Appropriate volumes of water for non-invasive swallowing assessments of nursing home residents: A descriptive correlational study.

Background: The volume of water that can be swallowed without risk of choking or aspiration is a common way to assess swallowing function in patients with dysphagia in institutional settings. However, no evidence-based study has established what volumes of water are safest and most effective for testing. Objective: A validated portable non-invasive device for swallowing and respiration (NIDSAR) was employed to determine safe swallowing volumes for nursing home residents with different levels of dysphagia. Methods: Participants (N = 94) were grouped by the absence or presence of a nasogastric (NG)-tube: those without an NG-tube (n = 60) and those with an NG-tube (n = 34).Swallowing 1 ml, 3 ml, and 5 ml of water was assessed with the Functional Oral Intake Scale (FOIS) and compared with measures with objective scores from the portable NIDSAR. In addition, swallowing measures were compared between groups, as well as relationships with participant-reported choking frequency. Results: Participants without an NG-tube had significant different scores for swallowing during the respiration phase and pharyngeal stage for both 3 ml (t = 3.894 to 4.277, p < .001) and 5 ml (t = 1.999 to 2.944, p < .05 to p < .01) compared with participants with an NG-tube. Discussion: Our research revealed that participants with frequent episodes of choking required more time to swallow 1 ml compared with 3 ml or 5 ml which might be a function of piecemeal swallowing. Conclusions: NIDSAR measures with 3 ml and 5 ml boluses of water are effective volumes for safely assessing swallowing ability of nursing home residents with dysphagia without risk of choking or aspiration.

Cervical gastric decompression tube: safety and efficacy outcomes for inoperable malignant bowel obstruction.

BACKGROUND: Inoperable malignant bowel obstruction, which results in chronic nausea, vomiting and abdominal pain, often requires nasogastric tube decompression. However, these tubes are often uncomfortable for patients and require hospitalization during the end-of-life care. Cervical esophago-gastric (CEG) decompression tubes are a potential palliative solution. The objective of this study is to present the outcomes of CEG tubes in 11 patients with malignant bowel obstruction. METHODS: We performed a retrospective review of patients requiring nasogastric tube decompression who received CEG decompression tubes for inoperable malignant bowel obstructions between 2016-2022. CEG tube placement was performed percutaneously through the left neck using a guidewire and an endoscopic technique. RESULTS: The average age of patients was 58 years (31-72 years), with metastatic colorectal cancer (36.4%) and ovarian cancer (27.3%) being the most common causes of malignant bowel obstruction. All procedures were completed percutaneously, without requiring conversion to open procedures. The morbidity of the procedure was 27%, which included tube dislodgement, local cellulitis, or bleeding at the insertion site. None of the patients required reoperation, with most of the patients successfully treated conservatively. Most patients were discharged home after the procedure (82%); however, 45% were readmitted (mostly due to abdominal pain). Most patients (73%) were able to continue additional chemotherapy after tube placement. The average survival from cancer diagnosis was approximately six months, whereas the average survival after the procedure was about four months. No mortalities occurred due to CEG tube placement. CONCLUSIONS: A CEG decompression tube is safe for patients with malignant bowel obstruction. The procedure allows patients to undergo additional chemotherapy and be discharged home with a more comfortable tube.

Use of a rigid curved laryngoscope for observation and debridement of degenerated cricoid cartilage in nasogastric tube syndrome: A case report.

Nasogastric tube syndrome (NGTS) is a complication of NGT placement that can cause sore throat, bilateral vocal cord paralysis, and airway constriction. Although rare, this condition should be known by all physicians because it is sometimes fatal. We report a case of NGTS that was successfully diagnosed and debrided with a rigid curved laryngoscope. A 79-year-old man was referred to our department for evaluation of persistent pharyngeal pain and dysphagia after thoracic aortic aneurysm surgery. He had restricted bilateral vocal fold abduction, and the NGT had been placed for nearly 120 days. After induction of general anesthesia, the patient underwent laryngeal examination using a rigid curved laryngoscope, which revealed ossified cricoid cartilage in the postcricoid area, leading to confirmation of NGTS. The NGT was removed, and the protruding bony lesion was debrided. Subsequently, the patient underwent gastrostomy to improve his nutritional status. One month later, the postcricoid lesion improved, and the patient was able to tolerate an oral diet. The pathophysiology of NGTS is thought to involve ulceration of the postcricoid mucosa and injury of the posterior cricoarytenoid muscle by contact with the NGT. Although the treatment has not been established, early removal of the NGT is important. In the present case, the rigid curved laryngoscope was useful for resection of the bony lesion, which contributed to early epithelialization and symptom improvement.

