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Suzuki N. Nasogastric Tube Syndrome: A Case Report of Otalgia and Hoarseness in a Palliative Care Setting. J Pain Symptom Manage 2025; 69:e788-e792. [PMID: 40032034 DOI: 10.1016/j.jpainsymman.2025.02.470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2025] [Revised: 02/22/2025] [Accepted: 02/24/2025] [Indexed: 03/05/2025]
Abstract
BACKGROUND Nasogastric tube syndrome (NGTS) is a rare but potentially life-threatening complication of nasogastric tube (NGT) placement. It is characterized by throat pain, hoarseness, and vocal cord paralysis. Awareness is essential for preventing severe airway compromise. CASE PRESENTATION A 57-year-old woman with pseudomyxoma peritonei developed NGTS while admitted to a palliative care unit with a prolonged NGT placement for intestinal obstruction. The patient presented with symptoms including throat pain, otalgia, and subsequent hoarseness. Fiberoptic laryngoscopy revealed restricted vocal cord abduction and posterior pharyngeal erythema. Despite the option of removing the NGT, it was retained due to ongoing drainage needs and the absence of respiratory distress. Conservative management, including corticosteroids, antibiotics, and proton pump inhibitors, led to symptom resolution. CONCLUSION This case emphasizes the importance of recognizing NGTS, particularly in palliative care settings, and highlights the need for vigilance for atypical symptoms like otalgia. Conservative management may be effective in selected cases, underscoring the importance of individualized care and increased awareness among clinicians.
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Affiliation(s)
- Naoki Suzuki
- Department of Palliative Medicine, Yamagata Prefectural Central Hospital, Yamagata 990-2292, Japan.
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2
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Heise KM, Miller S, Ptok M, Jungheim M. [Prevalence of mucosal injuries during flexible endoscopic evaluation of swallowing in the presence of a nasogastric tube]. HNO 2024; 72:25-31. [PMID: 37796338 PMCID: PMC10781840 DOI: 10.1007/s00106-023-01361-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND The flexible endoscopic evaluation of swallowing (FEES) is an established low-risk examination method to assess the risk of penetration or aspiration in patients with dysphagia. FEES might be more difficult or of higher-risk when a nasogastric tube is in place. OBJECTIVE This study aims to identify whether the prevalence of mucosal lesions is higher when the endoscopy is carried out with a nasogastric tube in place. Pre-existing mucosal lesions were also documented. METHODS In a retrospective, monocentric study, a total of 918 FEES procedures routinely performed in hospitalized patients of a university hospital from January 2014 to March 2019 were evaluated. Mucosal lesions were identified and characterized for descriptive statistics. RESULTS In the video material analysed here, no endoscopy-related injuries were identified. However, pre-existing mucosal lesions, which often occurred as multiple lesions, were detected in 48.6% of the endoscopies. Further analysis showed that these pre-existing lesions were not worsened by the endoscopy performed. CONCLUSION The results demonstrate that transnasal flexible endoscopy is a safe, low-risk examination method, even in patients with a nasogastric tube. A very high number of pre-existing mucosal lesions were found, which is probably related to the previous insertion of the nasogastric tube. Due to the high number of pre-existing lesions, strategies should be developed to minimize injuries when placing nasogastric tubes.
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Affiliation(s)
- Kira-Milena Heise
- Klinik und Poliklinik für Phoniatrie und Pädaudiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - Simone Miller
- Klinik und Poliklinik für Phoniatrie und Pädaudiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
| | - Martin Ptok
- Klinik und Poliklinik für Phoniatrie und Pädaudiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - Michael Jungheim
- Klinik und Poliklinik für Phoniatrie und Pädaudiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
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Cui W, Xiang J, Deng X, Qin Z. Difficult tracheostomy decannulation related to nasogastric tube syndrome: A case report. Int J Surg Case Rep 2023; 110:108734. [PMID: 37660494 PMCID: PMC10509863 DOI: 10.1016/j.ijscr.2023.108734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/22/2023] [Accepted: 08/25/2023] [Indexed: 09/05/2023] Open
Abstract
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.
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Affiliation(s)
- Wei Cui
- Department of Spine, Sichuan Province Orthopedic Hospital, Chengdu 610041, China
| | - Jilin Xiang
- Anesthesiology Department, Sichuan Province Orthopedic Hospital, Chengdu 610041, China
| | - Xuangeng Deng
- Department of Spine, Sichuan Province Orthopedic Hospital, Chengdu 610041, China
| | - Zhijun Qin
- Intensive Care Unit, Sichuan Province Orthopedic Hospital, Chengdu 610041, China.
