Nasogastric Tube Insertion Research Articles

Delayed return of gastrointestinal function after hepatectomy in an ERAS program: incidence and risk factors.

Delayed return of gastrointestinal function (DGIF) after hepatectomy can involve increased morbidity and prolonged hospital stay. Yet, data on incidence and risks factors are lacking. All consecutive patients who underwent hepatectomy between June 2018 and December 2020 were included. All patients were included in an enhanced recovery after surgery (ERAS) program. DGIF was defined by the need for nasogastric tube (NGT) insertion after surgery. DGIF risk factors were identified. Overall, 206 patients underwent hepatectomy. DGIF occurred in 41 patients (19.9%) after a median time of 2 days (range, 1-14). Among them, 6 patients (14.6%) developed aspiration pneumonia, of which one required ICU for mechanical ventilation. DGIF developed along with an intraabdominal complication in 7 patients (biliary fistula, n=5; anastomotic fistula, n=1; adhesive small bowel obstruction, n=1). DGIF was associated with significantly increased severe morbidity rate (p=0.001), prolonged time to normal food intake (p<0.001) and hospital stay (p<0.001) and significantly decreased overall compliance rate (p=0.001). Independent risk factors of DGIF were age (p<0.001), vascular reconstruction (p=0.007), anaesthetic induction using volatiles (p=0.003) and epidural analgesia (p=0.004). Using these 4 variables, a simple DGIF risk score has been developed allowing patient stratification in low-, intermediate- and high-risk groups. DGIF after hepatectomy was frequently observed and significantly impacted postoperative outcomes. Identifying risk factors remains critical for preventing its occurrence.

Bowel stimulation before loop ileostomy closure to reduce postoperative ileus: a multicenter, single-blinded, randomized controlled trial

IntroductionThe objective of this study was to evaluate the impact of preoperative bowel stimulation on the development of postoperative ileus (POI) after loop ileostomy closure.MethodsThis was a multicenter, randomized controlled trial (NCT025596350) including adult (≥ 18 years old) patients who underwent elective loop ileostomy closure at 7 participating hospitals. Participants were randomly assigned (1:1) using a centralized computer-generated sequence with block randomization to either preoperative bowel stimulation or no stimulation (control group). Bowel stimulation consisted of 10 outpatient sessions within the 3 weeks prior to ileostomy closure and was performed by trained Enterostomal Therapy nurses. The primary outcome was POI, defined as an intolerance to oral food in the absence of clinical or radiological signs of obstruction, on or after postoperative day 3, that either (a) required nasogastric tube insertion; or (b) was associated with two of the following: nausea/vomiting, abdominal distension, or the absence of flatus.ResultsBetween January 2017 and November 2020, 101 patients were randomized, and 5 patients never underwent ileostomy closure; thus, 96 patients (47 stimulated vs. 49 control) were analyzed according to a modified intention-to-treat protocol. Baseline characteristics were well balanced in both groups. The incidence of POI was lower among patients randomized to stimulation (6.4% vs. 24.5%, p = 0.034; unadjusted RR: 0.26, 95% CI 0.078–0.87). Stimulated patients also had earlier median time to first flatus (2.0 days (1.0–2.0) vs. 2.0 days (2.0–3.0), p = 0.025), were more likely to pass flatus on postoperative day 1 (46.8% vs. 22.4%, p = 0.022), and had a shorter median postoperative hospital stay (3.0 days (2.0–3.5) vs. 4.0 days (2.0–6.0), p = 0.003).ConclusionsPreoperative bowel stimulation via the efferent limb of the ileostomy reduced POI after elective loop ileostomy closure.

