Nasogastric Tube Feeding Research Articles

Nasogastric tube feeding under restraint: understanding the impact and improving care.

Nasogastric tube feeding under physical restraint is an intervention that clinicians working in specialist mental health in-patient units may need to implement. To examine the impact of this intervention on people with lived experience, carers and staff. People with lived experience and parents and/or carers were recruited via UK eating disorder charity Beat. Clinicians were recruited via the British Eating Disorders Society's research forum. Qualitative semi-structured interviews were conducted and transcribed, and the results were thematically analysed. Thirty-six participants took part, and overlapping themes were identified. All participants spoke in relation to four themes: (a) the short-term impact on the patient; (b) the impact on those around the patient; (c) the long-term impact; and (d) the positive impact. Subthemes were identified and explored. This lifesaving intervention can also negatively affect patients, parents and carers, peers and staff. Further research is needed to understand how interactions and environmental modifications can mitigate the negative impacts.

Remote monitoring for neonates requiring continued nasogastric tube feeding: implementation, patient characteristics, and early outcomes.

Our neonatal intensive care unit utilizes remote patient monitoring to facilitate hospital discharge with nasogastric tube (NGT) feeds. Program implementation, patient characteristics, and initial outcomes are described. Data was collected prospectively in this implementation study. Descriptive statistics define weight gain, number of NGT feed days, number of days on monitoring, and physician time spent. Patient characteristics, readmissions, and implementation details are described. One-hundred and four babies consented to and completed data collection. Average weight gain on monitoring was 31.4 g/day (SD 10.2). Eighty-nine babies (85.6%) achieved full oral feeds while on the program, requiring a median 5 NGT feed days (IQR 2-13) and a median 15 days on monitoring (IQR 11-27). Average physician time spent was 9.1 min per day (SD 3.7). Six babies (5.8%) had unscheduled readmissions while on the program. Remote monitoring programs can facilitate discharge for babies with continued NGT needs.

Evaluation of a novel platform for placement confirmation of enteral feeding tubes in adults

ObjectiveThe aim of this study was to validate the ability of a novel, impedance-based platform for nasogastric feeding tube (FT) insertion to correctly predict intragastric FT placement in healthy individuals with and without acid suppression medication. MethodsTen patients underwent successive placement of 8, 10, and 12 French FTs with the final intragastric position predicted using an impedance-based algorithm and verified with an abdominal x-ray. Study procedures were repeated after patients received a proton pump inhibitor (PPI) for 3 d. ResultsNasogastric FTs with embedded electrodes spaced along the distal 31 cm of the tubes were placed with the final insertion depth determined by an algorithm integrating impedance and other physiologic parameters. Sixty FT (30 pre-PPI and 30 post-PPI) insertions were performed. The algorithm-predicted location was confirmed as intragastric in all insertions by post-placement abdominal x-ray. For all tube sizes and those with and without PPIs, the impedance at electrodes within the esophagus was significantly higher than at electrodes in the stomach (P < 0.01). As a secondary objective to assess the use of gastric aspirate pH to determine location, gastric aspirate could only be obtained in 30% of insertions. The mean gastric pH was 6.9 (SD 0.6) in patients taking PPIs. ConclusionsA novel platform for real-time assistance with nasogastric FT placement confirmation correctly determined intragastric FT location as confirmed by abdominal x-ray (standard of care) in all 60 insertions. Gastric pH measurements were difficult to obtain and unreliable for intragastric FT placement confirmation in patients taking acid suppression medication.

Assessment of Readiness Toward Flipped Learning Among Novice Nursing Students on Fundamental Nursing Care in Puducherry, South India.

