A case of tracheal obstruction caused by reflux and aspiration of semi-solid nutrients via the nasogastric tube

Masatoshi Nakagawa,Kaori Sugihara,Kiyoshi Isobe,Masafumi Akasu,Kazutaka Tsujimoto,Yasuhiro Itsui,Yasuaki Nakajima

doi:10.1016/j.ijscr.2019.11.004

Masatoshi Nakagawa, Kaori Sugihara + Show 5 more

Open Access

https://doi.org/10.1016/j.ijscr.2019.11.004

Copy DOI

Abstract

IntroductionSemi-solid nutrients have several advantages, including reduced cases of diarrhea and aspiration pneumonia, and are usually administered via percutaneous endoscopic gastrostomy owing to its high viscosity. Administering semi-solid nutrients via a nasogastric tube was recently introduced in clinical practice; however, its safety has not been well confirmed. Presentation of caseAn 82-year-old man with a right occipital hemorrhage and severe diarrhea consulted the nutritional support team. Administrations of semi-solid nutrients (HINE E-GEL®) via the nasogastric tube was initiated, which gradually alleviated his symptoms. Fourteen days after initiation, he suddenly had pulmonary failure owing to a tracheal obstruction caused by the reflux and aspiration of semi-solid nutrients. Intubation and subsequent reflex cough expectorated sputum with gel-form particles, which quickly stabilized his pulmonary condition. After this, his hospital course was stable, and he was referred to another hospital for further rehabilitation. DiscussionSemi-solid nutrients administered via the nasogastric tube have different ingredients compared with those administered via percutaneous endoscopic gastrostomy. HINE E-GEL®, for example, contains pectin and calcium phosphate that changes from liquid to semi-solid inside the stomach via chemical reactions under acidic conditions. Data on the viscosity of HINE E-GEL® in vivo are insufficient. Uncertainty regarding the form and viscosity of HINE E-GEL® inside the stomach complicates clinical practice. ConclusionsAlthough semi-solid nutrients have several advantages, including reduced diarrhea and gastroesophageal reflux, evidence on semi-solid nutrients via the nasogastric tube is insufficient. It should be noted that semi-solid nutrient reflux can be more fatal than liquid nutrients.

Highlights

Semi-solid nutrients have several advantages, including reduced cases of diarrhea and aspiration pneumonia, and are usually administered via percutaneous endoscopic gastrostomy owing to its high viscosity
Semi-solid nutrients are usually given through percutaneous endoscopic gastrostomy (PEG), but it is unsuitable for nasogastric tube administration due to its high viscosity
On postoperative day (POD) 25, enteral nutrition was changed from semidigestive to semi-solid nutrients (HINE E-GEL®) to alleviate diarrhea

Summary

INTRODUCTION

Semi-solid nutrients have several advantages, including reduced cases of diarrhea and aspiration pneumonia, and are usually administered via percutaneous endoscopic gastrostomy owing to its high viscosity. Administering semi-solid nutrients via a nasogastric tube was recently introduced in clinical practice; its safety has not been well confirmed. Administrations of semi-solid nutrients (HINE E-GEL®) via the nasogastric tube was initiated, which gradually alleviated his symptoms. Intubation and subsequent reflex cough expectorated sputum with gel-form particles, which quickly stabilized his pulmonary condition. His hospital course was stable, and he was referred to another hospital for further rehabilitation. CONCLUSIONS: semi-solid nutrients have several advantages, including reduced diarrhea and gastroesophageal reflux, evidence on semi-solid nutrients via the nasogastric tube is insufficient. It should be noted that semi-solid nutrient reflux can be more fatal than liquid nutrients

Introduction

History of present illness and past medical history

Physical examination and laboratory data

Hospital course after NST consultation

Discussion

Ethical approval