Magnitude and Factors Associated with post-operative Sore Throat Among Adult Surgical Patients Undergoing General Anesthesia at a Tertiary Care Institution, Addis Ababa, Ethiopia

Background: Postoperative sore throat is a common postoperative complication of anesthesia. Complaints range from a minor self- limiting throat irritation to debilitating pain, inability to swallow for several days. Many factors can contribute to postoperative sore throat and the incidence has been found to vary with the method of airway management. Aim: The aim of this study was to determine magnitude and factors associated with post-operative sore throat among adult surgical patients who were operated under general anesthesia in a resource-limited setup at a tertiary care institution, Addis Ababa, Ethiopia. Materials and Methods: Hospital-based, cross-sectional study was conducted from August 1st to September 30th, 2021 in St. Paul's Hospital Millennium Medical Collage among 303 adult patients. Stratified random sampling technique was used to group surgical patients into departments then surgical patients were sampled from each department by using simple random sampling technique. For the study, data was collected using formatted questionnaire. Sore throat and it's severity was assessed and graded once patients were responsive, communicative and cooperative (within 2 hours) then at 6, 12, 24 and 48 hours of post operation. Severity was assessed using Numerical Rating Scale (NRS). Results: Out of 301 patients who had surgery with general anesthesia and completed 48 hours data collection, post-operative sore-throat was found in 48.5% of patients with variable severity. Approximately 71% of them developed post-operative sore-throat with in the first 2 hours of post-surgery. from the multivariate binary logistic regression analysis; Naso-gastric tube insertion , blood-stained tracheal tube on extubation , duration of anesthesia, for two to six hours and for greater than six hours, number of attempts at intubation for two attempts and no laryngoscopy were strongly associated and important predictors of post-operative sore-throat as compared to their counter-parts. Conclusion and Recommendations: Nearly half of surgical patients undergoing general anesthesia had post-operative sore-throat which is considerably high. It is recommended to give attention for patients undergoing long intubation hours (&gt;2 hours), NG tube inserted patients, multiple attempts at intubation and choice of air way equipment during General anesthesia.

Study on Influencing Factors Analysis of Gastric Tube Insertion Length and Construction of Estimation Method.

BackgroundInfluenced by individual differences, the depth of gastric tube placement is often different. Clinically, it is necessary to seek a simple and accurate gastric tube insertion scheme to improve the clinical efficacy of indwelling gastric tube.Materials and MethodsA total of 100 adult patients undergoing transesophageal manometry via nose were included in the study. The in vivo length (NCL) of apex-cardia was measured. At the same time, we entered our institutional database, summarized the clinical data of 100 patients, and analyzed the risk factors affecting NCL using stepwise regression analysis.ResultsThe NCL length scores of patients with different gender, age, marital status, height, weight, BMI, sitting height, sternum length, hairline-xiphoid process, nose tip-earlobe-xiphoid process and earlobe-xiphoid process were statistically significant (P < 0.05). Height, sitting height, gender, BMI and earlobe-xiphoid process were the factors that affected the NCL length score (P < 0.05). The prediction equation of the estimation method of gastric tube insertion length was as follows: NCL length score = 39.907 + 2.909× height +0.865× sitting height. Adjust R2 to 0.506. NCL was positively correlated with height and sitting height. Among them, the correlation with height (r = 0.711, P < 0.001) and sitting height (r = 0.397, P < 0.001).ConclusionHeight, sitting height, gender, BMI and earlobe-xiphoid process were the factors that affected the score of NCL length. There was a significant positive correlation between height, sitting height and NCL length. On this basis, the length of nasogastric tube insertion could be estimated.

Geriatricians' knowledge of terminal care in patients with advanced dementia

Objective: To learn about the disagreements among geriatricians from a Latin American country (Peru) as to the palliative therapy for dementia. Materials and methods: A descriptive and cross-sectional study. The population consisted of Peruvian geriatricians and geriatrics residents surveyed during August 2019. A non-probability convenience sampling was used. Considering a total population of 277 geriatricians in Peru and a design effect of 1.0, the minimum sample size was 162 geriatricians. The survey included different questions focused on geriatricians’ decisions on the daily clinical practice of terminal care in dementia. To ensure a better understanding of the answers, a typical case of the disease was presented. Results: One hundred sixty-two (162) doctors were surveyed, most of whom were geriatricians (81.48 %). Regarding the global level of attitudes and knowledge of palliative care, 89.61 % considered dementia as a non-oncological terminal illness, and 69.18 % considered laboratory sample collection, peripheral intravenous line insertion, urinary catheterization and nasogastric tube insertion as invasive measures. Conclusions: The survey showed a moderate level in attitudes and knowledge of palliative care. The weakest points were the practical perspective and suitability in decision-making. Therefore, training programs aimed at making adequate prognoses and improving decision-making of physicians involved in the care and support of older adults with late-stage dementia should be conducted to avoid implementing measures that will not generate a positive impact to and will harm the patient's quality of life.