Background This study aimed to assess the readiness towardflipped learning (FL)among novice nursing students in fundamental nursing care in Puducherry, South India. Methodology A cross-sectional descriptive study was conducted among 176 first-year B.Sc. Nursing students from threeprivate nursing colleges by purposive sampling technique. In theory and practical classes, the students were taught fundamental nursing procedures such as oral medication, intramuscular injection, peripheral intravenous cannulation, and nasogastric tube feeding as FL. The study was conducted from November 2021 to March 2022. The responses were collected using the Nursing Students'Readiness for Flipped Classroom(NSR-FC) scale with four domains such as personal, technological, environmental, and pedagogical readiness. Pearson correlation and chi-square tests were used to analyze data by incorporating IBM SPSS Statistics for Windows, Version 25.0 (IBM Corp.,Armonk, NY, USA). Results Among 176 nursing students, 73.9% were aged between 17 and 19 years, the majority (76.7%) were females, and 98% of them used mobile phones to access online FL content. Of the novice nursing students, 69.88% agreed, 27.84% strongly agreed, and 2.27% were in a neutral state for readiness to adopt FL in their nursing curriculum with a mean (standard deviation, SD) value of 77.02 (6.27). Among the four domains of readiness, a positive correlation was found between personal with technological readiness (P= 0.001; r=0.446)and pedagogical with personal readiness (P= 0.003; r= 0.223).Statistically, a significant association was found between students' readiness towardFL with the occupation of the head of the family, gadgets used to access the FL materials, and Wi-Fi/internet availability in the institutions with a P-value <0.05. Conclusions The study showed highly positive readiness for FL among nursing students in nursing subjects. It can be leveraged with educational institutions' environmental and technological support by properly utilizing mobile devices, computer laboratories, and access to the internet/Wi-Fi for students from their entry level to enhance FL.

Transiting Back Home: Caregivers' Lived Experiences in Caring for Loved Ones on the Nasogastric Tube in the Home-Setting in Singapore.

Little is understood about caregivers' lived experiences when first caring for patients on the nasogastric tube at home in an Asian setting. To enhance understanding, our study aimed to chart these caregivers' psycho-emotional evolutions felt during such caregiving experiences in Singapore. Utilizing purposive sampling, a descriptive phenomenological study was performed, with semi-structured interviews of 10 caregivers of persons on nasogastric tube feeding conducted. Thematic analysis was utilized. Our findings chart four psycho-emotional transitions of a caregiver's journey in nasogastric tube feeding and the cultural dynamics involved-(a) Disruption of Caregivers' Normality: Attempting to Grasp Reality, (b) Encountering Road-Blocks: Despondency Arises and Frustrations Abound, (c) Adjusting to the New Normal: Reclaiming Confidence and Positivity, (d) Thriving and Integrating into the New Normal, and (e) Cultural Dynamics At Play. Our findings illuminate the understanding of caregivers' varying needs, guiding delivery of culturally-congruent caregiver support targeted at each psycho-emotional evolution.

Used Nasogastric Feeding Tubes from Neonates Contain Infant-Specific Bacterial Profiles.

Nasogastric feeding tubes (NG-tubes) from neonates contain potentially pathogenic bacteria. Using culture-based techniques, we have previously determined that the usage duration of NG-tubes did not impact the colonization of the nasogastric tubes. In the present study, we performed 16S rRNA gene amplicon sequencing to evaluate the microbial profile of 94 used nasogastric tubes collected from a single neonatal intensive care unit. Using culture-based whole genome sequencing, we as-sessed whether the same strain persisted in NG-tubes collected from the same neonate across different time-points. We found that the most commonly occurring Gram-negative bacteria were Enterobacteriaceae, Klebsiella and Serratia, while the most common Gram-positive bacteria were staphylococci and streptococci. The microbiota of the NG-feeding tube was overall infant-specific, rather than dependent on the duration of use. Furthermore, we determined that reoccurring species from the individual infant represented the same strain and that several strains were common for more than one infant. Our findings indicate that bacterial profiles found in NG-tubes of neonates are host-specific, not dependent on the duration of use and strongly influenced by the environment.

