Nasogastric Tube Feeding Research Articles

Evaluation of early feeding through nasogastric tube in patients after cardiovascular surgery at the Hanoi Heart Hospital

Objectives: The goal of the study was to describle and understand the factors related to the nasogastric tube feeding in patients after cardio-vascular surgery. Methods: The study involved 100 consecutive patients who underwent cardio-vascular surgery at Hanoi Heart Hospital from April 1 to August 3, 2019..All subjects underwent assessed with the early feeding through nasogastric tube after 6 hours operation. Main results: The mean age of the patients was 54.4 ± 14.5 years old. The percentage of men were 48%, BMI <18.5 were 25%, used inotropic drug were 46% and sedative were 27%. The incidence of patients with abdominal distension and vomiting were 13%. No complications related to early feeding. Factors related to the residual index were sedation and duration of mechanical ventilation. Conclusion: Early nasogastric tube feeding in patients after cardiac and vascular surgery is safe, feasible and feasible.

Enteral Nutrition Support in Management of a Pediatric Patient with Secondary Acute Malnutrition and SARS-CoV-2 Infection : A Case Report

Severe acute malnutrition (SAM) contributes to about one million deaths annually in children under the age of 5 years. Secondary acute malnutrition is common in children with underlying medical conditions. It may pose a great risk in developing severe illness during SARS-CoV-2 infection among children. Proper implementation of nutrition care process is critical in management of secondary acute malnutrition among children in clinical settings. Eight months old male admitted with meningoencephalitis; septic shock, anemia, rickets, osteomyelitis, severe malnutrition and severe SARS-CoV-2 pneumonia complications. On admission, body temperature was 370C, random blood sugars were 17.5mmol/L and with saturation of 98% on room air. He had a body weight of 5.5kg on admission with a z-score of -3sd. Nutrition focused physical examination revealed severe loss of muscle mass and adipose tissue. Nutrition prescription of high calorie high protein diet providing 846 calories and 22.3 g of protein per day was prescribed. The feed of choice was fortified blended flour (FBF) porridge which was administered via nasogastric feeding tube. After fourteen days of nutrition care in the unit, the patient had a weight gain of 100g. The average weight gain rate was 1.29g/kg/day. This case report documents challenges in nutrition management of secondary acute malnutrition with SARS-CoV-2 pneumonia in resource limited clinical settings. The review of existing guidelines and disease specific nutrition commodities in the management of secondary acute malnutrition in clinical settings is recommended. Keywords: Enteral nutrition, Nutrition care process, Secondary acute malnutrition, SARS CoV2 infection, Covid19

Cost-effectiveness analysis of nasojejunal tube feeding for the prevention of pneumonia in adults who are critically ill.

Nasojejunal tube (NJT) feeding has demonstrated value in reducing pneumonia in adults who are critically ill who require enteral nutrition (EN) support. This study discusses whether EN support via NJT feeding is more cost-effective than nasogastric tube (NGT) feeding in reducing pneumonia. A decision-tree model was created. The analysis was based on data from a health care provider in China. Model inputs were derived from published data. The end points included incremental cost per pneumonia infection avoided, incremental cost-effectiveness ratio (ICER), net monetary benefit (NMB), and incremental NMB (INMB) associated with prevention of pneumonia. The uncertainty was assessed through one-way and probabilistic sensitivity analysis. The base case analysis showed that EN support via NJT feeding resulted in 0.7453 quality-adjusted life years (QALYs) at a cost of $3018.83 compared with NGT feeding, which resulted in 0.7354 QALYs at a cost of $4788.76. NJT feeding was better than NGT feeding, providing an INMB of $2075.09 and an ICER of -$178,813.96 per QALY gained, and the cost per pneumonia infection prevented was $16,808.51. The probabilistic sensitivity analysis indicated that NJT feeding was more cost-effective in 83.4% of the cases, with a cost below the WTP threshold. The NMB and INMB estimation for different WTP thresholds also indicated that NJT feeding is the optimal strategy. EN support via NJT feeding was a more cost-effective strategy than NGT feeding in preventing pneumonia in adults who are critically ill.