Predicting 30-Day Readmission for Stroke Using Machine Learning Algorithms: A Prospective Cohort Study.

BackgroundMachine learning algorithms for predicting 30-day stroke readmission are rarely discussed. The aims of this study were to identify significant predictors of 30-day readmission after stroke and to compare prediction accuracy and area under the receiver operating characteristic (AUROC) curve in five models: artificial neural network (ANN), K nearest neighbor (KNN), random forest (RF), support vector machine (SVM), naive Bayes classifier (NBC), and Cox regression (COX) models.MethodsThe subjects of this prospective cohort study were 1,476 patients with a history of admission for stroke to one of six hospitals between March, 2014, and September, 2019. A training dataset (n = 1,033) was used for model development, and a testing dataset (n = 443) was used for internal validation. Another 167 patients with stroke recruited from October, to December, 2019, were enrolled in the dataset for external validation. A feature importance analysis was also performed to identify the significance of the selected input variables.ResultsFor predicting 30-day readmission after stroke, the ANN model had significantly (P < 0.001) higher performance indices compared to the other models. According to the ANN model results, the best predictor of 30-day readmission was PAC followed by nasogastric tube insertion and stroke type (P < 0.05). Using a machine learning ANN model to obtain an accurate estimate of 30-day readmission for stroke and to identify risk factors may improve the precision and efficacy of management for these patients.ConclusionUsing a machine-learning ANN model to obtain an accurate estimate of 30-day readmission for stroke and to identify risk factors may improve the precision and efficacy of management for these patients. For stroke patients who are candidates for PAC rehabilitation, these predictors have practical applications in educating patients in the expected course of recovery and health outcomes.

P1384: EFFECT OF NUTRITIONAL SUPPORT ON THE INCIDENCE OF MUCOSITIS IN AUTOLOGOUS HEMATOPOIETIC STEM CELL TRANSPLANTATION (AUTOHSCT) IN PATIENTS WITH HODGKIN’S LYMPHOMA. (INTERIM RESULTS)

Background: Correction of metabolic disorders is one of the important point’s supportive care during high-dosechemotherapy with autologous stem cell transplantation (autoHSCT) in patients with Hodgkin’s lymphoma (HL). The impact of nutritional support on recovery during autoHSCT for this group of patients is not clearly understood. To assess the effect of combined nutritional support on the frequency of mucositis, grade of mucositis, number of nasogastric tube in patients group, and frequency of blood transfusions during high-dose chemotherapy with autoHSCT in patients with HL. Aims: The study analyzed 68 patients with Hodgkin’s lymphoma who received high-dose chemotherapy with only parenteral nutritional support (NS) between 2013 and 2016 and 71 patients treated between 2016 and 2020 who received combined NS: combination of parenteral and enteral sipping nutrition. The primary endpoints were the frequency of mucositis, number of nasogastric tube in patients group. Methods: Group of patient without combined NS group received nutritional support using parenteral nutrition in case of a decrease in the level of total protein or albumin, which was assessed by a biochemical blood test. Patients in the combined nutritional support group received combined nutritional support with enteral sips in combination with parenteral nutrition, regardless of total protein and albumin levels. Results: The relative risk (RR) of developing stomatitis in the combined NS group was lower than in the group without combined NS: RR=0.67 (95% CI 0.49-0.92), p=0.015. Enteral nutritional support was associated with a reduced risk of stomatitis when adjusted for age, sex, and BMI: odds ratio (OR)=0.33, 95% CI 0.14-0.78, p=0.012. The RR of developing colitis in the combined NS group was lower: RR=0.58 (95% CI 0.36-0.94), p=0.026. Enteral nutritional support was associated with a reduced risk of colitis after adjusting for age, sex, and baseline BMI: OR=0.38, 95% CI 0.17-0.86, p=0.021. A nasogastric tube was placed statistically less frequently in the combined NS group: 3.0% (n=2) versus 19.6% (n=10), p=0.015. Enteral nutritional support was associated with a reduced frequency of nasogastric tube insertion when adjusted for age, sex, and baseline BMI: OR=0.16, 95%CI 0.03-0.83, p=0.029. In patients with an installed nasogastric tube, the duration of its stay did not statistically significantly differ between groups with and without combined NS: median 6 days (IQD: 4-8) vs. 5 days (IQD: 3-6), respectively (p=0.382). Summary/Conclusion: The data obtained show that combined nutritional support reduces the risk of mucositis, reduces the during frequency of nasogastric tube insertion autoHSCT in patients with Hodgkin’s lymphoma.