Advantages of nasogastric tube feeding during neoadjuvant concurrent chemoradiotherapy for esophageal cancer: A retrospective study

ObjectiveTo compare the effects of oral intake and nasogastric tube (NG) feeding on nutritional status, complications and survival during neoadjuvant chemoradiotherapy for esophageal squamous-cell carcinoma (ESCC) patients. MethodsA total of 61 ​ESCC cases treated with neoadjuvant chemoradiotherapy from December 2018 to March 2020 were enrolled, including (38 in oral intake group, and 22 in NG feeding group. Disease characteristics and baseline nutritional markers were collected in both groups. Nutritional status, complication and completion rate of chemoradiotherapy in both groups were evaluated. ResultsCompared with the oral intake group, patients in the NG feeding group had a later T stage (P ​= ​0.027) and clinical stage (P ​= ​0.014). The levels of energy intake (P ​= ​0.033), serum prealbumin (P ​< ​0.001), albumin (P ​= ​0.017) and hemoglobin (P ​= ​0.015) before treatment in NG group were significantly lower than those in oral intake group. Furthermore, patient-generated subjective global assessment (PG-SGA) score (P ​= ​0.016) and the levels of serum C-reactive protein (P ​= ​0.014) of NG feeding group were significantly higher than those of oral intake group. However, at the end of treatment, PG-SGA scores were increased in oral intake group and decreased in NG feeding group. In addition, the NG feeding group had a lower incidence of grade ≥2 esophagitis (P ​= ​0.037), and higher completion rate of chemotherapy compared with oral intake group (P ​= ​0.034). Meanwhile, the proportion of parenteral nutrition (P ​= ​0.008) and anti-inflammatory (P ​= ​0.022) treatment in NG feeding group was significantly lower than that in oral intake group. Although patients in the NG feeding group had a worse prognosis, there were no statistically significant differences in overall survival (OS) and progression-free survival (PFS) between the two groups (P ​> ​0.05). ConclusionsAs a safe and effective enteral nutrition approach to improving nutrition, nasogastric tube feeding could increase treatment completion rate and reduce the incidence of ≥ grade 2 esophagitis reaction during neoadjuvant chemoradiotherapy.

Nasogastric tube feeding improves nutritional status and physical state in esophageal cancer patients during chemoradiotherapy: a retrospective study

ObjectiveTo compare the complication rates, nutritional status, and physical state between esophageal cancer (EC) patients managed by nasogastric tube (NGT) feeding versus those managed by oral nutritional supplementation (ONS) during chemoradiotherapy.MethodsEC patients undergoing chemoradiotherapy managed by nonintravenous nutritional support in our institute were retrospectively recruited and divided into an NGT group and an ONS group based on the nutritional support method. The main outcomes, including complications, nutritional status, and physical state, were compared between groups.ResultsThe baseline characteristics of EC patients were comparable. There were no significant differences in the incidence of treatment interruption (13.04% vs. 14.71%, P = 0.82), death (2.17% vs. 0.00%, P = 0.84), or esophageal fistula (2.17% vs. 1.47%, P = 1.00) between the NGT group and ONS group. Body weight loss and decrease in albumin level were significantly lower in the NGT group than in the ONS group (both P < 0.05). EC patients in the NGT group had significantly lower Nutritional Risk Screening 2002 (NRS2002) and Patient-Generated Subjective Global Assessment (PG-SGA) scores and significantly higher Karnofsky Performance Status (KPS) scores than patients in the ONS group (all P < 0.05). The rates of grade > 2 esophagitis (10.00% vs. 27.59%, P = 0.03) and grade > 2 bone marrow suppression (10.00% vs. 32.76%, P = 0.01) were significantly lower in the NGT group than in the ONS group. There were no significant differences in the incidence of infection and upper gastrointestinal disorders or therapeutic efficacy between groups (all P > 0.05).ConclusionsEN through NGT feeding leads to significantly better nutritional status and physical state in EC patients during chemoradiotherapy than EN via ONS. NGT may also prevent myelosuppression and esophagitis..

Nasogastric tube feeding under physical restraint: comprehensive audit and case series across in-patient mental health units in England.

To identify the clinical characteristics of patients receiving nasogastric tube (NGT) feeding under physical restraint. Clinicians participated via professional networks and subsequent telephone contact. In addition to completing a survey, participants were invited to submit up to ten case studies. The survey response rate from in-patient units was 100% and 143 case studies were submitted. An estimated 622 patients received NGT feeding under restraint in England in 2020-2021. The most common diagnosis was anorexia nervosa (68.5-75.7%), with depression, anxiety and autism spectrum disorder the most frequent comorbidities. Patients receiving the intervention ranged from 11 to 60 years in age (mean 19.02 years). There was wide variation in duration of use, from once to daily for 312 weeks (mode 1 week; mean 29.1 weeks, s.d. = 50.8 weeks). NGT feeding under restraint is not uncommon in England, with variation in implementation. Further research is needed to understand how the high comorbidity and complexity contribute to initiation and termination of the intervention.

