Clinical Outcomes and Patient Safety of Nasogastric Tube in Acute Stroke Patients

Abstract

Nasogastric tube (NGT) is often used in stroke patients who are dysphagic (deglutition disorders) or have decreased conscious state. This method of feeding is assumed to have minimal complications. The aim of this study is to analyze complications associated with NGT and variables associated with mortality. Retrospective analysis of 250 acute stroke patients requiring NGT feeding between 2003 and 2020. There were 250 patients (median age 76 (IQR 68–83), 56.4% males, median time to NGT 1 day (IQR 0–3). Discussion with family prior to insertion of NGT recorded in 46 (18.4%). There were 123 cases (49.2%) of aspiration pneumonia. There were 188 (75.2%) NGT associated complications: 67 patients (26.8%) had failed insertion, 31 required multiple attempts, 129 patients (51.6%) pulled out NGT, 107 patients (42.8%) had NGT placed in wrong positions and require reinsertion, 20 cases in the lung, 5 pneumothorax cases, 97 in the gastro oesophageal junction or hiatus hernias, 1 case of oesophageal ulceration, 37 coiled, kinked or resistance. 78 cases the tips were not seen on chest X-ray (CXR), gastrointestinal bleeding in 9 cases, epistaxis in 6 cases), 96 patients (38.4%) required restrain. There were 91 death (36.4%) with 73 patients occurring during hospital admission and a further 18 died within 6 months. Death was more frequent in those age > 60 (72 of 216 patients versus 1 of 33 patients, p < 0.01). The median National Institute of Health Stroke Score/NIHSS of those with aspiration pneumonia was higher than those without (19.5 versus 15, p < 0.01). Decision tree analysis first split at age (≤ 59 versus > 59, p = 0.03), NIHSS (≤ 16 or > 16, p = 0.02), post-stroke pneumonia (p = 0.04) and multiple NGT insertion (p = 0.01). The area under the ROC curve was for this model was 0.75 (95% CI 0.69–0.80). Complications were common among patients with NGT complications. These findings may be used to inform discussions with families regarding NGT.

Laryngopharyngeal Mucosal Injury Due to Nasogastric Tube Insertion during Cardiopulmonary Resuscitation: A Retrospective Cohort Study

“…Moreover, we perceived resistance in the middle or lower esophagus, and discontinued the insertion any further in four patients. This was probably due to the esophageal stenosis or hiatus hernia [ 17 ].…”

“…Previous studies have reported that complications associated with NGT insertion, such as wrong placements, pneumothorax, bleeding, and mucosal injury were more prone to occur in patients with obesity [ 18 ] and acute stroke [ 17 ], who experience difficult insertion. In our study, we focused on the laryngopharyngeal mucosal injury due to blind NGT insertion during CPR.…”

The Prevalence of Stroke-Acquired Pneumonia in Icu Patients Following a Cerebrovascular Accident (Cva)

“…Stroke-associated pneumonia is more prevalent in patients treated in a medical ICU, with twenty-one per cent to fortyfour per cent needing tube feeding (14).Pneumonia is the primary cause of fever in the initial 48 hours following an acute stroke. It is also commonly associated with frequent health complications within 30 days of stroke episode (15) .…”

Evolving Therapeutic Roles of Nasogastric Tubes: Current Concepts in Clinical Practice

“…NGTs in such patients are most often used for feeding. Another study in acute stroke patients by Rabaut et al [ 46 ] revealed that multiple serious complications could occur with the use of NGT. These included aspiration pneumonia (49.2%), multiple insertion attempts, failed insertions, reinsertions, placement in the wrong positions, resistance, kinking or coiling of NGT, pneumothorax, and death in 36.4% of patients during the hospital admission.…”