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Barriers and challenges to multiple-casualty management systems: a single-centre, cross-sectional study at the Nasser Medical Complex, Gaza Strip

BackgroundDuring a multiple-casualty incident, a large casualty caseload adversely affects the quality of care given to patients. From a trauma care perspective, the goal of the hospital emergency department plan is to simultaneously provide severely injured patients with a standard of care that approximates the care given to similar patients under normal conditions. This study highlights the barriers and challenges associated with implementing the emergency plans at the Nasser Medical Complex, Gaza Strip, occupied Palestinian territory, during a multiple-casualty incident, with the aim of facilitating appropriate staff training to address any deficiencies identified. MethodsA self-administered 70-item questionnaire reflecting the local major incident protocol (the Multiple Casualty Management System) was designed by the authors for completion by health-care staff. The questionnaire was divided into eight sections to assess knowledge and awareness and to specify deficiencies. Answers were analysed as frequencies and percentage points in terms of guideline adherence. Descriptive analysis were done on SPSS version 23. Findings70 questionnaires were completed by trauma team members (25 emergency doctors, 25 nurses, 15 surgeons, and five intensive care clinicians). The concepts of mass casualty and triage according to risk were understood by 40 (57%) of 70 participants, with most (65 ;93%) believing that the task of triage was to provide maximum care for the largest number of potential survivors. Only 50 (71%) reported competency in basic emergency skills like direct-current shock, chest tube insertion, cardiopulmonary resuscitation, nasogastric tube, and intravenous catheter insertion. Although 49 (70%) participants found the triage system very important, only 40 (57%) were able to apply it correctly. The biggest challenge was public acceptance of the concept of triage; only 5 (7%) participants believed that patients and relatives would accept a less urgent category. Furthermore, only 11 (16%) participants found that resources and equipment were adequate in case of mass casualty. Communication within the team was another struggle, with 45 participants were considering it unsatisfactory. However, 13 (19%) participants believed that the post-accident strategies with assessment plan to detect positive and negative points and clinical finding after the incident were satisfactory. Participants found the most important obstacles to efficient implementation of the emergency plan to be overcrowding in emergency department (63 [90%]), poor knowledge of the public regarding the importance of hospital triaging (59 [84%]), shortage of medical staff (57 [81%]), scarcity of resources (52 [74%]), ineffective security (52 [74%]), and insufficient staff training (41 [59%]). We also noticed that nearly all the emergency doctors were general practitioners without any specialised training. An emergency residency programme was started after the conclusion of this study, but results on the effects on multiple-casualty incident management are not yet available. InterpretationThis small study identified areas of weakness in the Multiple Casualty Management System, some due to poor resources and others to poor communication within the team or with the public. One important factor identified was the unawareness of the public of the importance of effective triage in this situation. Therefore, these areas should be addressed by staff feedback and training and by public awareness campaigns on the avoidance of overcrowding, the importance of non-threatening behaviour, and the purpose of triage in emergency department. Such interventions might also lead to improvement in day-to-day work at the emergency department, even outside the context of mass incidents. FundingNone.