Effects of PEG in patients with esophageal squamous cell carcinoma during concurrent chemoradiotherapy: a prospective study

This prospective study aimed to compare the changes in nutritional status and adverse events among patients with esophageal squamous cell carcinoma who received enteral nutrition through oral intake, PEG, and an enteral nasogastric tube (NGT) during concurrent chemoradiotherapy (CCRT). Of 141 included patients, 38, 74, and 29 patients were fed through oral intake, PEG, and NGTs, respectively. The clinical characteristics and baseline nutritional status of the 3 groups were recorded and analyzed. The Patient-Generated Subjective Global Assessment score, skeletal muscle index, and quality of life were evaluated before and after CCRT; the incidence of adverse events during feeding using PEG and NGTs was also recorded. The correlations among the different nutritional pathways and the CCRT-related adverse events (eg, radiation esophagitis and myelosuppression) were assessed. At baseline, the oral intake group had a significantly better nutritional status and lower disease stage than those in the PEG and NGT groups. However, during CCRT, the oral intake group exhibited the most significant decreases in weight and skeletal muscle index. The synchronous chemotherapy completion rate was the highest in the PEG group. Multivariate analysis showed that the planning tumor volume and oral intake and NGT feeding pathways were associated with radiation esophagitis of at least grade2. We found that PEG effectively maintained the body weight and skeletal muscle index of patients with esophageal cancer during CCRT. PEG also improved the synchronous chemotherapy completion rate and reduced the occurrence of at least grade 2 radiation esophagitis. (Clinical trial registration number: NCT04199832.).

Detection of Complications Associated With Nasogastric Tube Feeding in Patients With Haemorrhagic Stroke in a Tertiary Hospital

Background: Stroke poses the greatest disease burden in hospital admission among the non communicable diseases (NCD’s). In majority of cases haemorrhagic stroke is the common neurological problem. Many of the patients develop swallowing difficulty and require nasogastric feeding for maintenance of nutrition. But this feeding can be a double-edged sword as it can lead to many complications due to various factors including errors in the feeding method, dislodgement of the tube and many other causes. Our intention was to look into this neglected part of clinical practice as this is mostly handled by internists. Objectives: To evaluate the complications of nasogastric tube feeding practice on haemorrhagic stroke patients. Materials and methods: One hundred (100) adult patients aged between 18- 70 years with haemorrhagic strokeas enrolled in the study. Haemorrhagic stroke was diagnosed by the clinical presentation, neuroimaging (CT scan/ MRI). Patients requiring nasogastric tube feeding were included in the study. They were systematically examined for any complications related to use of nasogastric tube. Their caregivers were also thoroughly interviewed using a standard pre formed questionnaire regarding any complications as well. All data were be collected by using a preformed data sheet and results were presented in standard method after statistical analysis. Results: Of the 100 patients studied, most common age group for stroke was 51-60 years (53%). Male to female ratio was 2.22:1. In this study population, 70% had intracerebral haemorrhage, 24% had Sub arachnoid haemorrhage and 6% had aneurysmal haemorrhage. The most common indication for NG feeding was difficulty in swallowing (39%). Other common indications were semi consciousness (26%), unconsciousness (22%), inability to maintain feed (10%). Around 71 % of the patients had complications from NG tube feeding. Out of them, 53% of the patients had nasal irritation where 63.15%was suffering from intracerebral haemorrhage, 31.57% and 5.26% were suffering from subarachnoid haemorrhagic and aneurysmal haemorrhage respectively. 40 % patients developed aspiration pneumonia, out of them 65.51%wasintracerebral haemorrhage, 31.03% was subarachnoid haemorrhagie ,3.44% was aneurysmal haemorrhage. 38% of the patients were developed diarrhea. Diarrhoea was reported by 66.66%, 29.62%, 3.70% in intracerebral haemorrhage, subarachnoid haemorrhagic and aneurysmal haemorrhage respectively. 53% had tube blockage, out of them intracerebral haemorrhage 71.05%, subarachnoid haemorrhage 23.68%, aneurysmal haemorrhage 2.63%. 43% of the patients had electrolyte imbalance, among them intracerebral haemorrhage 67.74% and subarachnoid haemorrhage 32.25%. Tube displacement was experienced by intracerebral haemorrhage 74.16%, subarachnoid haemorrhage 25.80% and 18% of the patients were malnourished. Conclusion: NG tube feeding is an integral part of management of stroke patients with feeding difficulties. But often it is associated with various complications which can increase the morbidities in stroke patients. J Dhaka Med Coll. 2022; 31(1) : 77-85