Characteristics of older adults receiving enteral feeding at a geriatric medical center.

BACKGROUND: Malnutrition is a prevalent and hard-to-treat condition in older adults. enteral feeding is common in acute and long-term care. Data regarding the prognosis of patients receiving enteral feeding in geriatric medical settings is lacking. Such data is important for decision-making and preliminary instructions for patients, caregivers, and physicians. This study aimed to evaluate the prognosis and risk factors for mortality among older adults admitted to a geriatric medical center receiving or starting enteral nutrition (EN). METHODS: A cohort retrospective study, conducted from 2019 to 2021. Patients admitted to our geriatric medical center who received EN were included. Data was collected from electronic medical records including demographic, clinical, and blood tests, duration of enteral feeding, Norton scale, and Short Nutritional Assessment Questionnaire score. Mortality was assessed during and after hospitalization. Data were compared between survivors and non-survivors. Multivariate logistic regressions were performed to identify the variables most significantly associated with in-hospital mortality. RESULTS: Of 9169 patients admitted, 124 (1.35%) received enteral feeding tubes. More than half of the patients (50.8%) had polypharmacy (over 8 medications), 62% suffered from more than 10 chronic illnesses and the majority of patients (122/124) had a Norton scale under 14. Most of the patients had a nasogastric tube (NGT) (95/124) and 29 had percutaneous endoscopic gastrostomies (PEGs). Ninety patients (72%) died during the trial period with a median follow-up of 12.7 months (0.1-62.9 months) and one-year mortality was 16% (20/124). Associations to mortality were found for marital status, oxygen use, and Red Cell Distribution Width (RDW). Age and poly-morbidity were not associated with mortality. CONCLUSION: In patients receiving EN at a geriatric medical center mortality was lower than in a general hospital. The prognosis remained grim with high mortality rates and low quality of life. This data should aid decision-making and promote preliminary instructions.

Validating nasogastric tube placement with pH testing: A randomized controlled trial protocol.

Background: Enteral nutrition (EN) is preferred when oral feeding is not possible. The use of the Nasogastric Tube (NGT) ensures rapid and low-risk nutrient administration. However, confirming the placement through chest radiography, besides delaying the initiation of nutritional therapy, exposes patients to radiation. The pH test of gastric aspirate provides a quicker check for NGT placement, but its reliability is compromised by challenges related to aspirating gastric secretions. Study objective: The main objective of this study is to assess the high-performance placement of NGTs for nutritional purposes, optimizing the evaluation of correct insertion through pH testing using an electronic pH meter. Additionally, the study aims to evaluate patient tolerance to the intervention. Materials and methods: This single-center RCT will include 150 EN candidate patients divided into three groups. Each group will use distinct NGTs, evaluating placement through pH testing and chest radiography for safety. Tolerance, complications related to NGT placement, and costs will be assessed, with data collected anonymously through a secure electronic database. Ethical considerations: authorization no. 3624, Territorial Ethical Committee Lombardy 5, October 20, 2023. Implications and perspectives: This protocol introduces innovative technologies, such as advanced NGTs and an electronic pH meter, aiming to optimize enteral nutrition management. This RCT focuses on replacing X-rays as the primary method for verifying NGT placement, thereby reducing costs, time, and patient exposure to radiation. Data analysis may provide insights into managing patients on pH-altering medication. Implementing innovative technologies has the potential to reduce errors and improve economic efficiency and process sustainability.