Predictors of weight restoration for nasogastric tube feeding in the treatment of children and adolescents with anorexia nervosa: an observational study

Rationale: The current guidelines recommend the use of nasogastric tube feeding (NGT) in the treatment of Anorexia Nervosa (AN) in child and adolescents, though the critical treatment elements promoting weight restoration are not widely known (1). Our study aims to investigate prognostic factors to affect weight recovery in child and adolescent hospitalized for AN, treated with NGT.

Clinical audit on nasogastric feeding technique in patients with acute cerebrovascular accidents in a tertiary care setting

Rationale: Although nasogastric (NG) tube feeding is an effective modality of short-term enteral nutrition administration in patients with acute cerebrovascular accidents (CVA), it is important to adhere to safe feeding practices to prevent potential adverse effects. This clinical audit is based on assessing NG feeding technique in a tertiary care hospital in Kandy, Sri Lanka among patients with acute CVA with the standard of ASPEN Safe Practices for Enteral Nutrition Therapy consensus recommendation 2017.

Development and validation of ester impregnated pH strips for locating nasogastric feeding tubes in the stomach\u2014a multicentre prospective diagnostic performance study

BackgroundNG (nasogastric) tubes are used worldwide as a means to provide enteral nutrition. Testing the pH of tube aspirates prior to feeding is commonly used to verify tube location before feeding or medication. A pH at or lower than 5.5 was taken as evidence for stomach intubation. However, the existing standard pH strips lack sensitivity, especially in patients receiving feeding and antacids medication. We developed and validated a first-generation ester-impregnated pH strip test to improve the accuracy towards gastric placements in adult population receiving routine NG-tube feeding. The sensitivity was improved by its augmentation with the action of human gastric lipase (HGL), an enzyme specific to the stomach.MethodsWe carried out a multi-centred, prospective, two-gate diagnostic accuracy study on patients who require routine NG-tube feeding in 10 NHS hospitals comparing the sensitivity of the novel pH strip to the standard pH test, using either chest X-rays or, in its absence, clinical observation of the absence of adverse events as the reference standard. We also tested the novel pH strips in lung aspirates from patients undergoing oesophageal cancer surgeries using visual inspection as the reference standard. We simulated health economics using a decision analytic model and carried out adoption studies to understand its route to commercialisation. The primary end point is the sensitivity of novel and standard pH tests at the recommended pH cut-off of 5.5.ResultsA total of 6400 ester-impregnated pH strips were prepared based on an ISO13485 quality management system. A total of 376 gastric samples were collected from adult patients in 10 NHS hospitals who were receiving routine NG-tube feeding. The sensitivities of the standard and novel pH tests were respectively 49.2% (95% CI 44.1‑54.3%) and 70.2% (95% CI 65.6‑74.8%) under pH cut-off of 5.5 and the novel test has a lung specificity of 89.5% (95% CI 79.6%, 99.4%). Our simulation showed that using the novel test can potentially save 132 unnecessary chest X-rays per check per every 1000 eligible patients, or direct savings of £4034 to the NHS.ConclusionsThe novel pH test correctly identified significantly more patients with tubes located inside the stomach compared to the standard pH test used widely by the NHS.Trial registrationhttp://www.isrctn.com/ISRCTN11170249, Registered 21 June 2017—retrospectively registered

Impact of nasogastric tube feeding on swallowing function in patients with dysphagia: a pilot study

During dysphagia treatment, direct oral swallowing therapy is applied to some patients temporarily fed via nasogastric tube. However, the risk of aspiration in oral swallowing while nasogastric tube in situ may be disregarded in a standard videofluoroscopic swallowing study performed without a nasogastric tube. To evaluate the diagnostic significance of nasogastric tube in situ videofluoroscopic swallowing study of nectar and pureed diet compared to the standard videofluoroscopic swallowing study without nasogastric tube. Videofluoroscopic swallowing study records of dysphagia patients conducted between June and August 2017 in a university hospital were collected for review. Rosenbek’s penetration-aspiration scale, diagnostic criteria of aspiration were used to define aspiration. videofluoroscopic dysphagia scale for videofluoroscopic swallowing study with or without nasogastric tube were compared for nectar and pureed diet swallowing. Patients had various duration of nasogastric tube feeding. Paired T-test comparing the videofluoroscopic dysphagia scales for videofluoroscopic swallowing study with or without nasogastric tube revealed significant aggravation of swallowing dysfunction in nectar drinking while nasogastric tube in situ. This aggravation was noted in 19% (n=4) of patients who suffered from stroke regardless of nasogastric tube duration. Nasogastric tube in situ videofluoroscopic swallowing study, at least of nectar drinking could be beneficial in selecting a safe candidate for direct oral swallowing therapy in conjunction with the conventional nasogastric tube removed videofluoroscopic swallowing study.