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Nihira T, Fukaguchi K, Taguchi A, Fukui H, Sekine I, Yamamoto D, Moriya H, Yamagami H. Bilateral vocal cord palsy induced by long-term use of small-bore nasogastric tube. Acute Med Surg 2023; 10:e872. [PMID: 37469376 PMCID: PMC10352541 DOI: 10.1002/ams2.872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/03/2023] [Accepted: 06/25/2023] [Indexed: 07/21/2023] Open
Abstract
Background Nasogastric tube syndrome is a rare but life-threatening complication of nasogastric tube placement due to acute upper airway obstruction caused by bilateral vocal cord paresis. Case Presentation An 86-year-old woman was brought to the emergency department with acute stridor. She had been diagnosed with stroke 106 days prior, and an 8F nasogastric tube was placed on the day following the diagnosis. A laryngeal fiberscopy revealed bilateral laryngeal edema and bilateral vocal cord palsy. Nasogastric tube removal and intubation were carried out, and the stridor disappeared. Two days later, a tracheostomy was performed. Unfortunately, the patient's vocal cord function had not improved at the 1 month follow-up upon assessment with a laryngeal fiberscope. Conclusion Long-term small-bore nasogastric tube placement can cause upper airway obstruction due to bilateral vocal cord palsy.
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Affiliation(s)
- Takashi Nihira
- Department of Emergency MedicineShonan Kamakura General HospitalKamakuraJapan
| | - Kiyomitsu Fukaguchi
- Department of Emergency MedicineShonan Kamakura General HospitalKamakuraJapan
| | - Azusa Taguchi
- Department of Emergency MedicineShonan Kamakura General HospitalKamakuraJapan
| | - Hiroyuki Fukui
- Department of Emergency MedicineShonan Kamakura General HospitalKamakuraJapan
| | - Ichiro Sekine
- Department of Emergency MedicineShonan Kamakura General HospitalKamakuraJapan
| | - Daisuke Yamamoto
- Department of NeurologyShonan Kamakura General HospitalKamakuraJapan
| | - Hidekazu Moriya
- Department of General Internal MedicineShonan Kamakura General HospitalKamakuraJapan
| | - Hiroshi Yamagami
- Department of Emergency MedicineShonan Kamakura General HospitalKamakuraJapan
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Singh A, Kumar P, Mahajan V, Ray A. Sofferman syndrome: A deadly outcome of an everyday procedurea. Indian J Anaesth 2021; 65:413-415. [PMID: 34211203 PMCID: PMC8202797 DOI: 10.4103/ija.ija_1305_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 10/23/2020] [Accepted: 12/21/2020] [Indexed: 11/04/2022] Open
Affiliation(s)
- Ajay Singh
- Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India
| | - Pankaj Kumar
- Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India
| | - Varun Mahajan
- Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India
| | - Ananya Ray
- Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India
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Motta APG, Rigobello MCG, Silveira RCDCP, Gimenes FRE. Nasogastric/nasoenteric tube-related adverse events: an integrative review. Rev Lat Am Enfermagem 2021; 29:e3400. [PMID: 33439952 PMCID: PMC7798396 DOI: 10.1590/1518-8345.3355.3400] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 07/23/2020] [Indexed: 12/23/2022] Open
Abstract
Objective: to analyze in the scientific literature the evidence on nasogastric/nasoenteric tube related adverse events in adult patients. Method: integrative literature review through the search of publications in journals indexed in PubMed/MEDLINE, CINAHL, LILACS, EMBASE and Scopus, and hand searching, was undertaken up to April 2017. Results: the sample consisted of 69 primary studies, mainly in English and published in the USA and UK. They were divided in two main categories and subcategories: the first category refers to Mechanical Adverse Events (respiratory complications; esophageal or pharyngeal complications; tube obstruction; intestinal perforation; intracranial perforation and unplanned tube removal) and the second alludes to Others (pressure injury related to fixation and misconnections). Death was reported in 16 articles. Conclusion: nasogastric/nasoenteric tube related adverse events are relatively common and the majority involved respiratory harm that resulted in increased hospitalization and/or death. The results may contribute to healthcare professionals, especially nurses, to develop an evidence-based guideline for insertion and correct positioning of bedside enteral tubes in adult patients.