The effect of mechanical ventilation compared to high-flow nasal cannula on gastric residual volume and reflux events using novel automated technology.

BACKGROUND & AIM: High flow nasal cannula (HFNC) oxygen therapy is frequently used following extubation. A case report, utilizing an innovative medical technology (The smART + Platform, ART MEDICAL Ltd., Netanya, Israel) that enables the detection of gastric refluxes and gastric residual volumes (GRV), has suggested that HFNC may be associated with increased reflux events and GRV. This study measured reflux events and GRV using smART+ in mechanically ventilated patients before and after extubation while they were receiving HFNC therapy. We aim to show if there is a significant difference in reflux events and GRV between HFNC users and mechanically ventilated patients. METHODS: This is a post hoc analysis examines data of a randomized controlled trial (RCT) involving critically ill adult patients who received enteral nutrition through the smART + Platform. The study was approved by the local ethics committee. We compared the frequency and amplitude of reflux events and GRV in mechanically ventilated patients. These parameters were assessed both 3 h before extubation and subsequently after extubation when the patients were connected to HFNC. Patients served as their own controls. To evaluate the differences between the pre- and post-extubation measurements, we applied a parametric paired t-test. RESULTS: Ten patients (mean age of 58 years; mean APACHE II score 22; mean 3.9 days of mechanical ventilation) were included. Three hours prior extubation the mean GRV was 4.1 ml/h compared to 14.03 ml/h on HFNC (p = 0.004). The mean frequency of major reflux events was 2.33/h in ventilated patients versus 4.4/h in the HFNC patients (p = 0.73). The mean frequency of major reflux events was 9.17/h in ventilated patients versus 9.83/h in HFNC patients (p = 0.14). CONCLUSIONS: Leveraging the smART + Platform, we demonstrated that the use of HFNC significantly increases GRV compared with patients on mechanical ventilation and may increase the frequency of major reflux events, thereby increasing the risk of aspiration. Further studies are required to support our conclusions.

Supradiaphragmatic Jejunal Perforation Following Total Gastrectomy With Esophagojejunostomy Reconstruction for Gastric Adenocarcinoma.

Nasogastric tube decompression is a common technique used after abdominal surgery as it is widely accepted to play a role in the management of postoperative ileus and possibly reduce anastomotic leaks after gastrointestinal surgery. However, the routine practice of nasogastric/nasoenteric tube decompression in elective abdominal surgeries has been challenged due to the increased incidence of pulmonary complications and the argued lack of expected benefit. Here, we present a rare complication of nasogastric tube drainage following a routine total gastrectomy for signet-ring cell adenocarcinoma of the cardia in a 43-year-old female. Her postoperative course was complicated with a supradiaphragmatic jejunal perforation presumably from nasogastric tube decompression resulting in a left pleural effusion. The workup included an endoscopy showing the perforation, after which the nasojejunal tube was removed and the patient was managed conservatively. She was eventually discharged on postoperative day 28.

Feeding tube use and complications in Prader-Willi syndrome: Data from the Global Prader-Willi Syndrome Registry.

Guidance on indications for, and types of, feeding tubes recommended in Prader-Willi syndrome (PWS) is needed. A Global PWS Registry survey was developed to investigate nasogastric (NG) and gastrostomy (G) tube use and associated complications. Of 346 participants, 242 (69.9%) had NG-tubes, 17 (4.9%) had G-tubes, and 87 (25.1%) had both NG- and G-tubes. Primary indication for placement was "feeding difficulties and/or poor weight gain" for both NG- (90.2%) and G-tubes (71.2%), while "aspiration/breathing difficulties" was the procedural indication for 6.4% of NG-tubes and 23.1% of G-tubes. NG-tubes were generally removed by age 6 months (NG Only: 82.9%; NG/G: 98.8%), while G-tubes were often removed by age 2 years (G Only: 85.7%; NG/G: 70.5%). The severe complication rate from G-tubes was 31.7% and from NG-tubes was 1.2%. Overall, caregivers indicated the presence of an NG- or G-tube had a positive effect on quality of life. Feeding difficulties in PWS are largely managed by NG-tube alone. The severe complication rate from G-tubes was about 25 times higher than from NG-tubes; yet, G-tube placement rates have generally increased. G-tube placement puts individuals with PWS at risk for anesthesia and surgery-related complications and should be considered judiciously by a multidisciplinary team.