Video Conference Discharge Process for NICU Infants with Medical Complexity.

Purpose: Discharging infants from the NICU is complex, requiring the coordination of multiple aspects of care. Patient follow-up includes transferring medical care to primary care providers (PCP) who initially may have to rely on parents/caregivers for details about the child's history and current needs. Improving communication between the NICU and primary care offices within this pediatric health system was a goal of the organization, especially as value-based care was launched. Design: A pilot program was introduced in which families, PCP, and NICU providers for medically complex infants were offered the opportunity to participate in video conference calls. Sample: Infants selected for this pilot were those discharging from a Level IV NICU for the first time with medical complexity, such as those who would require care from multiple specialists, those with nasogastric feeding tubes, gastrostomy feeding tubes, and/or requiring oxygen post-discharge. The agenda during calls consisted of a review of the infant's birth, NICU course, and post-discharge needs. Participants were encouraged to provide detail and ask clarifying questions. Main Outcome Variable: Outcomes of this project included the evaluation of satisfaction with newer phone call methods for all participants and tracking readmission rates for those infants whose families experienced the video conference call. Results: High satisfaction levels were recorded among stakeholders as evidenced by 77 percent of parents and NICU providers being "very satisfied" or "completely satisfied" and 96 percent of primary care physicians being "very satisfied" or "completely satisfied." The rate of 30-day readmission for those who participated in the pilot was 23 percent and those readmissions were not unexpected. Conclusion: Involving families and accepting primary care physicians into the discharge communication are satisfying to stakeholders and allow participants the opportunity to have bidirectional conversations regarding the unique care needs of infants discharged from the NICU with special needs.

Factors Associated with In-Hospital Mortality in Elderly Internal Medicine Patients with Nasogastric Tube Feeding.

To evaluate demographic, clinical, and laboratory variables, and their associations with in-hospital mortality, among elderly internal medicine patients with nasogastric tube (NGT) feeding. Demographic, clinical, and laboratory data were collected retrospectively for 129 patients aged ≥80 years who initiated NGT feeding during their hospitalization in internal medicine wards. The data were compared between survivors and non-survivors. Multivariate logistic regressions were performed to identify the variables most significantly associated with in-hospital mortality. The in-hospital mortality rate was 60.5%. Compared to survivors, non-survivors more often presented with pressure sores (P=0.005) and lymphopenia (P<0.001), were more often treated with invasive mechanical ventilation (P<0.001), and less often underwent geriatric assessment (P<0.001). Non-survivors demonstrated higher mean levels of C-reactive protein, and lower mean values of serum cholesterol, triglycerides, total protein, and albumin (P<0.001 for all comparisons). On multivariate analysis, the following variables were most significantly associated with in-hospital mortality in the entire cohort: the presence of pressure sores (odds ratio [OR], 4.34; 95% confidence interval [CI], 1.68-11.48; P=0.003) and lymphopenia (OR, 4.09; 95% CI, 1.51-11.08; P=0.006), and serum cholesterol (OR, 0.98; 95% CI, 0.96-0.99; P=0.003). Among elderly acutely ill patients who initiated NGT feeding during hospitalization, in-hospital mortality was extremely high. The factors most strongly associated with in-hospital mortality were the presence of pressure sores and lymphopenia, and lower serum cholesterol levels. These findings may provide useful prognostic information for decision-making regarding initiation of NGT feeding in elderly hospitalized patients.