Análisis de factores predictivos en la aparición de fístulas faringocutáneas poslaringectomía total

Background: Pharyngocutaneous fistula is the most common complication after total laryngectomy. The factors associated with its development have been studied by several authors without conclusive results. Objective: To evaluate the causes for the development of PCF and to describe the risk factors associated with PCF in the population studied. Material and methods: We conducted a retrospective and observational study with statistical analysis of the variables. A total of 55 patients undergoing initial or salvage total laryngectomy from January 2000 to December 2019 were included. Male-to-female ratio was 48/7. Mean age was 61.3 years. The pathological diagnosis was epidermoid carcinoma in 96.36% of the cases. Statistical analysis: (chi square test and Mann-Whitney test) of the variables related with the development of pharyngocutaneous fistula. Results: The incidence of fistula in patients with laryngectomy was 20%. Spontaneous closure occurred in 72.73% and 3 patients (27.27%) required the use of flaps. In patients with fistula, 63.64% had previous radiotherapy. In these patients, the use of nasogastric tube feeding lasted > 15 days. Mean length of hospital stay in patients with fistula with 23 days. Conclusion: In our environment, previous radiotherapy was the most significant factor associated with the development of fistula. In these patients, fistula took longer to close and required more complex reconstructions in some cases.

Nasogastric enteral feeding tubes modulate preterm colonization in early life.

Preterm infants are generally fed through nasogastric enteral feeding tubes (NEFTs). The aim of this work was to evaluate the role of NEFTs in the initial colonization of the preterm gut and its evolution within the first 2 weeks after birth. For this purpose, fecal and NEFT-derived samples from 30 preterm infants hospitalized in a neonatal intensive care unit (NICU) were collected from birth to the second week of life. Samples were cultivated in ten culture media, including three for the isolation of antibiotic-resistant microorganisms. Isolates (561) were identified by 16S ribosomal RNA gene sequencing. Although the first NEFTs inserted into the neonates after birth were rarely colonized, analysis of NEFTs and fecal samples over time revealed a significant increase in bacterial abundance, diversity, and detection frequency. Results showed a parallel colonization between time-matched NEFTs and fecal samples, suggesting an ongoing bidirectional transfer of bacteria from the neonatal gut to the NEFTs and vice versa. In short-term hospitalization, length is by far the determinant factor for the early colonization of preterm infants. As NEFT populations reflect the bacterial populations that are colonizing the preterm in a precise moment, their knowledge could be useful to prevent the dissemination of antibiotic-resistant strains. The hospital environment modulates preterm colonization immediately after birth. The colonization of preterm feces and NEFTs occurs in parallel. There is an ongoing bidirectional transfer of microorganisms from the neonatal gut to the NEFTs and vice versa. Bacterial communities inside NEFTs could act as reservoirs of antibiotic resistance genes. NEFT populations reflect the bacteria that are colonizing the preterm at a precise moment.

The outcome and complications of total parenteral nutrition in pediatric hematopoietic stem cell transplantation.