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Affiliation(s)
- Ana Paula Gobbo Motta
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
| | - Mayara Carvalho Godinho Rigobello
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
| | | | - Fernanda Raphael Escobar Gimenes
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
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Zhukhovitskaya A, Weiland DJ, Goshtasbi K, Verma SP. Is nasogastric tube feeding necessary after hypopharyngeal diverticulum surgery? Am J Otolaryngol 2020; 41:102453. [PMID: 32199712 DOI: 10.1016/j.amjoto.2020.102453] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 03/05/2020] [Indexed: 01/18/2023]
Abstract
OBJECTIVES Nasogastric tubes (NGT) are often placed after surgery for cricopharyngeal muscle pathology due to risk of infection and mediastinitis. The aim of this study was to examine if this practice is necessary. METHODS A retrospective case series of subjects who underwent surgery for hypopharyngeal diverticula or cricopharyngeal bars from March 2011 to June 2018 was conducted. Demographic data, type of surgery, placement of feeding tube, initiation of oral feeding, and any complications were recorded. RESULTS Sixty-four surgeries were performed for Zenker's diverticula (ZD; N = 52), Killian-Jamieson diverticula (N = 2), and cricopharyngeal bar (N = 10). Mean age and ZD pouch size were 74.0 ± 10.6 years and 3.1 ± 1.8 cm, respectively. Procedures included 48 carbon dioxide laser-assisted myotomies, 14 open diverticulectomies, and 2 endoscopic stapler-assisted diverticulotomies. Of the 64 patients, 19 (29.7%) received intraoperative NGTs while the remaining 45 (70.3%) did not receive NGTs. The former cohort had the NGTs removed on post-operative day (POD) 4.5 ± 2.5, and the non-NGT cohort started clear liquid diet (CLD) on POD 1.2 ± 0.7 days, where 38 patients (84.4%) started CLD on POD 1, and 5 patients (7.8%) were started on oral diet on POD 2-4. Over time, fewer NGTs were placed and oral diets were started sooner. There were 5 complications occurring in 3 patients from the NGT cohort (15.5%) and 2 from the non-NGT cohort (4.4%). CONCLUSIONS Surgery for hypopharyngeal diverticula and CPB may not require routine perioperative NGT placement which can be associated with higher rates of complication. Patients can safely receive CLD on POD 1.
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Affiliation(s)
- Alisa Zhukhovitskaya
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, USA
| | - David J Weiland
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, USA
| | - Khodayar Goshtasbi
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, USA
| | - Sunil P Verma
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, USA.
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9
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Ueha R, Nito T, Goto T, Sato T, Ushiku T, Yamasoba T. Bilateral vocal cord immobility resulting from cytomegalovirus pharyngitis: A case report. J Infect Chemother 2017; 24:142-146. [PMID: 29054457 DOI: 10.1016/j.jiac.2017.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 09/07/2017] [Accepted: 09/15/2017] [Indexed: 10/18/2022]
Abstract
Human cytomegalovirus (CMV) is an infectious herpes virus present in approximately 50% of the world's population. Pharyngitis is an uncommon manifestation of CMV infection, and vocal cord immobility (VCI) following CMV pharyngitis is quite rare. An 83-year-old man with well-controlled diabetes mellitus and hypertension was admitted due to dyspnea, odynophagia, and dysphagia. Laryngeal fiberscopy revealed bilateral vocal cords almost fixed at the median position, with mucosal redness, swelling, and edema at the hypopharyngeal area. The airway was so narrowed that an emergency tracheostomy was performed to secure an airway. VCI resulting from a malignant tumor was suspected at first, but repeated pathological examinations revealed CMV infection in the pharyngeal mucosa. Despite intravenous ganciclovir treatment (5 mg/kg), the patient's bilateral VCI improved only slightly. Laryngeal electromyography was used to investigate the causes of VCI, and revealed vocal fold paralysis on the left side and cricoarytenoid joint fixation on the right side. This case highlights the importance of considering CMV infection in the differential diagnosis of patients with pharyngitis and VCI. To the best of our knowledge, this is the first case report describing the etiology of VCI following CMV pharyngitis using laryngeal electromyography.
