Effect of Nasogastric Tube on Aspiration Risk: Results from 147 Patients with Dysphagia and Literature Review

Abstract

Nasogastric tube (NGT) is a common feeding strategy for patients at risk of endotracheal aspiration with an oral diet. With NGT feeding, however, swallowing of small amounts saliva cannot be avoided. We investigated whether the aspiration rate when swallowing 1 mL of fluid increased in patients using an NGT in different dysphagia severities. One hundred forty-seven patients who had been receiving NGT feeding underwent a videofluoroscopic swallowing study (VFSS). During VFSS, subjects were offered 1 mL of fluid twice: initially, with the tube inserted (NGT-in) and, subsequently, with the tube removed (NGT-out). Aspiration depth was determined using the 8-point Penetration-Aspiration Scale (PAS) (0 points, no aspiration/penetration; 8 points, aspiration passing the vocal cords with no ejection efforts). PAS-diff was computed (PAS - PAS), and a positive PAS-diff (PAS-diff > 0) meant increased aspiration depth in the presence of NGT. After VFSS, diet recommendations were made according to dysphagia severity assessment: non-oral feeding (n = 59), diet modification (n = 74), and diet as tolerated (n = 13). Cognitive level (mini-mental state examination, MMSE) and general functional level (Modified Barthel Index, MBI) were compared between the PAS-diff > 0 and PAS-diff ≤ 0 groups. Aspiration severity did not significantly change after NGT removal (PAS, 2.45 ± 2.40; PAS, 2.57 ± 2.58; P = .50). Regardless of recommended diet, PAS-diff values were not significantly different (P = .49). MMSE and MBI were not significantly different (P = .23 and .94) between subjects with PAS-diff > 0 (n = 25) and PAS-diff ≤ 0 (n = 121). In conclusion, the risk of aspirating a small amount of fluid was not significantly different before and after NGT removal, regardless of swallowing function, cognitive level, or general functional level.

Development and validation of two aspiration prediction models in patients receiving nasogastric feeding

“…The number of comorbidities was significantly associated with aspiration in this study. A randomized controlled trial concluded that stroke, traumatic brain injury, Parkinson disease and dementia may cause aspiration in patients receiving nasogastric feeding (Kim et al, 2018). This study showed that although the same factors were reserved in both models, indwelling days and food type were reserved in the CART model and the use of sedative-hypnotics was reserved in the nomogram model.…”

“…The difficulties in medical treatment and nursing caused by aspiration pose challenges to the quality management provided by the medical system. Some studies have revealed that the swallowing of saliva and regurgitated gastric contents that occurs during nasogastric feeding may result in aspiration (Kim et al, 2018;Torsy et al, 2018…”

“…A randomized controlled trial combined the Penetration-Aspiration Scale (PAS) with the VFSS to predict aspiration in nasogastric and oral feeding groups (Kim et al, 2018). The total PAS score ranged from 0 to 8, and higher scores were associated with a higher aspiration risk.…”

“…Previous studies have identified various aspiration risk factors after nasogastric feeding (Blumenstein et al, 2014;Kim et al, 2018).…”

Fiberendoskopische Untersuchung des Schluckaktes (FEES) – Schritt für Schritt

“…9). Eine eventuell liegende nasogastrale Sonde muss für die Untersuchung nicht entfernt werden [15,16] (▶ Video 2).…”