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Miyamoto K, Takayasu H, Katsuki S, Maeda A, Suzuki K, Nakamura M, Hida N, Sambe T, Yagi M, Sasaki J, Hayashi M, Dohi K. Laryngopharyngeal Mucosal Injury Due to Nasogastric Tube Insertion during Cardiopulmonary Resuscitation: A Retrospective Cohort Study. J Clin Med 2024; 13:261. [PMID: 38202269 PMCID: PMC10780124 DOI: 10.3390/jcm13010261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 12/24/2023] [Accepted: 12/31/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Patients under cardiopulmonary resuscitation (CPR) are at high risk of aspirating gastric contents. Nasogastric tube insertion (NGTI) after tracheal intubation is usually performed blindly. This sometimes causes laryngopharyngeal mucosal injury (LPMI), leading to severe bleeding. This study clarified the incidence of LPMI due to blind NGTI during CPR. METHODS We retrospectively analyzed 84 patients presenting with cardiopulmonary arrest on arrival, categorized them into a Smooth group (Smooth; blind NGTI was possible within 2 min), and Difficult group (blind NGTI was not possible), and consequently performed video laryngoscope-assisted NGTI. The laryngopharyngeal mucosal condition was recorded using video laryngoscope. Success rates and insertion time for the Smooth group were calculated. Insertion number and LPMI scores were compared between the groups. Each regression line of outcome measurements was obtained using simple regression analysis. We also analyzed the causes of the Difficult group, using recorded video laryngoscope-assisted videos. RESULTS The success rate was 78.6% (66/84). NGTI time was 48.8 ± 4.0 s in the Smooth group. Insertion number and injury scores in the Smooth group were significantly lower than those in the Difficult group. The severity of LPMI increased with NGT insertion time and insertion number. CONCLUSIONS Whenever blind NGTI is difficult, switching to other methods is essential to prevent unnecessary persistence.
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Affiliation(s)
- Kazuyuki Miyamoto
- Department of Emergency, Critical care and Disaster Medicine, School of Medicine, Showa University, Hatanodai, Shinagawa-ku, Tokyo 1428666, Japan; (H.T.); (S.K.); (A.M.); (K.S.); (M.N.); (M.Y.); (J.S.); (M.H.); (K.D.)
- Department of Emergency, Critical care and Disaster Medicine, Showa University Fujigaoka Hospital, Fujigaoka Aoba-ku, Yokohama City 2278501, Japan
| | - Hiromi Takayasu
- Department of Emergency, Critical care and Disaster Medicine, School of Medicine, Showa University, Hatanodai, Shinagawa-ku, Tokyo 1428666, Japan; (H.T.); (S.K.); (A.M.); (K.S.); (M.N.); (M.Y.); (J.S.); (M.H.); (K.D.)
- Department of Emergency, Critical care and Disaster Medicine, Showa University Fujigaoka Hospital, Fujigaoka Aoba-ku, Yokohama City 2278501, Japan
| | - Shino Katsuki
- Department of Emergency, Critical care and Disaster Medicine, School of Medicine, Showa University, Hatanodai, Shinagawa-ku, Tokyo 1428666, Japan; (H.T.); (S.K.); (A.M.); (K.S.); (M.N.); (M.Y.); (J.S.); (M.H.); (K.D.)
- Department of Emergency, Critical care and Disaster Medicine, Showa University Fujigaoka Hospital, Fujigaoka Aoba-ku, Yokohama City 2278501, Japan
| | - Atsuo Maeda
- Department of Emergency, Critical care and Disaster Medicine, School of Medicine, Showa University, Hatanodai, Shinagawa-ku, Tokyo 1428666, Japan; (H.T.); (S.K.); (A.M.); (K.S.); (M.N.); (M.Y.); (J.S.); (M.H.); (K.D.)