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Affiliation(s)
- Rumi Ueha
- Department of Otolaryngology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655 Japan.
| | - Takaharu Nito
- Department of Otolaryngology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655 Japan
| | - Takao Goto
- Department of Otolaryngology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655 Japan
| | - Taku Sato
- Department of Otolaryngology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655 Japan
| | - Tetsuo Ushiku
- Department of Pathology and Diagnostic Pathology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Tatsuya Yamasoba
- Department of Otolaryngology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655 Japan
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10
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Sano N, Yamamoto M, Nagai K, Yamada K, Ohkohchi N. Nasogastric tube syndrome induced by an indwelling long intestinal tube. World J Gastroenterol 2016; 22:4057-4061. [PMID: 27099450 PMCID: PMC4823257 DOI: 10.3748/wjg.v22.i15.4057] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 10/14/2015] [Accepted: 12/30/2015] [Indexed: 02/06/2023] Open
Abstract
The nasogastric tube (NGT) has become a frequently used device to alleviate gastrointestinal symptoms. Nasogastric tube syndrome (NTS) is an uncommon but potentially life-threatening complication of an indwelling NGT. NTS is characterized by acute upper airway obstruction due to bilateral vocal cord paralysis. We report a case of a 76-year-old man with NTS, induced by an indwelling long intestinal tube. He was admitted to our hospital for treatment of sigmoid colon cancer. He underwent sigmoidectomy to release a bowel obstruction, and had a long intestinal tube inserted to decompress the intestinal tract. He presented acute dyspnea following prolonged intestinal intubation, and bronchoscopy showed bilateral vocal cord paralysis. The NGT was removed immediately, and tracheotomy was performed. The patient was finally discharged in a fully recovered state. NTS be considered in patients complaining of acute upper airway obstruction, not only with a NGT inserted but also with a long intestinal tube.
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11
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Kim T, Kim SM, Sohn SB, Lee YH, Lim SY, Sim JK. Nasogastric Tube Syndrome: Why Is It Important in the Intensive Care Unit? Korean J Crit Care Med 2015. [DOI: 10.4266/kjccm.2015.30.3.231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2022] Open
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12
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Sakurai K, Tanaka S, Yanagisawa T, Mori K, Horiuchi M, Hasegawa Y. [Life-threatening airway obstruction accompanied by vocal cord paralysis due to indwelling nasogastric tube in malnourished elderly patients: a report of four cases]. Rinsho Shinkeigaku 2015; 55:555-560. [PMID: 26050663 DOI: 10.5692/clinicalneurol.cn-000670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
We report 4 cases of elderly patients with abrupt onset of serious airway obstruction that is presumed to be due to indwelling nasogastric tube. 2 cases are patients of cerebral infarction and 2 cases are patients of Parkinson disease. The average number of days until NGTS is 17.8 days. In all cases, fiber-optic examination revealed complete loss of adduction in both vocal cords. Infection in the posterior cricoid region caused by ulcerative lesions at the upper end of the esophagus has been implicated as a pathophysiological mechanism of this syndrome, but it was not possible to confirm in the 4 cases. Because it is difficult to exactly diagnose with NGTS in clinical practice, there is a need to consider the inducing factor and response. Body mass index is very low in each of the 4 cases, ranging from 14.2 to 18.0, implying a severely malnourished or immunocompromised state, and may represent a high risk factor for this syndrome. Whenever this life-threatening syndrome is suspected, direct vocal cord examination and removal of the tube are recommended. In addition, the clinicians should not hesitate about doing intubation or tracheotomy in emergency.
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Affiliation(s)
- Kenzo Sakurai
- Department of Neurology, St. Marianna University School of Medicine
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Han Y, Qu XL, Fu H. Gastric cancer surgery without nasogastric decompression. Shijie Huaren Xiaohua Zazhi 2014; 22:4075-4080. [DOI: 10.11569/wcjd.v22.i27.4075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Nasogastric decompression (ND) has been used worldwide in gastric cancer surgery as a traditional way since Hunter pioneered. Most surgeons believe that using ND in abdominal surgery could relieve the internal pressure of anastomosis and reduce the incidence of anastomotic leakage. However, there has no strict scientific evidence for this obtained from medical studies, especially prospective studies. In recent years, several studies have shown that routine use of ND after surgery could not prevent anastomotic leakage or accelerate the recovery of bowel function, and surgery without ND did not increase the risk of anastomotic leakage. All kinds of gastric cancer surgery could be performed safely without ND, which greatly reduces the suffering of the patients, accelerates postoperative recovery, and reduces the workload significantly. If patients with pyloric obstruction or bleeding receive ND before surgery, nasogastric tube could be removed after they waked up. Gastric cancer surgery without ND is safe and deserves clinical popularization. This review summarizes the safety and significance of gastric cancer surgery without ND.
