Feeding Patients after Stroke: Who, When, and How

It's Friday at 5:30 p.m. Monday is a holiday. You have just admitted a 75-year-old woman with dysarthria and dysphagia from a lateral medullary stroke. A swallowing study will not be available for more than 72 hours. What should you do about feeding her?

This common scenario, and the even more pragmatic questions of how and when to feed patients with previous stroke regardless of their swallowing function, represents a fundamental yet relatively understudied aspect of stroke care. The importance of these everyday issues is manifest in the numbers: More than 700 000 persons in the United States have a stroke each year, and this number is projected to increase to more than 1.25 million by 2050 (1). Of the more than 90% of persons who survive the acute event, as many as 50% will have at least transient difficulty in swallowing (2). Knowing which patients with previous stroke should be fed, when to feed them, and how to deliver the feedings are key questions for which the recent noteworthy Feed Or Ordinary Diet (FOOD) trials provide some answers (3, 4).