Mal-positioned nasogastric feeding tubes: are medical students safe to identify them?

OBJECTIVES: Nasogastric tube (NGT) placement is listed against Clinical Imaging in the upcoming Medical Licensing Assessment-compulsory for every graduating UK medical student from 2025. This study aims to establish the ability of medical students to correctly identify the position of an NGT on Chest X-ray (CXR) and to evaluate a learning tool to improve student outcome in this area. METHODS: Fourth-year (MB4) and fifth-year (MB5) medical students were invited to view 20 CXRs with 14 correctly sited and 6 mal-positioned NGT. MB5 students (Intervention) were exposed to an online interactive learning tool, with MB4 students kept as control. One week later, both groups of students were invited to view 20 more CXRs for NGT placement. RESULTS: Only 12 (4.8%) of 249 MB5 students and 5 (3.1%) of 161 MB4 students correctly identified all the NGTs on CXRs. The number of students misidentifying 1 or more mal-positioned NGT as "safe to feed" was 129 (51.8%) for MB5 and 76 (47.2%) for MB4 students. This improved significantly (P < .001) following exposure to the learning tool with 58% scoring all CXRs correctly, while 28% scored 1 or more mal-positioned NGT incorrectly. Students struggled to determine if the NGT tip had adequately passed into the stomach. However, they failed to identify an NG tube in the lung ("never event") in just one out of 1,108 opportunities. CONCLUSION: Medical students' ability to determine if the NGT was in the stomach remains suboptimal despite exposure to over 60 CXRs. Feeding NGT should be formally reported before use. ADVANCES IN KNOWLEDGE: This is the first attempt at quantifying graduating medical students', and by inference junior doctors', competence in safely identifying misplaced nasogastric feeding tubes. An online, experiential learning resource significantly improved their ability.

Placement of Nasogastric Tubes in Pancreaticoduodenectomy Patients: Switching from Immediate Intraoperative Removal to Avoiding Unnecessary Perioperative Use.

BACKGROUND: The placement of nasogastric tubes (NGTs) in abdominal surgery has been adopted for decades to attenuate ileus and prevent aspiration pneumonia. In the recent era, the guidelines recommend not using NGT routinely, and even in pancreaticoduodenectomy (PD), immediate removal of NGT in operating rooms (ORs) was suggested. However, the clinical outcome and safety of abandoning NGT during the pre-PD and intra-PD periods remain unknown. METHODS: We conducted a single-center retrospective review on adult PD patients aged between 20 and 75 years from 2013 to 2022. The study population was grouped into the NGT group (NGT was placed before PD and immediately removed in the ORs) and the non-NGT group (NGT was not placed preoperatively). Safety was evaluated by the number of adverse events. The primary aim of this study is to evaluate the need of NGT insertion in ORs among PD patients. RESULTS: The case numbers in the NGT and non-NGT groups were 391 and 578, respectively. No case in the non-NGT group needed the intraoperative insertion of NGT. The rate of pulmonary complications was 2.3% in the NGT group compared to 1.6% in the non-NGT group (P = 0.400). Furthermore, there were no significant differences in terms of rates of major complications (12.8% vs. 9.3%, P = 0.089) or mortality (1.0% vs. 1.0%, P =0.980) between the two groups. The rates of the postoperative insertion of NGT in the NGT and non-NGT groups were 2.6% and 2.8% (P = 0.840), respectively. CONCLUSION: For selected PD patients, the placement of NGT during pre-PD and intra-PD periods may be safely omitted. This primary study is considered the first foundation stone in the extension of the element of no NGT in PD.

Survival of a Rhino-Orbital-Cerebral Mucormycosis Patient after Localized Combination Liposomal Amphotericin B Medications: A Case Report.