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Pollack AZ, Ward RF, DeRowe A, April MM. Iatrogenic velopharyngeal insufficiency caused by neonatal nasogastric feeding tube. Int J Pediatr Otorhinolaryngol 2014; 78:1410-2. [PMID: 24865808 DOI: 10.1016/j.ijporl.2014.04.051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Revised: 04/27/2014] [Accepted: 04/29/2014] [Indexed: 11/29/2022]
Abstract
Complications from a prolonged nasogastric tube intubation, though seldom reported, are well described. Herein we describe the first two reported cases of velopharyngeal insufficiency secondary to velopharyngeal scarring and immobility from repetitive nasogastric tube insertions and prolonged use. Differing only in location, the proposed pathophysiologic mechanism of injury is identical to that of the nasogastric tube syndrome, a rare and serious, well described entity consisting of bilateral vocal fold paralysis due to pressure-induced ulceration of the posterior cricoarytenoid musculature.
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Affiliation(s)
- Aron Z Pollack
- Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology, New York University School of Medicine, New York, NY, USA.
| | - Robert F Ward
- Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology, New York University School of Medicine, New York, NY, USA
| | - Ari DeRowe
- Pediatric Otolaryngology Unit, Department of Otolaryngology-Head and Neck Surgery, Dana Children's Hospital, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Max M April
- Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology, New York University School of Medicine, New York, NY, USA
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Harmon J, Balakrishnan K, de Alarcon A, Hart CK. The nasogastric tube syndrome in infants. Int J Pediatr Otorhinolaryngol 2014; 78:882-4. [PMID: 24725648 DOI: 10.1016/j.ijporl.2014.02.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 02/07/2014] [Accepted: 02/08/2014] [Indexed: 01/29/2023]
Abstract
This series of three patients is the first description of the presentation, clinical course, and endoscopic findings of nasogastric tube-related airway distress, or nasogastric tube syndrome, in infants. We identify key differences in disease features from those described in adults, based on our literature review. Specifically, infant nasogastric tube syndrome presented as significant respiratory distress and postcricoid inflammation without vocal fold immobility. Symptoms resolved more quickly (mean±SD, 2±1 days) than reported in adults. We suggest that nasogastric tube syndrome should be considered in infants with otherwise unexplained respiratory distress, even in the absence of impaired vocal fold mobility.
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Affiliation(s)
- Jeffrey Harmon
- University of Cincinnati College of Medicine, Office of Student Affairs, Medical Sciences Building E-251, PO Box 670552, Cincinnati, OH 45267, United States
| | - Karthik Balakrishnan
- Division of Pediatric Otolaryngology - Head & Neck Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC-2018, Cincinnati, OH 45229, United States.
| | - Alessandro de Alarcon
- Division of Pediatric Otolaryngology - Head & Neck Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC-2018, Cincinnati, OH 45229, United States; Department of Otolaryngology - Head & Neck Surgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way ML 0528, Cincinnati, OH 45267, United States
| | - Catherine K Hart
- Division of Pediatric Otolaryngology - Head & Neck Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC-2018, Cincinnati, OH 45229, United States; Department of Otolaryngology - Head & Neck Surgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way ML 0528, Cincinnati, OH 45267, United States
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Miller KR, McClave SA, Kiraly LN, Martindale RG, Benns MV. A Tutorial on Enteral Access in Adult Patients in the Hospitalized Setting. JPEN J Parenter Enteral Nutr 2014; 38:282-95. [DOI: 10.1177/0148607114522487] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Kitamura T, Yamamoto Y, Tomiyama Y, Yoshii T, Takenaka Y, Inohara H. [A case of laryngeal necrosis following concurrent chemoradiotherapy for advanced hypopharyngeal cancer after insertion of a nasogastric tube]. ACTA ACUST UNITED AC 2013; 116:1041-5. [PMID: 24191591 DOI: 10.3950/jibiinkoka.116.1041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
A 62-year-old male with cT4bN2cM0 hypopharyngeal carcinoma with ipsilateral vocal cord fixation was initially treated with concurrent chemoradiotherapy. Since the patient complained of dysphagia caused by mucositis, a nasogastric tube was placed on the day of irradiation with a dose of 20 Gy. Bilateral vocal cord fixation and laryngeal necrosis became evident 3 weeks after the concurrent chemoradiotherapy. He underwent a total pharyngolaryngectomy (neck dissection, and reconstruction with a free jejunal graft) followed by adjuvant chemotherapy. It is highly suspected that the nasogastric tube compressed the mucosa of the post cricoid region, resulting in laryngeal necrosis.