- Department of Emergency, Critical care and Disaster Medicine, Showa University Fujigaoka Hospital, Fujigaoka Aoba-ku, Yokohama City 2278501, Japan
| | - Keisuke Suzuki
- Department of Emergency, Critical care and Disaster Medicine, School of Medicine, Showa University, Hatanodai, Shinagawa-ku, Tokyo 1428666, Japan; (H.T.); (S.K.); (A.M.); (K.S.); (M.N.); (M.Y.); (J.S.); (M.H.); (K.D.)
| | - Motoyasu Nakamura
- Department of Emergency, Critical care and Disaster Medicine, School of Medicine, Showa University, Hatanodai, Shinagawa-ku, Tokyo 1428666, Japan; (H.T.); (S.K.); (A.M.); (K.S.); (M.N.); (M.Y.); (J.S.); (M.H.); (K.D.)
| | - Noriko Hida
- Department of Clinical Pharmacy, Division of Clinical Research and Development, School of Pharmacy, Showa University, Kita-karasuyama, Setagaya-ku, Tokyo 1578577, Japan;
| | - Takehiko Sambe
- Department of Pharmacology, Clinical Pharmacology, School of Medicine, Showa University, Hatanodai, Shinagawa-ku, Tokyo 1428666, Japan;
| | - Masaharu Yagi
- Department of Emergency, Critical care and Disaster Medicine, School of Medicine, Showa University, Hatanodai, Shinagawa-ku, Tokyo 1428666, Japan; (H.T.); (S.K.); (A.M.); (K.S.); (M.N.); (M.Y.); (J.S.); (M.H.); (K.D.)
| | - Jun Sasaki
- Department of Emergency, Critical care and Disaster Medicine, School of Medicine, Showa University, Hatanodai, Shinagawa-ku, Tokyo 1428666, Japan; (H.T.); (S.K.); (A.M.); (K.S.); (M.N.); (M.Y.); (J.S.); (M.H.); (K.D.)
| | - Munetaka Hayashi
- Department of Emergency, Critical care and Disaster Medicine, School of Medicine, Showa University, Hatanodai, Shinagawa-ku, Tokyo 1428666, Japan; (H.T.); (S.K.); (A.M.); (K.S.); (M.N.); (M.Y.); (J.S.); (M.H.); (K.D.)
- Department of Emergency, Critical care and Disaster Medicine, Showa University Fujigaoka Hospital, Fujigaoka Aoba-ku, Yokohama City 2278501, Japan
| | - Kenji Dohi
- Department of Emergency, Critical care and Disaster Medicine, School of Medicine, Showa University, Hatanodai, Shinagawa-ku, Tokyo 1428666, Japan; (H.T.); (S.K.); (A.M.); (K.S.); (M.N.); (M.Y.); (J.S.); (M.H.); (K.D.)
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Cho A, Hong S, So J. Nasogastric tube insertion difficulty in a patient with a large goiter: A case report. J Int Med Res 2021; 48:300060520927875. [PMID: 32495658 PMCID: PMC7273570 DOI: 10.1177/0300060520927875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Airway management under anesthesia is given special attention in patients who have large goiters. Nasogastric tube insertion may be difficult in intubated patients with large goiters. Several methods have been proposed to facilitate the insertion of nasogastric tubes in patients with endotracheal intubation; however, a standard insertion method has not been established. A 33-year-old man was admitted to our otolaryngology department for right thyroid lobectomy to remove a larger goiter. A thyroid computed tomography scan revealed a huge cystic mass with tracheal displacement. Although difficult intubation was expected, endotracheal intubation was performed successfully. An anesthesiologist attempted nasogastric tube insertion via the right nostril; however, this was not successful. Next, an angiography catheter was placed in a nasogastric tube, and the nasogastric tube was gently inserted with the patient’s neck in mild flexion. This attempt also failed. Finally, the nasogastric tube was gently inserted via anterior displacement of the cricoid cartilage. The nasogastric tube advanced up to 60 cm. Surgery was performed, and the patient was discharged with no complications on postoperative day 8.
