1153: BLIND NG TUBE INSERTION WITHIN 1 MINUTE OR 3 ATTEMPTS MINIMIZES MUCOSAL INJURY DURING RESUSCITATION

Abstract

Introduction: Patients under resuscitation are at high risk for aspiration of gastric contents which causes ventilator-associated pneumonia. Therefore, blind nasogastric (NG) insertion is performed for decompression, however minimal trauma to the laryngopharynx can sometimes lead to severe bleeding in patients with a bleeding diathesis. Recently, the usefulness of NG tube placement under the assistance of a Video-laryngoscope (VLS) has reported. However, NG tube insertion is still performed blind, and insertion techniques to minimize mucosal injury during resuscitation are not well understood. We investigated laryngopharyngeal mucosal injury associated with blind NG tube insertion during resuscitation and considered practical blind NG tube insertion guidelines to minimize mucosal injury. Methods: We included patients (n = 84) with cardio pulmonary arrest on arrival in whom blind nasogastric tube insertion was possible within 120 s in the Blind group and those in whom it was not possible in the Difficult (Dif) group. In the Dif group, VLS-assisted nasogastric tube insertion was performed. The laryngopharyngeal mucosal condition was recorded after NG tube insertion using VLS. Patient background, success rates, insertion time, the number of insertions, and injury scores were evaluated. A single regression analysis was performed, and practical blind NG tube parameters for insertion during resuscitation were assessed. Results: Success rates in the Blind and Dif groups were 98.5% and 76.5%, respectively, and insertion times were 48.8 ± 4.0 and 54.8 ± 3.0 s, respectively. The number of insertions (2.1 ± 0.2 vs. 8.1 ± 0.8) and injury scores (1.04 ± 0.21 vs. 6.40 ± 0.64) in the Blind group were significantly lower than those in the Dif group, respectively. Mucosal injuries were most severe in the retropharyngeal wall in both groups. The number of insertions and insertion time both showed strong positive correlations with injury scores. Conclusions: The severity of laryngopharyngeal mucosal injury increased with increased insertion time and the number of insertions. Blind nasogastric tube insertion performed within 1 min or for a maximum of two or three attempts may minimize laryngopharyngeal mucosal injury, and VLS-assisted insertion should be considered if these limits are exceeded.