Nutritional support posthematopoietic stem cell transplantation (HSCT) with total parenteral nutrition (TPN) or nasogastric tube feeding (NGT) in pediatric patients is associated with benefits and risks. We retrospectively reviewed the indication of TPN use in our pediatric HSCT patients and its impact on survival and possible related complications. A total of 228 HSCTs were performed during the study period. TPN was used in 144 patients (63.2%) for a median of 14days, while 8.8% had NGT feeding and 28% were able to tolerate oral feeding. Severe mucositis was seen in 104 TPN patients (72.2%) in comparison with 22 patients (26.2%) who were on Enteral Nutrition (EN) (p=<.001). Sinusoidal obstruction syndrome (SOS) was seen in 19 (13.2%) patients who had TPN compared to none in the patients who received EN (p=.001). The majority of patients who had SOS received myeloablative conditioning (MAC) therapy for hemoglobinopathy. Acute graft-versus-host disease (aGVHD) was seen in 24.8% of TPN patients and 9.1% of non-TPN patients (p=.01). However, there were no statistically significant differences in chronic GVHD, bacteremia, and patients' survival between both groups. TPN is commonly used after pediatric HSCT in cases of severe mucositis. NGT feeding was found to be the least used nutritional support method. SOS and aGVHD were associated more frequently in TPN patients compared to EN patients. This suggests the possible disadvantages of TPN and importance of SOS preventative measures in high-risk patients.

Factors Impacting Long-Term Gastrostomy Tube Dependence in Infants with Congenital Heart Disease

Infants with congenital heart disease (CHD) often experience oral feeding intolerance requiring gastrostomy (GT). Complications related to GT use are common. The study aim was to identify factors associated with continued GT use at one-year. A retrospective cohort study was performed at a tertiary children's hospital using the Society of Thoracic Surgeons database and patients' electronic medical record. Infants <1-year with CHD who underwent cardiac and GT surgery between January 2014-October 2019 were identified. Patient demographics, preoperative feeding, clinical variables, and GT use at one-year was evaluated. A separate cohort discharged with a nasogastric tube (NGT) was identified for longitudinal comparisons. Of 137 infants who received a GT, 115 (84%) continued using their GT at one-year. Factors associated with continued GT use included lower median percent of goal oral feeding before GT placement (0% IQR 0-6.5 versus 3.7% IQR 0-31), prolonged hospitalization after GT placement (36% versus 14%, P-value=0.048), and failure to take oral feeds at discharge (69% versus 27%, P-value <0.001). There was no difference in demographics or clinical comorbidities between groups. Clinic/emergency room visits for GT complications were common (72%). Eight infants discharged with a NGT did not require GT placement. Patients with CHD tolerating minimal oral nutrition before GT placement, prolonged hospitalization after GT, and difficulty with oral feeds at discharge were more likely to use their GT at 1-year. Outpatient NGT feeding is feasible for select infants with CHD. Efforts to optimize care for this complex, device-dependent population are warranted to minimize risks and facilitate family engagement for long-term care.

Can Videofluoroscopic Swallowing Kinematic Analysis Predict Recovery of Oral Intake in Postoperative Oral Cancer Patients Requiring Nasogastric Tube Feeding?

This retrospective study determined the significant predictive factors for the number of days required to remove nasogastric tubes (NGTs) after surgery in patients with oral cancer (OC). In this study, patients underwent a videofluoroscopic swallowing study (VFSS) approximately 2 weeks after surgery. Videofluoroscopic images were analyzed, and variables such as swallowing and swallowing kinematics were measured. Patient characteristics, swallowing kinematics, and swallowing results were assessed using a Cox proportional hazards model. This study assessed 129 participants (66 men, 63 women, mean age: 69.0 ± 14.1 years) with nine types of cancer. The Cox proportional hazard ratio revealed that sex, body mass index before surgery, radiotherapy and/or chemotherapy, dysphagia before surgery, normalized pharyngeal constriction ratio, upper esophageal sphincter (UES) opening, and laryngeal vestibule disclosure (LVC) disorder were predictive factors for the removal of NGTs when adjusted for age. The study identified several predictive factors for the removal of NGTs and oral intake recovery in patients with OC. Regarding swallowing kinematics, UES opening is the most significant predictive factor. After surgery for OC, VFSS should be performed to assess safe eating methods and predict the recovery of oral intake and removal of the NGT.