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Affiliation(s)
- Takahiro Kitamura
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, Suita
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Nanjegowda N, Umakanth S, Undrakonda V. Laryngospasm during extubation. Can nasogastric tube be the culprit? BMJ Case Rep 2013; 2013:bcr-2013-009645. [PMID: 23780769 DOI: 10.1136/bcr-2013-009645] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Nasogastric tube insertion is a common clinical procedure carried out both by doctors and other paramedical personnel. Misplacement of the nasogastric tube into the tracheobronchial tree is not uncommon. It can easily be detected in awake patients with intact cough reflex. Insertion of the nasogastric tube under general endotracheal anaesthesia can be difficult and when the misplacement is not promptly detected can result in unusual and disastrous complications. Laryngospasm is not uncommon in anaesthetic practice; however, reports of recurrent laryngospasm are very sparse. We report a case of misplaced nasogastric tube causing recurrent laryngospasm.
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Prabhakaran S, Doraiswamy VA, Nagaraja V, Cipolla J, Ofurum U, Evans DC, Lindsey DE, Seamon MJ, Kavuturu S, Gerlach AT, Jaik NP, Eiferman DS, Papadimos TJ, Adolph MD, Cook CH, Stawicki SPA. Nasoenteric Tube Complications. Scand J Surg 2012; 101:147-55. [DOI: 10.1177/145749691210100302] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The use of nasoenteric tubes (NETs) is ubiquitous, and clinicians often take their placement, function, and maintenance for granted. NETs are used for gastrointestinal decompression, enteral feeding, medication administration, naso-biliary drainage, and specialized indications such as upper gastrointestinal bleeding. Morbidity associated with NETETs is common, but frequently subtle, mandating high index of suspicion, clinical vigilance, and patient safety protocols. Common complications include sinusitis, sore throat and epistaxis. More serious complications include luminal perforation, pulmonary injury, aspiration, and intracranial placement. Frequent monitoring and continual re-review of the indications for continued use of any NETET is prudent, including consideration of changing goals of care. This manuscript reviews NET-related complications and associated topics.
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Affiliation(s)
- S. Prabhakaran
- University of North Dakota, Fargo, ND, U.S.A
- OPUS 12 Foundation Review Group, Plymouth Meeting, PA, U.S.A
| | - V. A. Doraiswamy
- University of Arizona, Tucson, AZ, U.S.A
- OPUS 12 Foundation Review Group, Plymouth Meeting, PA, U.S.A
| | - V. Nagaraja
- University of Arizona, Tucson, AZ, U.S.A
- OPUS 12 Foundation Review Group, Plymouth Meeting, PA, U.S.A
| | - J. Cipolla
- Temple St Luke's Medical School, Bethlehem, PA, U.S.A
- OPUS 12 Foundation Review Group, Plymouth Meeting, PA, U.S.A
| | - U. Ofurum
- Temple St Luke's Medical School, Bethlehem, PA, U.S.A
| | - D. C. Evans
- The Ohio State University Medical Center, Columbus, OH, U.S.A
- OPUS 12 Foundation Review Group, Plymouth Meeting, PA, U.S.A
| | - D. E. Lindsey
- The Ohio State University Medical Center, Columbus, OH, U.S.A
- OPUS 12 Foundation Review Group, Plymouth Meeting, PA, U.S.A
| | - M. J. Seamon
- Cooper University Hospital, Camden, NJ, U.S.A
- OPUS 12 Foundation Review Group, Plymouth Meeting, PA, U.S.A
| | - S. Kavuturu
- OPUS 12 Foundation Review Group, Plymouth Meeting, PA, U.S.A
| | - A. T. Gerlach
- The Ohio State University Medical Center, Columbus, OH, U.S.A
- OPUS 12 Foundation Review Group, Plymouth Meeting, PA, U.S.A
| | - N. P. Jaik
- Vanderbilt University Medical Center, Nashville, TN, U.S.A