Introduction: The aim of this study was to report a case of ROCM related to nasogastric intubation who was survived by liposomal amphotericin B (LAmB) combination therapy in situ without orbital exenteration. Case Presentation: A 44-year-old woman presented with a 1-week history of rapidly enlarging swelling on the right nose, cheek, and lower eyelid after underwent gastrointestinal decompression. The lesions were derived from the nasal area where the nasogastric tube had been placed. Based on the biopsy results and clinical manifestations, ROCM was diagnosed. Immediate combination therapy with intravenous LAmB and micafungin and multisection debridement of the right facial region were applied. Postoperative treatment included cleaning, irrigating, and local dressing of the wound area using LAmB. LAmB was also used daily as binocular eye drops against deep infection on the eyeballs. The patient recovered well 4 months later and remained free of disease after 40 months of follow-up. Conclusion: This case adds to our knowledge on the potential risk of nasogastric intubation for mucormycosis infection. Nasogastric tube may be the source of infection associated with ROCM. This report evaluates the beneficial effect of LAmB combination therapy in situ for cleaning, irrigating, local wound dressing, and eye drops on lesion areas. The combination of LAmB as cleaning, irrigating, local dressing solution, and eye drops to control intraocular and intraorbital ROCM infection has not been previously reported to our knowledge. These methods provide multiple choices to substitute for orbital exenteration on the survival of ROCM patients.

Optimizing the Postoperative Management of Children Undergoing Resection of High-Risk Abdominal Neuroblastoma.

BACKGROUND: Surgical resection is a mainstay of treatment in high-risk neuroblastoma (HR-NB), but there exists wide variability in perioperative management practices. The aim of this study was to evaluate two standardized adult perioperative enhanced recovery practices (ERPs) in pediatric patients undergoing open resection of abdominal HR-NB. METHODS: All patients with abdominal HR-NB surgically resected at a free-standing children's hospital between 12/2010 and 7/2020 were retrospectively reviewed. Perioperative ERPs of interest included avoidance of routine nasogastric tube (NGT) use and the use of neuraxial anesthesia. Primary outcomes included time to enteral intake, urinary catheter use, opioid utilization, and length of stay (LOS). RESULTS: Overall, 37 children, median age 33 months (IQR: 20-48 months), were identified. Avoidance of an NGT allowed for earlier feeding after surgery (P = .03). Neuraxial anesthesia use more frequently required an indwelling urinary catheter (P < .01) for a longer duration (P = .02), with no difference in total opioid utilization (P = .77) compared to patients without neuraxial anesthesia. Postoperative LOS was unaffected by avoidance of routine NGT use (P = .68) or use of neuraxial anesthesia (P = .89). CONCLUSION: Children undergoing open resection of abdominal HR-NB initiated diet sooner when an NGT was not left postoperatively, and the need for a urinary catheter was significantly higher in patients who received neuraxial anesthesia. However, these two ERP components did not decrease postoperative LOS. To optimize the postoperative management of NB patients, postoperative NGTs should be avoided, while the benefit of neuraxial anesthesia is less clear as it necessitates the placement of a urinary catheter without decreasing opioid utilization.

Relative bioavailability of fedratinib through various alternative oral administration methods in healthy adults.

Fedratinib is an oral Janus kinase 2-selective inhibitor for the treatment of adult patients with intermediate-2 or high-risk myelofibrosis; however, some patients have difficulty with oral dosing. This randomized, phase 1, open-label, 2-part crossover study evaluated the relative bioavailability, safety, tolerability, taste, and palatability of fedratinib resulting from various alternative oral administration methods in healthy adults. Participants could receive fedratinib 400 mg orally as intact capsules along with a nutritional supplement; as contents of capsules dispersed in a nutritional supplement, delivered via nasogastric tube; or as a divided dose of 200 mg orally twice daily as intact capsules with a nutritional supplement. Fifty-eight participants received treatment. Total exposure to fedratinib was similar after oral administration of intact capsules or when dispersed in a nutritional supplement (area under the plasma concentration-time curve from time 0 to the time of the last quantifiable concentration geometric mean ratio [AUC0-t GMR] [90% CI], 1.007 [0.929-1.092]). Total exposure to fedratinib was slightly reduced following nasogastric administration (AUC0-t GMR 0.850 [0.802-0.901]) and as a divided dose (AUC0-t GMR 0.836 [0.789-0.886]). No new safety signals were identified for fedratinib, and most participants found the taste and palatability acceptable when dispersed in a nutritional supplement. Overall, results suggest no clinically meaningful differences in total exposure to fedratinib between the tested oral administration methods. These findings may facilitate administration of fedratinib to patients who are intolerant of swallowing the capsule dosage form. (ClinicalTrials.gov: NCT05051553).