Association between teeth loss and nasogastric tube feeding dependency in older adults from Taiwan: a retrospective cohort study

BackgroundTo examine the association between teeth loss and nasogastric tube feeding dependency in older people.MethodsThe National Health Interview Survey (NHIS) 2005, 2009, and 2013 in Taiwan. Participants were selected by a multistage stratified sampling method and baseline characteristics, including socioeconomic status and health habits, were obtained by well-trained interviewers. The NHIS was linked with the National Health Insurance research database 2000–2016 and the National Deaths Dataset, which contains all the medical information of ambulatory and inpatient care. Cox regression was used to examine the association between the number of teeth lost and nasogastric tube feeding dependency.ResultsThere were 6165 adults older than 65 years old enrolled in the analysis, with 2959 male (48%) and the mean (SD) age was 73.95(6.46) years old. The mean follow-up duration was 6.5(3.3) years. Regarding the teeth loss categories, 1660 (26.93%), 2123 (34.44%), and 2382 (38.64%) of participants were categorized as having no teeth loss, loss of 1–9 teeth, and loss of 10–28 teeth, respectively. During 39,962 person-years of follow-up, new-onset nasogastric feeding dependency was recognized in 220(13.25%), 256(12.06%), and 461(19.35%) participants who were categorized as having no teeth loss, loss of 1–9 teeth, and loss of 10–28 teeth, respectively. Kaplan-Meier curves demonstrated significant findings (Log-rank P < 0.01). After potential confounders were adjusted, compared with those without teeth loss, older adults who had lost 10–28 teeth had significantly increased risks of occurrence nasogastric feeding dependency (AHR, 1.31; 95% CI, 1.05–1.62; p-value = 0.02). Furthermore, a significant dose-response relation between the number of teeth lost and increased risk of nasogastric feeding was found (p for trend< 0.01).ConclusionsOlder adults who had lost 10–28 teeth had a significantly increased risk of nasogastric tube feeding dependency. Early identification of the oral disease is crucial for the prevention of the occurrence of teeth loss and the following nutrition problems, which would reduce risk of nasogastric tube feeding dependency.

Evaluation of methods used to verify nasogastric feeding tube placement in hospitalized infants and children – A follow-up study

BackgroundNasogastric (NG) feeding tubes are used to deliver nutrition, hydration, and medications to hospitalized infants and children but the ongoing use of non-evidence-based practice (EBP) methods to confirm NG tube (NGT) placement has been associated with adverse patient events. MethodsA study was undertaken to ascertain if practice changes have occurred since findings from a previous study were published by the New Opportunities for Verification of Enteral tube Location (NOVEL) project. The NOVEL project was an initiative of the American Society of Parenteral and Enteral Nutrition (ASPEN). A survey was distributed to member organizations participating in the NOVEL project. Respondents were also asked if and when a change in practice occurred in the policy for NGT placement verification, if there was variation within the institutional units and if there were barriers to practice change. FindingsRespondents were primarily nurses (205/245) from 166 institutions that provided care to combined adult/pediatric/neonatal (122/166) patients. Respondents indicated a radiograph (64%) or pH measurement (24%) were best practice but in actual practice 42% use pH measurement and 23% use a radiograph to verify NGT placement. There was variability within institutions, with the Neonatal Intensive Care Unit (NICU) most often using aspiration and direct eye visualization to verify placement and the other units within the institutions using EBP method(s). DiscussionComparing these results to previous work by the NOVEL project shows an increase toward the use of EBP method(s) to verify NGT placement verification. Application to practiceThis study demonstrates variation within units at the same facility using methods unsupported by the literature, demonstrating that many centers still rely on non-EBP methods of NG placement confirmation, despite cautions issued by many major healthcare organizations.