- OPUS 12 Foundation Review Group, Plymouth Meeting, PA, U.S.A
| | - D. S. Eiferman
- The Ohio State University Medical Center, Columbus, OH, U.S.A
| | - T. J. Papadimos
- The Ohio State University Medical Center, Columbus, OH, U.S.A
- OPUS 12 Foundation Review Group, Plymouth Meeting, PA, U.S.A
| | - M. D. Adolph
- The Ohio State University Medical Center, Columbus, OH, U.S.A
- OPUS 12 Foundation Review Group, Plymouth Meeting, PA, U.S.A
| | - C. H. Cook
- The Ohio State University Medical Center, Columbus, OH, U.S.A
- OPUS 12 Foundation Review Group, Plymouth Meeting, PA, U.S.A
| | - S. P. A. Stawicki
- The Ohio State University Medical Center, Columbus, OH, U.S.A
- OPUS 12 Foundation Review Group, Plymouth Meeting, PA, U.S.A
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Kitagawa H, Imashuku Y, Yamazaki T. Pediatric airway scope is available for gastric tube insertion in adult patients. J Cardiothorac Vasc Anesth 2012; 26:e52. [PMID: 22560064 DOI: 10.1053/j.jvca.2012.03.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Indexed: 11/11/2022]
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Sparks DA, Chase DM, Coughlin LM, Perry E. Pulmonary Complications of 9931 Narrow-Bore Nasoenteric Tubes During Blind Placement. JPEN J Parenter Enteral Nutr 2011; 35:625-9. [DOI: 10.1177/0148607111413898] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
| | - Daniel M. Chase
- Department of Surgery, Hoopeston Community Memorial Hospital, Hoopeston, Illinois
| | - Lisa M. Coughlin
- Department of Surgery, Hoopeston Community Memorial Hospital, Hoopeston, Illinois
| | - Earnest Perry
- Department of Surgery, Hoopeston Community Memorial Hospital, Hoopeston, Illinois
- Deceased
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Koga Y, Mishima Y, Saho M, Ito A, Ito T, Hiraki T, Ushijima K. A case of serious laryngeal edema unpredictably detected during laryngoscopy for orotracheal intubation following induction of anesthesia. J Anesth 2011; 25:589-91. [PMID: 21533587 PMCID: PMC3152709 DOI: 10.1007/s00540-011-1150-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Accepted: 04/11/2011] [Indexed: 11/30/2022]
Abstract
We report a case of unpredictable and serious laryngeal edema probably caused by preoperative esophagogastroduodenoscopy (EGD). A 54-year-old man with type 2 diabetes mellitus was scheduled to undergo coronary artery bypass grafting (CABG). Two days before surgery, EGD was performed to explore the cause of occult bleeding, resulting in a slightly sore throat and an increased white blood cell count (18,300/μl). Without premedication, general anesthesia was uneventfully induced with intravenous midazolam (10 mg) and fentanyl (50 μg), followed by inhalation of sevoflurane (3%) and intravenous rocuronium (50 mg). Thereafter, manual ventilation was easily performed with a bag and mask. However, on laryngoscopy for orotracheal intubation, serious swelling with rubor and light pus in the epiglottis extending to the arytenoid cartilage was detected, leading to the cancellation of surgery. Immediately following intravenous drip of hydrocortisone (300 mg) and bolus of sugammadex (200 mg), the patient recovered smoothly from anesthesia without complications such as dyspnea, but his sore throat persisted. He was diagnosed with acute epiglottitis. Treatment consisted of intravenous cefazolin (2 g/day) and hydrocortisone (300 mg/day tapered to 100 mg/day) for 9 consecutive days. Consequently, the patient recovered gradually from the inflammation and underwent CABG as scheduled 28 days later. Anesthesiologists should be aware that EGD performed just before anesthesia could unpredictably cause acute epiglottitis, especially in immunocompromised patients, such as those with diabetes.