Gastric Fluid Volume in Patients Fasting for Clear Fluid Ingestion from Midnight Versus 2 Hours Prior Laparoscopic Cholecystectomy

Objective: To assess the mean gastric fluid volume in the group ingesting clear fluid 8 hours prior to surgery (8-hour group) in comparison to the group ingesting clear liquid 2 hours prior to surgery (2-hour group) Study Design: Randomized controlled trial Place and Duration of Study: Department of Anesthesiology, The Indus Hospital, Karachi from 30th June 2016to 20th May 2017. Methodology: Sixty eligible patients were identified in the preoperative visit and all study detail was discussed with the patients and informed consent was obtained. Patients were divided two equal groups through randomization i.e. 2 hours fasting prior to surgery versus 8 hours fasting prior to surgery. The insertion of nasogastric tube is required in all laparoscopic cholecystectomies to deflate the stomach, not only to improve surgical view but also to avoid gastric injury on trocar insertion. Aspirate from stomach was through 20ml syringe. Volume of aspirate was also noted. Results: Mean age in 2 hours fasting prior to surgery and 8 hours fasting prior to surgery was 36.20±10.14 with CI (32.41-39.98) and 38.90±10.27 with C.I (35.06-42.73) years respectively. Five (16.7%) male and 25 (83.3%) female was enrolled in 2 hours fasting prior to surgery group and 6 (20.0%) male and 24 (80.0%) female were included in 8 hours fasting prior to surgery group. In comparison of both groups, mean of 2 hours prior to surgery group was 11.53±3.68 and in 8 hours prior to surgery group was 13.66±5.32 and P value found to be non-significant (p=0.076). Conclusion: There was no significant difference in mean gastric fluid volume between the group ingesting clear fluid 8 hours prior to surgery (8-hour group) in comparison to the group ingesting clear liquid 2 hours prior to surgery (2-hour group). Keywords: Gastric fluid, Preoperative fasting, Cholecystectomy

Delayed tension gastrothorax caused necrosis of stomach and re-expansion pulmonary edema: a case report

BackgroundTraumatic tension gastrothorax is a rare and potentially fatal condition occurring in patients with congenital or acquired diaphragmatic defects. Traumatic tension gastrothorax leads to acute and severe respiratory distress. Delayed tension gastrothorax that develops late during injury can be more severe.Case presentationAn 84-year-old woman was brought to our facility with cardiac arrest and returned to spontaneous circulation after 2 min of cardiopulmonary resuscitation. Computed tomography showed diaphragmatic injury and tension gastrothorax due to trauma because of a fall episode few days earlier. Emergency thoracotomy and laparotomy was performed, because nasogastric tube insertion failed. There was a partially necrotic stomach in the chest cavity. The stomach was retracted from the thoracic cavity into the abdominal cavity and placed in its proper position. There was a 5 cm tear of the diaphragm. The tear was sutured and closed and then the necrotic area of the stomach was resected. Although the surgery relieved the intrathoracic compression, it resulted in re-expansion pulmonary edema immediately after surgery and hypoxemia. The patient was unable to overcome the hypoxemic state and eventually died.ConclusionsDelayed tension gastrothorax can lead not only to obstructive shock due to intrathoracic compression but also to more severe organ ischemia and re-expansion pulmonary edema due to insufflation.

Laparoscopic surgery reduced frequency of postoperative small bowel obstruction, and hospital stay compared with open surgery in a cohort of patients with colorectal cancer: a propensity score matching analysis.