Oncological and Functional Outcomes of Supracricoid Partial Laryngectomy

Objective: The aim of this study is to review the oncological outcomes of T1-T4 glottic or supraglottic tumor patients who underwent supracricoid partial laryngectomy in our clinic. Material and Methods: A total of 43 patients with laryngeal squamous cell carcinoma who underwent supracricoid partial laryngectomy between January 2014 and December 2016 in the Otorhinolaryngology Department of Istinye University Hospital were retrospectively analyzed. Postoperative data of these patients regarding surgical margin, nasogastric feeding tube removal time, decannulation time, postoperative radiotherapy, local regional recurrence, and distant metastases were recorded. Results: Cricohyoidoepiglotopexy was applied to 16 patients by preserving both arytenoids and applied to 7 patients with a single arytenoid; Cricohyoidopexy was applied to 14 patients with both arytenoids preserved, and 6 patients were treated with a single arytenoid. The five-year survival was compared for Cricohyoidopexy/Cricohyoidoepiglotopexy with single arytenoid to double arytenoid preservation and found to be 80%-76% (p=0.56). The mean 5-year survival was 88% in the post-operative radiotherapy group, and 86% in the non- radiotherapy group. The study compared patients with Cricohyoidopexy/Cricohyoidoepiglotopexy with a single arytenoid to those with double arytenoid preservation; the mean decannulation time was 54.23±34.12 to 35.62±27.08 (p=0.05). Postoperative radiotherapy prolonged the decannulation time (51.16±38.5 versus 32.68±20.1; p=0.043). The duration of nasogastric tube placement in the Cricohyoidopexy/Cricohyoidoepiglotopexy with a single arytenoid group was 50.3±14.3 and double arytenoid preservation was 35.17±32.9 (p=0.088). Nasogastric tube removal time was 53.29±50.2 in the post-operative radiotherapy group and was 30.24±16.8 in patients who did not receive post-operative radiotherapy (p=0.040). Conclusion: Supracricoid partial laryngectomy with Cricohyoidoepiglotopexy and Cricohyoidopexy had satisfactory oncological outcomes, and laryngeal function was preserved by rebuilding the neolarynx.

How to provide early enteral nutrition in the canine pancreatitis patient

This article provides a useful insight into the benefits of early enteral nutrition in canine pancreatitis patients. A brief explanation of the anatomy and physiology, followed by the pathophysiology, helps the reader understand the disease process. Feeding tubes are beneficial in anorexic patients and selecting a diet and calculating the resting energy requirements is an essential skill to practice to help prevent malnutrition. This article provides a practical step-by-step guide on how to place a nasogastric feeding tube in dogs, including how to clean and secure it in place. Owner education is essential in helping them understand the disease, manage chronic cases and prevent further flare ups in the future.

Is there a need for advance care planning in China?-an interview survey of healthcare professionals in the neurology department.

Family-oriented medical decision-making in China is founded on Confucian family-determination. The value and necessity of individual autonomy are marginalized in theory and practice. However, the dilemma in end-of-life (EOL) decision-making caused by the lack of advance care planning (ACP) has been increasingly concerned by the public. This study explores the value and necessity of ACP practice in China from the perspective of healthcare professionals (HCPs). We conducted semi-structured interviews with five neurological physicians and five neurological nurses from a Grade 3 Class A hospital in Beijing. The results showed that in situations with a poor prognosis, respondents tended to believe that as part of ACP regarding, a patient's right to refuse invasive treatments should be followed, although all ten interviewees agreed that nasogastric feeding tubes (NGTs) should be maintained. Factors influencing a families' considerations in EOL decision making included prognosis and age, prior similar experiences, others' moral judgement, and the advice of HCPs. Four respondents had experienced patients expressing their wishes for EOL treatments and reported some obstacles in considering these wishes. Seven respondents considered creating an ACP themselves, two respondents doubted it would work in practice, and one respondent thought it was unnecessary. The differences in the concept and practice of palliative care may be significantly related to the differences in the idea of ACP between Chinese and Western. The family-oriented decision-making model under Confucian culture cannot replace the ACP practice. Clinical situations and therapeutic measures that reveal the necessity and value of ACP should be the priority exploration to advance ACP practice. The practice of ACP and palliative care should be promoted simultaneously at the national level, and legislation for advance directives (ADs) is necessary for mainland China.

Unusual Mandibular Distraction Complication in Two Neonatal Pierre Robin Sequence Patients.

The Pierre Robin sequence (PRS) is characterized by the triad of micrognathia, glossoptosis, and airway obstruction. Conservative management in Pierre Robin sequence consists of nasogastric tube feeding and positioning of the neonate (prone or lateral position) that facilitates the anterior position of the tongue or the application of continuous positive nasal pressure. In case of failure of this treatment, emergency tracheostomy and/or mandibular distraction must be performed.Mandibular distraction is a standard technique used by craniofacial surgeons to achieve an anteroposterior horizontal lengthening of the mandibular body, correcting the posterior position of the base of the tongue and thus retropharyngeal enlargement of the airway.The authors present 2 clinical cases of hypertrophy of the sublingual salivary glands with the use of mandibular distractors in SPR patients with severe airway obstruction.