Safety of omitting nasogastric decompression after esophagectomy: a propensity score-matched study.

Background: Nasogastric (NG) decompression is routinely performed after esophagectomy. However, whether it aids postoperative recovery is still controversial. This study aimed to assess the effects of NG decompression on postoperative complications after esophagectomy. Methods: Data of 1,489 consecutive patients who underwent esophagectomy between January 2019 and December 2020 were retrospectively analyzed. All patients were assigned to two groups based on whether they had undergone NG decompression or not. We conducted a propensity score matching (PSM) analysis to minimize the effect of potential confounders. Results: In total, 1,466 patients (including 1,235 patients with NG tubes and 231 without NG tubes) were included in the study, and 219 pairs were successfully matched. After PSM analysis, there was no difference in morbidity and mortality between the two groups. Postoperative hospital stay in the non-NG tube group was shorter than that in the NG tube group (8 vs. 10 days, P<0.001). The incidence of pneumonia and anastomotic leakage showed no significant differences (13.2% vs. 17.8%, P=0.235 for pneumonia; 13.7% vs. 11.0%, P=0.460 for anastomotic leakage). For patients who developed anastomotic leakage after surgery, the leakage developed earlier in the non-NG group (6 vs. 8 days, P=0.033) than in the NG group. However, no significant between-group differences were observed in the postoperative hospital stay and severity of leakage. Conclusions: Routine NG decompression may not confer any discernible benefits for patients who have undergone esophagectomy. As such, the omission of this procedure could be considered in postoperative care.

Effectiveness of Lidocaine nasal drops versus placebo drops for reducing the discomfort of nasogastric tube insertion: a randomized controlled trial study.

PURPOSE: Nasogastric tube (NGT) insertion can be painful and distressing for the patient. Lidocaine nasal drops might be effective as a local anesthetic agent before the procedure. This study aimed to compare the effects of Lidocaine nasal drops versus placebo drops for reducing the discomfort of this procedure. METHODS: Patients indicated for NGT insertion were categorized into two groups randomly. The Lidocaine group had 2% Lidocaine instilled nasally 3 min before the procedure and the control group had normal saline drops instilled. We compared the pain scores (using a visual analog scale) and complications between the two groups. RESULTS: A total of 126 patients who required NGT insertion between September, 2021 and August, 2022 were enrolled in this study. The pain score of the Lidocaine nasal drops group was 1.41 ± 0.50 (range 1-2) and that of the control group was 4.54 ± 1.03 (range 3-7) (p < 0.01). The duration of the procedure in the Lidocaine and control groups was 1.52 ± 0.76 min and 3.38 ± 1.36 min, respectively (p < 0.01). The insertion was completed successfully within the first attempt in 98% of the Lidocaine group patients, whereas two or three attempts were needed in the control group. The incidence of complications such as vomiting, coughing, difficult breathing, and aspiration was lower in the Lidocaine group than in the control group (p < 0.01). CONCLUSION: Instilling Lidocaine nasal drops before NGT insertion alleviated discomfort and reduced procedure-associated complications.

Difficult tracheostomy decannulation related to nasogastric tube syndrome: A case report.

