34 days of systematic rehabilitation treatment, the patient was able to stand and walk, resume eating independently, and communicate normally with his family without using gestures. He was discharged from the hospital on October 14, 2024.

Science Time

What is IOE?

IOE stands for intermittent oral-to-esophageal feeding. When the patient needs to eat, the IOE tube is inserted into the esophagus through the mouth and can be removed after eating. This avoids problems such as esophageal reflux and aspiration pneumonia caused by the indwelling nasogastric tube.

Except for meal times, intubation is not required at other times, which does not affect swallowing training and daily activities, and protects the patient's self-esteem to the greatest extent.

The IOE tube is directly inserted into the esophagus without affecting the closure of the gastric cardia. Each meal can reach 500-600ml, and three meals a day can ensure the supply of nutrition. This technology can stimulate the root of the tongue during the intubation operation and induce swallowing reflex, which is more in line with the physiological law of oral feeding and is conducive to the recovery of swallowing function.

Hunan Medical Chat Special Author: Xia Weiwei from Shimen County Traditional Chinese Medicine Hospital

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(Edited by YT)