Laparoscopic surgery (LS) is reported to reduce postoperative complications and hospital stay compared with open surgery (OP). Because patient selection may have been biased in previous studies, propensity score matching (PSM) analysis was used in this study to test the benefits of LS compared with OP. A total of 759 patients with stage I-III colorectal cancer undergoing curative surgery were retrospectively reviewed. To minimize confounding bias between LS and OP groups, a 1:1 PSM analysis was performed based on adjuvant chemotherapy, age, albumin, body mass index, American Society of Anesthesiologists physical status depth of tumor, gender, lymph node dissection, maximum tumor size, obstructive tumor, previous abdominal surgery, pathological stage, tumor differentiation, and tumor location. Statistical analyses including chi-square test, Mann-Whitney U test, univariate analyses and Kaplan-Meier method and log-rank test were performed using the data after PSM to investigate the benefits of LS compared with OP. After PSM analysis, 460 patients remained in the study. The LS group had lower intraoperative blood loss (34 ± 70 vs 237 ± 391, mL; P < 0.001), lower frequency of postoperative small bowel obstruction (SBO) (17/213 vs 30/230; P = 0.045), lower rate of nasogastric tube insertion (7/223 vs 17/213; P = 0.036), and shorter postoperative hospital stay (13 ± 10 vs 25 ± 47, day; P < 0.001) than the OP group. Univariate analyses showed that LS significantly reduced the risk of postoperative SBO (odds ratio [OR] 0.532; 95% confidence interval [CI] 0.285-0.995; P = 0.048) and nasogastric tube insertion (OR 0.393; 95% CI 0.160-0.967; P = 0.042) compared with OP. There were no significant differences in OS and RFS between the groups. LS reduced intraoperative blood loss, frequency of postoperative SBO, rate of nasogastric tube insertion, and postoperative hospital stay compared with OP.

A Study to Assess the Effectiveness of Structured Teaching Programme on Knowledge and Practice of Nasogastric Tube Feeding to Adult Patient among Nursing Personnel Working in Selected Hospitals, Bangalore

Administration of nutrients directly into the stomach, duodenum, or jejunum through a tube is more physiologically beneficial and cost effective than parenteral feeding. In the hospital settings, most of the critically ill patients are on naso gastric tube feeding to meet their nutritional needs. The unhygienic practices and improper insertion of naso gastric tube by the nursing personnel’s increases the risk of infection and other health hazards. Nursing practice still needs to understand how modern technology and instrumental device in naso gastric tube feeding works. Though the nursing personnel are handling the procedure with knowledge and skills, the exciting condition of the patient cannot be satisfied due to the misplacement of the tube. Hence the researcher conducted “A study to assess the effectiveness of structured teaching programme on knowledge and practice of Naso gastric tube feeding to adult patient among nursing personnel” working in selected hospitals, Bangalore. A quantitative research approach and Non probability convenient sampling technique was used. The sample was selected by using simple random technique was used to select 50 nursing personnel working in selected hospital, Bangalore. Structured questionnaire was used to assess the levels of knowledge and practice. Descriptive and inferential statistics were used for analysis and interpretation of data. Effectiveness of Structured teaching programme on the levels of knowledge and practice regarding Naso gastric tube feeding among nursing personnel was assessed by using Paired ‘t’test. Association between pretest knowledge level with the selected demographic variables was analyzed using Chi-square test. Keywords: Naso gastric tube feeding, Nursing personnel, adult patient.

Effect of prophylactic gastrostomy on nutritional and clinical outcomes in patients with head and neck cancer.

We aimed to identify which enteral feeding method was most beneficial for patients and compare clinical outcomes, quality of life, and complication rates by assessing patients who underwent prophylactic percutaneous endoscopic gastrostomy (pPEG) tube, reactive percutaneous endoscopic gastrostomy (rPEG) tube or reactive nasogastric tube (rNGT) insertion. Patients with head and neck cancers (HNCs) were enrolled between April 1, 2013 and April 17, 2019 (n = 335; 296 males, 39 females). Data concerning patient characteristics and treatment modalities were extracted from the medical records. Comparisons between enteral feeding methods were made by univariate and multivariate analysis. Overall survival (OS) outcomes were analyzed by the log rank test using the Kaplan-Meier method. A total of 335 patients were included. The median follow-up time was 29.5 months. There were forty-six patients in the pPEG tube group, 23 patients in the rPEG tube group, and 266 patients in the rNGT group. pPEG, increased body-mass index (BMI), and N0-1 category were significantly associated with less weight loss in the multivariate analysis (all P &lt; 0.05). pPEG decreased the rate of radiotherapy delay compared with that of reactive interventions (23.1% vs. 47.1%, P = 0.007). In terms of quality of life, global health status, role functioning, emotional functioning, cognitive functioning, pain, and dyspnea were significantly improved in the pPEG tube group (all P &lt; 0.05). BMI and weight loss were independent prognostic factors for clinical survival outcomes (all P &lt; 0.05). pPEG could improve nutrition outcomes, reduce treatment delay, and maintain quality of life.