A Multidisciplinary Approach to the Reactive Placement of Nasogastric Feeding Tubes in Clinic During Treatment for Head and Neck Cancer

Radiation therapy (RT) associated oral mucositis, xerostomia and loss of taste may result in significantly compromised oral intake in patients undergoing treatment for head and neck cancers (HNC). We sought to determine if reactive nasogastric tube (NGT) placement was an effective strategy for nutritional support in these patients and if invasive percutaneous endoscopic gastrostomy (PEG) tube insertion could be avoided.This is an IRB- approved study of patients treated for HNC using definitive or adjuvant RT with or without concurrent chemotherapy between June 2017 and December 2020. We evaluated the indications for NGT (Dobhoff) placement, time of placement during the course of RT, patient tolerance of NGT and median duration of NGT placement. In addition, we followed weight loss during treatment, treatment interruptions, and treatment related toxicities. Complications associated with having the NGT, if the NGT needed to be replaced during treatment, and if the patient had any hospitalization during the course of treatment was tracked. The indication for NGT placement is weight loss > 10% of baseline during the course of treatment, most often due to dysphagia and/or odynophagia unrelieved by pain medication. NGT placement is done in the radiation oncology outpatient clinic by the attending physician and/or nurse practitioner.Of the 441 patients treated during the time period of this study, 47 required reactive NGT placement for nutritional support. Patients included 40 with primary oropharynx, 3 oral cavity, 2 larynx, 1 nasopharyngeal, and 1 unknown. Chemotherapy was given concurrently with radiation in 87.2% (41/47) patients. The median time of NGT placement was during week 5.0 of the 6-7-week course of RT. The median percentage weight loss from baseline to the date of NGT placement was 12.9%. The median duration of NGT placement was 29 days (range, 5 to 151 days). There were no serious medical complications associated with having the NGT in place during treatment. 27.6% (13/47) of patients had the NGT dislodged or displaced and needed replacement. 4.3% (2/47) of patients had the NGT replaced due to clogging. 38.3% (18/47) of patients with an NGT had to be hospitalized during the course of RT, with the predominant symptoms being failure to thrive 22.2% (4/18) and nausea/vomiting 22.2% (4/18). 6.4% (3/47) of patients requested removal of the NGT due to local irritation. 76.6% (36/47) of patients did not require further nutritional support with the placement of a percutaneous endoscopic gastrostomy (PEG) tube.This study indicates clinic placement of an NGT for patients receiving RT for head and neck cancer is a safe and effective way to maintain nutrition during treatment. The rate of weight loss decreased after the patient had an NGT placed. The placement procedure is well tolerated and there were no complications associated with having the NGT during treatment. PEG tube insertion was avoided in 76.6% of the patients.

Multichannel esophageal signals to monitor respiratory rate in preterm infants

BackgroundApnea of prematurity cannot be reliably measured with current monitoring techniques. Instead, indirect parameters such as oxygen desaturation or bradycardia are captured. We propose a Kalman filter-based detection of respiration activity and hence apnea using multichannel esophageal signals in neonatal intensive care unit patients.MethodsWe performed a single-center observational study with moderately preterm infants. Commercially available nasogastric feeding tubes containing multiple electrodes were used to capture signals with customized software. Multichannel esophageal raw signals were manually annotated, processed using extended Kalman filter, and compared with standard monitoring data including chest impedance to measure respiration activity.ResultsOut of a total of 405.4 h captured signals in 13 infants, 100 episodes of drop in oxygen saturation or heart rate were examined. Median (interquartile range) difference in respiratory rate was 0.04 (−2.45 to 1.48)/min between esophageal measurements annotated manually and with Kalman filter and −3.51 (−7.05 to −1.33)/min when compared to standard monitoring, suggesting an underestimation of respiratory rate when using the latter.ConclusionsKalman filter-based estimation of respiratory activity using multichannel esophageal signals is safe and feasible and results in respiratory rate closer to visual annotation than that derived from chest impedance of standard monitoring.