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Affiliation(s)
- Ana Cho
- Department of Anesthesiology & Pain Medicine, Soonchunhyang University Hospital Bucheon, Bucheon, Republic of Korea
| | - Seokhyung Hong
- Department of Anesthesiology & Pain Medicine, Soonchunhyang University Hospital Bucheon, Bucheon, Republic of Korea
| | - Jinyoung So
- Department of Anesthesiology & Pain Medicine, Soonchunhyang University Hospital Bucheon, Bucheon, Republic of Korea
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Kandeel A, Elmorhedi M, Abdalla U. Digital assistance of nasogastric tube insertion in intubated patients under general anesthesia: A single-blinded prospective randomized study. Saudi J Anaesth 2017; 11:283-286. [PMID: 28757827 PMCID: PMC5516489 DOI: 10.4103/sja.sja_524_16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background: Nasogastric tube (NGT) insertion may pose a special problem in patients under general anesthesia with first attempt failure rates up to 50%. To increase insertion success rate and decreases related complications, several techniques have been developed. In this study, digital assistance technique is compared to the classic insertion technique in neck flexion. Materials and Methods: In this prospective randomized study, 160 patients were randomly allocated into two groups; control group (Group C, n = 80) where NGT tube will be inserted with the neck in flexion position and digital facilitation group (Group D, n = 80). Results: Overall success rate and first attempt success were statistically higher in Group D compared to Group C (94% vs. 81%, P = 0.02, 80% vs. 62%, P = 0.01 respectively) with significantly lower insertion time in Group D (13 ± 5 s. vs. 10 ± 3 s., P = 0.00). Conclusions: Digital assistance of NGT insertion in the anesthetized or unconscious patient is an effective, fast, and safe method that can be either used as a routine technique or as a rescue in case of failed other methods.
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Affiliation(s)
- Alrefaey Kandeel
- Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Mansoura University, Egypt
| | - Mohammed Elmorhedi
- Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Mansoura University, Egypt
| | - Usama Abdalla
- Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Mansoura University, Egypt
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Long M, Machan M, Tollinche L. Intraoperative Gastric Tube Intubation: A Summary of Case Studies and Review of the Literature. ACTA ACUST UNITED AC 2017; 7:43-62. [PMID: 29780661 PMCID: PMC5954836 DOI: 10.4236/ojanes.2017.73005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Study Objective Establish complications and risk factors that are associated with blind tube insertion, evaluate the validity of correct placement verification methods, establish the rationales supporting its employment by anesthesia providers, and describe various deployment facilitators described in current literature. Measurements An exhaustive literature review of the databases Medline, CINAHL, Cochrane Collaboration, Scopus, and Google Scholar was performed applying the search terms “gastric tube”, “complications”, “decompression”, “blind insertion”, “perioperative”, “intraoperative” in various order sequences. A five-year limit was applied to limit the number and timeliness of articles selected. Main Results Patients are exposed to potentially serious morbidity and mortality from blindly inserted gastric tubes. Risk factors associated with malposition include blind insertion, the presence of endotracheal tubes, altered sensorium, and previous tube misplacements. Pulmonary aspiration risk prevention remains the only indication for anesthesia-related intraoperative use. There are no singularly effective tools that predict or verify the proper placement of blindly inserted gastric tubes. Current placement facilitation techniques are perpetuated through anecdotal experience and technique variability warrants further study. Conclusion In the absence of aspiration risk factors or the need for surgical decompression in ASA classification I & II patients, a moratorium should be instituted on the elective use of gastric tubes.
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Affiliation(s)
- Michael Long
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, USA.,Barry University, College of Health Sciences, Hollywood, USA
| | - Melissa Machan
- Barry University, College of Health Sciences, Hollywood, USA.,Department of Anesthesiology, Plantation General Hospital, Plantation, USA
| | - Luis Tollinche
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
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