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Affiliation(s)
- Yukari Koga
- Department of Anesthesiology, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan
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Halloran O, Grecu B, Sinha A. Methods and complications of nasoenteral intubation. JPEN J Parenter Enteral Nutr 2010; 35:61-6. [PMID: 20978245 DOI: 10.1177/0148607110370976] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Nasoenteral intubation is among the most common procedures performed by clinicians across all medical specialties. The most common technique for nasoenteral intubation is blind passage, as it does not require the use of sophisticated or expensive medical equipment. Unfortunately, blind placement too frequently results in trauma and is a source of significant morbidity and mortality. It is apparent that altered mental status, a preexisting endotracheal tube, and critical illness put a patient in a higher risk group for malposition and complications. Nasoenteral intubation should be attempted only with an understanding of the possibility for difficult placement and the potential complications that can arise from trauma or malposition.
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Affiliation(s)
- Owen Halloran
- Johns Hopkins Bayview Medical Center, Baltimore, Maryland 21224, USA.
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Palamidessi N, Sinert R, Falzon L, Zehtabchi S. Nasogastric aspiration and lavage in emergency department patients with hematochezia or melena without hematemesis. Acad Emerg Med 2010; 17:126-32. [PMID: 20370741 DOI: 10.1111/j.1553-2712.2009.00609.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The utility of nasogastric aspiration and lavage in the emergency management of patients with melena or hematochezia without hematemesis is controversial. This evidence-based emergency medicine review evaluates the following question: does nasogastric aspiration and lavage in patients with melena or hematochezia and no hematemesis differentiate an upper from lower source of gastrointestinal (GI) bleeding? METHODS MEDLINE, EMBASE, the Cochrane Library, and other databases were searched. Studies were selected for inclusion in the review if the authors had performed nasogastric aspiration (with or without lavage) in all patients with hematochezia or melena and performed esophagogastroduodenal endoscopy (EGD) in all patients. Studies were excluded if they enrolled patients with history of esophageal varices or included patients with hematemesis or coffee ground emesis (unless the data for patients without hematemesis or coffee ground emesis could be separated out). The outcome was identifying upper GI hemorrhage (active bleeding or high-risk lesions potentially responsible for hemorrhage) and the rate of complications associated with the nasogastric tube insertion. Quality of the included studies was assessed using standard criteria for diagnostic accuracy studies. RESULTS Three retrospective studies met our inclusion and exclusion criteria. The prevalence of an upper GI source for patients with melena or hematochezia without hematemesis was 32% to 74%. According to the included studies, the diagnostic performance of the nasogastric aspiration and lavage for predicting upper GI bleeding is poor. The sensitivity of this test ranged from 42% to 84%, the specificity from 54% to 91%, and negative likelihood ratios from 0.62 to 0.20. Only one study reported the rate complications associated with nasogastric aspiration and lavage (1.6%). CONCLUSIONS Nasogastric aspiration, with or without lavage, has a low sensitivity and poor negative likelihood ratio, which limits its utility in ruling out an upper GI source of bleeding in patients with melena or hematochezia without hematemesis.
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Affiliation(s)
- Nicholas Palamidessi
- Department of Emergency Medicine, State University of New York, Downstate Medical Center, Brooklyn, New York, USA.
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An unusual case of airway obstruction at the tip of an endotracheal tube caused by insertion of a nasogastric tube. J Anesth 2008; 22:52-4. [PMID: 18306014 DOI: 10.1007/s00540-007-0563-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2007] [Accepted: 07/30/2007] [Indexed: 10/22/2022]
Abstract
We report an unusual case of ventilatory impediment caused by the obstruction of an endotracheal tube (ETT) by a nasogastric (NG) tube. A 72-year-old woman with bronchial asthma was scheduled for colostomy closure. An ETT of 7.5-mm internal diameter (ID) could not be advanced, and finally a 5.0-mm ID ETT was placed, because she had post-intubation tracheal stenosis. When an NG tube was inserted after endotracheal intubation, ventilation suddenly became nearly impossible. She was treated for an asthmatic attack, but her respiratory condition did not recover. We then exchanged the ETT for a laryngeal mask airway (LMA) and removed the NG tube. It was suspected that the cause of the airway obstruction was that the NG tube in the esophagus compressed the membranous portion of the stenotic trachea and the tip of the ETT was obstructed.
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Reddy VM, Sutton CD, Ubhi SS. Letter 1: Randomized clinical trial comparing feeding jejunostomy with nasoduodenal tube placement in patients undergoing oesophag- ectomy (Br J Surg 2007; 94: 31-35). Br J Surg 2007; 94:513; author reply 513-4. [PMID: 17385185 DOI: 10.1002/bjs.5841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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