PO-1101 Early NGT insertion prevents weight loss & treatment breaks in post-op CTRT and QoL assessment.

PO-1101 Early NGT insertion prevents weight loss & treatment breaks in post-op CTRT and QoL assessment.

Impact of Early Oral Feeding on Nasogastric Tube Reinsertion After Elective Colorectal Surgery: A Systematic Review and Meta-Analysis.

BackgroundColorectal cancer is a common malignant tumor appearing in the gastrointestinal tract. Surgical resection is recognized as the best means to improve patient survival. However, it is controversial whether early oral feeding (EOF) after elective colorectal resection demonstrates safety and efficacy in concerned clinical outcomes.MethodsWe searched PubMed, Embase, Cochrane Library, and CNKI from inception to September 2021. Two authors independently screened the retrieved records and extracted data. EOF was defined as feeding within 24 h after surgery, while traditional oral feeding (TOF) was defined as feeding that started after the gastrointestinal flatus or ileus was resolved. The primary outcome was nasogastric tube insertion, and the secondary outcomes were the length of hospital stay and total complications. Categorical data were combined using odds ratio (OR), and continuous data were combined using mean difference (MD).ResultsWe screened 10 studies from 34 records after full-text reading, with 1,199 patients included in the analysis. Nasogastric tube reinsertion (OR 1.69; 95% CI 1.08 to 2.64, p=0.02) was more frequent in the EOF group, and older ages (>60 years) were associated with higher risk of nasogastric tube reinsertion (OR 2.05; 95% CI 1.05 to 3.99, p = 0.04). Reduced length of hospital stay (MD −1.76; 95% CI −2.32 to −1.21; p < 0.01) and the rate of total complications (OR 0.49; 95% CI 0.37 to 0.65, p < 0.01) were observed in EOF compared with TOF.ConclusionsEOF was safe and effective for patients undergoing elective colorectal surgery, but the higher rate of nasogastric tube reinsertion compared with TOF should not be ignored.

Clinical Outcomes and Patient Safety of Nasogastric Tube in Acute Stroke Patients

Nasogastric tube (NGT) is often used in stroke patients who are dysphagic (deglutition disorders) or have decreased conscious state. This method of feeding is assumed to have minimal complications. The aim of this study is to analyze complications associated with NGT and variables associated with mortality. Retrospective analysis of 250 acute stroke patients requiring NGT feeding between 2003 and 2020. There were 250 patients (median age 76 (IQR 68–83), 56.4% males, median time to NGT 1 day (IQR 0–3). Discussion with family prior to insertion of NGT recorded in 46 (18.4%). There were 123 cases (49.2%) of aspiration pneumonia. There were 188 (75.2%) NGT associated complications: 67 patients (26.8%) had failed insertion, 31 required multiple attempts, 129 patients (51.6%) pulled out NGT, 107 patients (42.8%) had NGT placed in wrong positions and require reinsertion, 20 cases in the lung, 5 pneumothorax cases, 97 in the gastro oesophageal junction or hiatus hernias, 1 case of oesophageal ulceration, 37 coiled, kinked or resistance. 78 cases the tips were not seen on chest X-ray (CXR), gastrointestinal bleeding in 9 cases, epistaxis in 6 cases), 96 patients (38.4%) required restrain. There were 91 death (36.4%) with 73 patients occurring during hospital admission and a further 18 died within 6 months. Death was more frequent in those age > 60 (72 of 216 patients versus 1 of 33 patients, p < 0.01). The median National Institute of Health Stroke Score/NIHSS of those with aspiration pneumonia was higher than those without (19.5 versus 15, p < 0.01). Decision tree analysis first split at age (≤ 59 versus > 59, p = 0.03), NIHSS (≤ 16 or > 16, p = 0.02), post-stroke pneumonia (p = 0.04) and multiple NGT insertion (p = 0.01). The area under the ROC curve was for this model was 0.75 (95% CI 0.69–0.80). Complications were common among patients with NGT complications. These findings may be used to inform discussions with families regarding NGT.