Intravenous Immunoglobulin Therapy for Autoimmune Dysautonomia in children: A Case Series (P10-5.013)

<h3>Objective:</h3> To assess the efficacy of intravenous immunoglobulin (IVIG) therapy in Autoimmune Dysautonomia <h3>Background:</h3> IVIG has been successfully used in the past for pain management and Autoimmune Gastric Dysmotility Disorder (AGID) of adult patients with suspected autoimmune etiology. However, the literature on efficacy of IVIG in children is scarce. <h3>Design/Methods:</h3> A retrospective review of AGID patients treated with IVIG was conducted. All symptoms were reviewed. <h3>Results:</h3> Patient 1 was positive for IgM TS-HDS Ab. Patients 2 and 3 were positive for Neuronal Acetylcholine Receptor Ganglionic (alpha-3) Ab. Patients 1 and 2 had Small Fiber Neuropathy diagnosis. Age at diagnosis of patients 1, 2, and 3 were 14, 17.25, and 16.5 years, respectively. Duration of treatment for patient 3 was 6 months, and 1 year for patients 1 and 2. Post treatment, patient 1 did not require venting of J tube; though still dependent on Total Parenteral Nutrition (TPN). Patient 1 is no longer dependent on enemas, as distal colonic and antroduodenal contractions have normalized. Esophageal dysmotility remains unchanged. Abdominal pain and distention, Postural Orthostatic Tachycardia Syndrome (POTS), and neuropathic pain improved. Patient 2 presented with intractable vomiting and POTS. She was dependent on Nasogastric tube (NG) feedings due to vomiting and was on cyproheptadine, erythromycin, bethanechol, amitriptyline, and prucalopride. Post treatment, vomiting resolved and all but prucalopride were discontinued. Colonic motility has not been re-assessed, however constipation, abdominal distention, and pain resolved. Polyethylene glycol and Bisacodyl were discontinued. Likewise, her POTS resolved. Patient 3 had hyperadrenergic POTS, persistent vomiting, and constipation, suffering a 4 kg weight loss. Following treatment, her vomiting and constipation improved, regaining 3.5 kg. Activity levels and orthostatic dizziness improved, and midodrine and fludrocortisone were discontinued. <h3>Conclusions:</h3> IVIG is an effective treatment for autoimmune dysautonomia in patients with positive IgM TS-HDS Ab and N-AchR Ganglionic (alpha-3) Ab. <b>Disclosure:</b> Mr. Bolufer has nothing to disclose. Dr. Prakash has nothing to disclose.

Parent experiences of a remote patient monitoring program enabling early discharge from the neonatal intensive care unit with nasogastric tube feeding.

This exploratory study examined parents' experiences with "Growing at Home" (G@H), a remote patient monitoring program for stable infants discharged from the Neonatal Intensive Care Unit (NICU) with continued need for nasogastric tube feeding. We used classical content analysis to identify and refine emergent themes from 13 semi-structured key informant interviews. The primary emergent theme was the desire to return to normalcy, which was expressed as a primary motivator for participating in G@H. Parents reported G@H assisted them in transitioning from the NICU's highly medicalized setting to establishing a new normal with incorporation of their infant into their lives and families. Parental preparation is important, as some parents experienced challenges that indicate the program may not be suitable for all families. Parental experiences offer insight into benefits and challenges of early discharge from the NICU and highlight opportunities to support families beginning in the NICU and as they transition home.

Nutrition nurse-led outpatient ‘hot’ clinics are efficient and cost-effective: a retrospective single-centre evaluation

Nutrition nurses work in multidisciplinary and nurse-led outpatient clinics. The daily nutrition nurse-led 'hot' clinic in this study sees patients for enteral or home parenteral nutritional support. Appointments may be for routine procedures or emergency reviews. This study aimed to identify activities and procedures performed in the nutrition nurse-led clinic, identifying admission avoidance activity. Nurse-held records for the period from April 2018 to March 2020 were reviewed retrospectively. Data were collated in an Excel spreadsheet for analysis and results are presented using descriptive statistics. Records covered a total of 590 patients, 294 men and 296 women with a median age of 59 years, and 606 procedures. Key activities were troubleshooting enteral feeding tubes (29%), insertion of fine-bore nasogastric feeding tubes (18%) and management of home parenteral nutrition issues (11%). The presenting problem or issue was resolved in 90% of patients, with no need for hospital admission or additional medical review. The nutrition nurse-led clinic provides an efficient and cost-effective service, preventing hospital admission and emergency department attendance in most cases.