INTRODUCTION AND IMPORTANCE: Nasogastric tube syndrome (NGTS) is a rare but potentially life-threatening complication. Patients receiving both tracheostomy and indwelling nasogastric tube (NGT) are not uncommon, however difficult tracheostomy decannulation due to NGTS has not been reported. CASE PRESENTATION: A 65-year-old woman was hospitalized with cervical spine stenosis and cervical spinal cord injury after a fall. The surgeon planned neck surgery, but unanticipated tracheotomy had to perform due to emergency airway during anesthesia induction. She then suffered from acute respiratory distress syndrome and underwent a series of treatments including indwelling NGT. About 2 weeks later, tracheostomy decannulation was planned. Following tracheostomy-tube-occlusion test, however, she experienced severe inspiratory difficulty. Severe supraglottic swelling was found, and the opening of glottis was completely covered by swollen tissue. Three weeks post-tracheostomy, the airway patency test failed again, and NGT was removed. Finally, the tracheostomy tube was successfully removed at 5 weeks after tracheotomy. CLINICAL DISCUSSION: This patient developed difficult tracheostomy decannulation due to upper airway obstruction, and NGTS was considered as the main cause. Although vocal cord paralysis and post-cricoid ulcer did not occur in this case, we suggest that severe periglottic swelling may also be a symptom of NGTS. In this patient, upper airway edema gradually relieved after NGT removal, and the artificial airway was also removed 2 weeks later. Therefore, removal of NGT is the primary measure to deal with NGTS. CONCLUSIONS: Attention should be paid to the effect of NGTS on decannulation in patients receiving long-term tracheotomy and NGT insertion.

Nasogastric tube feeding improves nutritional status and physical state in esophageal cancer patients during chemoradiotherapy: a retrospective study.

OBJECTIVE: To compare the complication rates, nutritional status, and physical state between esophageal cancer (EC) patients managed by nasogastric tube (NGT) feeding versus those managed by oral nutritional supplementation (ONS) during chemoradiotherapy. METHODS: EC patients undergoing chemoradiotherapy managed by nonintravenous nutritional support in our institute were retrospectively recruited and divided into an NGT group and an ONS group based on the nutritional support method. The main outcomes, including complications, nutritional status, and physical state, were compared between groups. RESULTS: The baseline characteristics of EC patients were comparable. There were no significant differences in the incidence of treatment interruption (13.04% vs. 14.71%, P = 0.82), death (2.17% vs. 0.00%, P = 0.84), or esophageal fistula (2.17% vs. 1.47%, P = 1.00) between the NGT group and ONS group. Body weight loss and decrease in albumin level were significantly lower in the NGT group than in the ONS group (both P < 0.05). EC patients in the NGT group had significantly lower Nutritional Risk Screening 2002 (NRS2002) and Patient-Generated Subjective Global Assessment (PG-SGA) scores and significantly higher Karnofsky Performance Status (KPS) scores than patients in the ONS group (all P < 0.05). The rates of grade > 2 esophagitis (10.00% vs. 27.59%, P = 0.03) and grade > 2 bone marrow suppression (10.00% vs. 32.76%, P = 0.01) were significantly lower in the NGT group than in the ONS group. There were no significant differences in the incidence of infection and upper gastrointestinal disorders or therapeutic efficacy between groups (all P > 0.05). CONCLUSIONS: EN through NGT feeding leads to significantly better nutritional status and physical state in EC patients during chemoradiotherapy than EN via ONS. NGT may also prevent myelosuppression and esophagitis..

Complications and outcomes of gastrostomy versus nasogastric tube feeding in paediatric allogeneic bone marrow transplant: A prospective cohort study.