Placement of Nasogastric Feeding Tube and Postinsertion Care Review

Insertion and postinsertion care of enteral nasogastric feeding tubes are common procedures in the United States, with more than 1.2 million temporary nasogastric feeding tubes inserted annually. Although there are some evidence-based practice guidelines and recommendations for care of these tubes, variation in practice still exists. Additional research is needed to determine the best methodology for insertion and confirmation of nasogastric feeding tubes. Routine competency and training on feeding tube insertion, enteral nutrition, and postinsertion care is crucial to prevent patient safety events. Variable results have been reported with different technologies; however, radiographic confirmation remains the criterion standard. It is important that health care institutions develop standardized procedures for insertion and confirmation on the basis of evidence-based practices to minimize risks and complications from temporary nasogastric feeding tubes.

An unexpected cause of proximal small intestinal obstruction

A 63-year-old caucasian male with history of tonsil cancer, under induction chemotherapy, reported food intolerance and vomiting with duration of one month. Symptoms had increased over the last days and were associated with a weight loss of 10 Kg during the past three months. The patient lived all of is life in an urban environment. General physical examination revealed cachexia and dehydration. Gastrointestinal symptoms persisted despite intravenous pantoprazole, prokinetic drugs and nasogastric tube insertion. On investigation, patient presented normocytic and normochromic anemia (9.2 g/dL), lymphocytosis (11.78 x109/L) with neutrophilia (70.7%) and eosinophilia (7.7%), hypoalbuminemia (2.8 g/dL) and elevated C-reactive protein (25.5 mg/dL). Upper endoscopy revealed deformation of bulb and second part of the duodenum with mucosal edema, superficial ulceration and friability (Figure 1a). Biopsies were taken from the bulb and second portion of the duodenum. Computer tomography demonstrated gastric distention, duodenal wall thickening and lumen narrowing in the second and third portion of the duodenum (Figure 2). These findings were indicative of a functionally relevant duodenum stenosis. Histopathologic evaluation of biopsy specimens from the duodenum revealed moderate accumulation of eosinophilic granulocytes and nematode larvae within mucosal crypts (Figure 1b). What is the diagnosis?

7: Comparison of real-time cervical oesophageal ultrasonography and gastric antral ultrasonography to detect gastric insufflation during face-mask ventilation under general anaesthesia-Aprospective observational study.

Background and Aims:Face mask ventilation (FMV) is live saving. It is paramount to maintain oxygenation and ventilation. But FMV is avoided in rapid sequence induction( RSI), for fear of gastric insufflation. Gastric insufflation predisposes the patient to pulmonary aspiration. But the current methods available to detect gastric insufflation are not reliable markers. These include epigastric auscultation for insufflated gases, insertion of nasogastric tube to aspirate and measure the gases, and gastric antral cross-sectional area (CSA) measurement. Each of the above have their own limitations. So, reliable markers denoting gastric insufflation can prevent pulmonary aspiration and can enable “safe” FMV. Real-time transcutaneous ultrasonography(USG) of cervical oesophagus during FMV was done to look for comet-tail artefacts (acoustic shadows created by entrainment of gases into digestive tract)The aim of this study was to compare real-time upper cervical USG with gastric antral USG to detect gastric insufflation during FMV under general anaesthesia.Methods:Results:Ninety patients were recruited. One case of accidental intubation was withdrawn. Remaining 89 patients were analysed. There was an increased incidence of comet-tail artefacts in the oesophagus when compared to gastric antrum. This difference was statistically significant as analysed by Mcnemar test. The lowest peak airway pressure at which comet-tail artefacts appeared in oesophagus was 21.47 (SD-2.86) cm H20.Conclusion:Cervical oesophageal USG is better than gastric antral USG in identifying insufflation of gas into digestive tract. Limiting the airway pressures to < 20 cm H2O would be safer in providing safe FMV without cricoid pressure. Real-time USG monitoring of oesophagus in the neck for comet-tail artefacts is useful in early identification of early gastrooesophageal insufflation.