Prevalence and Risk Factors of Enteral Feeding Intolerance in Critically Ill Patients and the Effectiveness of Preventive Treatments: A Prospective Study.

Feeding intolerance (FI) is a prevalent cause of enteral nutrition (EN) disruption. Factors that can prevent FI are poorly described. To determine the prevalence and risk factors associated with FI in critically ill patients and the effectiveness of preventive treatments. This prospective observational study included critically ill patients admitted to the ICU of a general hospital who received EN through a nasogastric or nasointestinal tube from March 2020 to October 2021. Independent sample t-test, repeated measurement analysis of variance, and multivariate analysis were used to explore independent risk factors and the efficacy of preventive treatments. The study included 200 critically ill patients (mean age: 59.1 ± 17.8 years), of whom 131 were male. Most patients (58.50%) developed FI after a median EN duration of 2 days. The independent risk factors for FI were fasting for >3 days, high APACHE II score, and acute gastrointestinal injury (AGI) grade I before EN (P < 0.05). During EN, whole protein was found to be an independent preventive treatment that significantly decreased FI (P < 0.05), while before EN, early use of enema and gastric motility drugs in patients with abdominal distention/constipation significantly decreased FI (for both, P < 0.05). The preventive treatment group had significantly higher intake of the nutrient solution and significantly shorter invasive mechanical ventilation duration than the without preventive treatment group (for both, P < 0.05). In ICU patients receiving nasogastric or nasointestinal tube feeding, FI was frequent, occurred early, and was more frequent in patients with fasting >3 days, a high APACHE II score, and an AGI grade before EN. Preventive treatments can reduce FI prevalence and result in patients consuming more nutrient solutions and having shorter invasive mechanical ventilation duration. ChiCTR-DOD-16008532.

Profiles of oral microbiome associated with nasogastric tube feeding

ABSTRACT Background Dysbiosis of oral microbiome causes chronic diseases including dental caries and periodontitis, which frequently affect older patient populations. Severely disabled individuals with impaired swallowing functions may require nutritional supply via nasogastric (NG) tubes, further impacting their oral condition and possibly microbial composition. However, little is known about the effect of NG tube on oral microbes and its potential ramification. Methods By using 16S rRNA amplicon sequencing, we characterized the tongue microbiome of 27 patients fed with NG tubes and 26 others fed orally. Results The microbial compositions of NG-tube and oral-feeding patients were substantially different, with more Gram-negative aerobes enriched in the presence of NG tube. Specifically, NG-tube patients presented more opportunistic pathogens like Pseudomonas and Corynebacterium associated with pneumonia and lower levels of commensal Streptococcus and Veillonella. Co-occurrence analysis further showed an inverse relationship between commensal and pathogenic species. Conclusion We present a systematic, high-throughput profiling of oral microbiome with regard to long-term NG tube feeding among the older patient population.

Why do we fear bottles and pacifiers?

Why do we fear bottles and pacifiers?

Methods Used in Confirmation of the Position of Nasogastric Feeding Tubes: Advantages and Limitations

Confirmation of the placement of the nasogastric tube is essential to ensure safe feeding without the risk of aspiration, pneumonia, and pneumothorax that may occur due to incorrect placement of the nasogastric tube. The risk of incorrect placement of the nasogastric tube may increase in the high-risk patient group, especially with some factors such as decreased consciousness, weak gag reflex, intubation, mechanical ventilation, and sedation. In addition to the problems that may occur during the initial placement of the nasogastric tube, displacement of the nasogastric tube may occur during the enteral feeding process. For this reason, tube placement should be checked regularly in order to minimize the complications of enteral nutrition. Although there are some advantages and limitations of the methods used to determine the location of the nasogastric tube, it is seen that there is no standard practice on this subject in clinics. The aim of this review is to summarize the commonly used methods for the initial placement of the nasogastric tube and the confirmation of the tube position during the feeding process and to summarize the advantages and limitations of these methods.