BACKGROUND & AIMS: The intensive conditioning regimens administered during bone marrow transplant (BMT) frequently cause mucositis, gastrointestinal toxicity and reduced oral intake. Children are consequently at risk of malnutrition. First-line nutrition support is recommended as enteral nutrition (EN). Nasogastric tube (NGT) is the mainstay for administration. Gastrostomies provide an alternative, but there is limited evidence of their efficacy and safety in paediatric BMT. This study aimed to compare enteral tube complications and nutritional and clinical outcomes between children with a gastrostomy versus NGT throughout BMT. METHODS: A prospective cohort study was conducted at a single centre in the United Kingdom. During pre-admission consultations families were offered choice of a prophylactic gastrostomy or NGT. Children undergoing allogeneic BMT were recruited from April 2021 to April 2022. Data compared between children with either tube included: tube complications, change in weight, body mass index and mid-upper-arm circumference, calorie, protein and fluid intake, timing and use of EN and parenteral nutrition, survival, graft-versus-host disease and length of admission. Following BMT, data were collected weekly for the first six weeks from electronic records, monthly thereafter from 3-day averaged food diaries and clinic assessments, until six months post-BMT. RESULTS: Nineteen children with NGT were compared to 24 with a gastrostomy. Of gastrostomy complications, 94.2% (129/137) were minor, mechanical issues being most common (80/137). Dislodgement comprised 80.2% (109/136) of NGT complications. No significant differences were seen between tubes on nutritional, anthropometric and clinical outcomes. CONCLUSIONS: Gastrostomies were popular with families, relatively safe, associated with mostly minor complications and similarly effective as NGTs in supporting children's nutritional intake and status. Where an NGT may not be tolerated, a prophylactic gastrostomy could be considered. Placement of either tube requires balancing their risks, benefits, the child's nutritional status, conditioning, expected duration of EN and family preferences.

An Empirical Study of Feedforward Control in Unplanned Extubation of Nasogastric Tube.

Objective: To explore the effect of feedforward control on reducing the incidence of unplanned extubation and improving the quality of catheter nursing. Methods: A total of 186 patients with nasogastric tube after gastrointestinal surgery in the eastern region of our hospital from September 2020 to September 2021 were selected as the control group; 186 patients with nasogastric tube after gastrointestinal surgery in the western region of our hospital at the same period were selected as the experimental group. The influencing factors of unplanned extubation in patients with long-term postoperative nasogastric tube were analyzed, and effective preoperative and postoperative health education was conducted. The ratio of unplanned extubation of nasogastric tube and nursing satisfaction of patients in the two groups were compared. Results: Patient constraint, perceived pressure score, anxiety score, nasal gastrointestinal canal health education feedback score and indwell tube comfort score were independent risk factors for unplanned extubation. The restraint rate and the incidence of unplanned extubation in the experimental group were lower than those in the control group after intervention, with statistical significance (P < 0.05). The nursing satisfaction of the experimental group was significantly higher than that of the control group after feedforward cognitive intervention. After intervention, serum albumin and gastric PH in the experimental group were significantly higher than those in the control group (P < 0.05). Conclusion: The safe nursing management method of feed forward control can effectively reduce the incidence of unplanned extubation in inpatients, which is worth further promoting in nursing work.

Management of small bowel obstruction and systematic review of treatment without nasogastric tube decompression.

Background: Small bowel obstruction (SBO) is common and its management has evolved in recent years. Study design: The literature describing adhesive small bowel obstruction (aSBO) treatment was reviewed, and a formal systematic review was performed to identify publications reporting results of aSBO treatment without NGTs. Results: The annual rate of hospital admission for SBO in the US has increased, with 340,100 admissions in 2019 alone. SBO is usually treated with bowel rest, intravenous hydration and NGT placement. In recent years, water soluble contrast (WSC) has been used as a cathartic to simulate bowel function and may reduce hospital length of stay (HLOS) by 1.95 days (95%CI 0.56-3.3). There were 3 articles of the initial 1650 screened that reported outcomes of SBO treatment without NGTs. These articles included 759 patients, of whom 272 (36%) with aSBO were managed successfully without NGTs. When comparing outcomes to patients who did receive NGT decompression, there were no significant differences in operative rates (28.6% v 16.5%, risk ratio 1.34, 95% CI 1.0, 1.8). Mortality and rates of bowel resection were also not affected by NGT decompression (risk ratio 1.98, 95% CI 0.43, 9.10 and risk ratio 1.56, 95% CI 0.92, 2.65, respectively). Conclusion: SBO is a common disease process with increasing annual incidence. Use of WSC stimulates the bowel and may reduce HLOS. Modern aSBO treatment protocols should include NGT decompression with consideration of WSC administration. Selection of patients for treatment without NGT decompression requires further investigation.