Complications Associated With Nasogastric Tube Placement in the Acute Phase of Stroke: A Systematic Review

Nascimento, Ana; Carvalho, M. Viseu De; Nogueira, Jerina; Abreu, Pedro Farto e; Nzwalo, Hipólito

doi:10.1097/jnn.0000000000000372

Cited by 16 publications

(16 citation statements)

References 1 publication

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“…Several studies addressed the role of NGT as a risk factor for pneumonia but with contrasting results due to the absence, as in our study, of specific analysis on the number of NGT used per patient during the hospitalization [ 44 ]. Anyway, the presence of a high gastric residual volume, coupled with stroke-induced deglutition impairments, may easily lead to aspiration of gastric content in the lungs [ 45 ]. Moreover, both dislodgement of the tube and the repetition of the positioning procedure are risk factors for developing pneumonia.…”

Section: Discussionmentioning

confidence: 99%

The role of the Sapienza GLObal Bedside Evaluation of Swallowing after Stroke (GLOBE-3S) in the prevention of stroke-associated pneumonia (SAP)

et al. 2021

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Background and purpose Stroke-associated pneumonia (SAP) affects 10 to 38% of patients in the acute phase of stroke. Stroke patients diagnosed with dysphagia have an 11-fold higher risk of developing SAP. Thus, identifying dysphagic patients through a highly accurate screening tool might be crucial in reducing the incidence of SAP. We present a case–control study designed to evaluate efficacy in reducing the risk of SAP between two swallowing screening tools, the classic water swallow test (WST) and a recently validated tool such as the GLOBE-3S (the Sapienza GLObal Bedside Evaluation of Swallowing after Stroke), which is a highly sensitive swallowing screening tool particularly accurate in detecting silent aspiration as well. Methods We analyzed the occurrence of dysphagia in 100 acute stroke patients distributed in two groups: half were screened with WST and the other half with GLOBE-3S. Results Dysphagia was diagnosed in 28 patients. The main result is that, among patients who passed the dysphagia screenings, none of those screened with the GLOBE-3S method developed pneumonia compared to 31.82% in the WST group. Discriminant function analysis (DFA) showed that NIH Stroke Scale (NIHSS) score and the dysphagia screening method (i.e., GLOBE-3S vs. WST) were the two main factors in the SAP’s predicting model and the only significant ones per se. Conclusions The new GLOBE-3S screening test can reduce the risk of SAP compared to WST.

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Section: Discussionmentioning

confidence: 99%

The role of the Sapienza GLObal Bedside Evaluation of Swallowing after Stroke (GLOBE-3S) in the prevention of stroke-associated pneumonia (SAP)

et al. 2021

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“…A systematic review on the topic noted that only 6 of 12 papers on the topic described NGT placement failure and malposition [14]. The authors concluded "Data are scarce on the topic.…”

Section: Complicationsmentioning

confidence: 99%

“…Research about the frequency of local and systemic NGT complications and strategies for prevention will certainly contribute to enhance evidence-based management of dysphagia in acute stroke" [14]. Search for specific terms relating to chest complications were not found in the papers reviewed in this meta-analysis [14]. By contrast, NGT insertion was better documented outside of the stroke literature [15][16][17][18][19].…”

Section: Complicationsmentioning

confidence: 99%

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

et al. 2022

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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.

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“…Enteric feeding is, in situations of severe dysphagia, the only way to ensure nutritional and hydration intake, as well as allowing the administration of medication [69]. However, its use is not without risks, with mechanical complications, such as nasal trauma, displacement, poor positioning and obstruction [70], gastrointestinal complications [71], metabolic disorders [72], resulting in a worse quality of life [73]. Different international guidelines recommend as soon as possible enteral nutrition by NGT in patients who, after a stroke, do not swallow safely, with recommendations varying between the first 24 h [18], the first 3 days [17,19,21] or the first 7 days [16,22,27].…”

Section: Summary Of Evidencementioning

confidence: 99%

Best Practice Recommendations for Dysphagia Management in Stroke Patients: A Consensus from a Portuguese Expert Panel

Oliveira

Couto

Santos

et al. 2021

Port J Public Health

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Dysphagia is frequent after stroke, and it increases the risk of respiratory infection, dehydration and malnutrition, resulting in worse outcomes. Different clinical guidelines present recommendations for the assessment and management of dysphagia in stroke patients in a scattered way. These best practice recommendations address seven clinical questions on the assessment and management of dysphagia in stroke patients, gathering the best-updated evidence. A systematic literature review using the PICO strategy was performed. The recommendations draft was then appraised by a multidisciplinary panel of experts (nutritionists, physiatrists, speech-language pathologists and rehabilitation nurses) in a total of 3 Delphi rounds. A minimum of 80% consensus was established, and the final version offers a total of 21 recommendations for use in clinical practice for stroke patients. These clinical recommendations are an overview of the most recent evidence combined with experts’ consensus and translated into clinically relevant statements. In implementing recommendations at the local level, health professionals should identify facilitators and barriers to evidence-based practice within their contexts and determine the best strategies to address local needs. Where the change is needed, initial and continuing training on all recommendations is essential and relevant.

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Complications Associated With Nasogastric Tube Placement in the Acute Phase of Stroke: A Systematic Review

Cited by 16 publications

References 1 publication

The role of the Sapienza GLObal Bedside Evaluation of Swallowing after Stroke (GLOBE-3S) in the prevention of stroke-associated pneumonia (SAP)

The role of the Sapienza GLObal Bedside Evaluation of Swallowing after Stroke (GLOBE-3S) in the prevention of stroke-associated pneumonia (SAP)

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

Best Practice Recommendations for Dysphagia Management in Stroke Patients: A Consensus from a Portuguese Expert Panel

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