The nasogastric feeding tube as a risk factor for aspiration and aspiration pneumonia

Abstract

Sometimes it is possible to differentiate whether the aspirate is gastric or pharyngeal. The kind of bacterial contamination is, however, more difficult to establish. Oral or dental disease, antibiotic therapy, systemic illness or malnutrition and reduction of salivary flow are responsible for colonization of Gram-negative bacteria in oral and pharyngeal flora in nasogastric-tube-fed patients. The use of a nasogastric feeding tube and the administration of food increase gastric pH and lead to colonization of gastric secretions. It has also been suggested that gastric bacteria could migrate upward along the tube and colonize the pharynx.

Percutaneous endoscopic gastrostomy in intensive care unit

“…Pulmoner aspirasyon, hastaların supin pozisyonda nazogastrik tüp ile beslendiği durumlarda sık görülmektedir (10)(11)(12)(13) . Bu geri kaçış, alt özefagus sifinkterinin bozulmuş relaksasyonu, yetersiz özefagus gövde kontraksiyonu ve gastrik kardiyadan geçen tüp varlığı birlikteliği ile ortaya çıkmaktadır (10,14) .…”

Nasogastric tube feeding is a cause of aspiration pneumonia in ventilated patients

“…Moreover, the widespread use of (macrolide) antibiotics has not prevented a clear increase in asthma prevalence. On the contrary, it seems that a decrease in hospitalisation and mortality is strongly associated with an increase in the use of inhaled steroids [3], and there is no indication that this is associated with the use of antibiotics.However, it is certainly worthwhile to pay attention to the socalled Chlamydia-asthma theory proposed by D.L. Hahn and to investigate the presence of Chlamydia pneumoniae or other infectious organisms in new asthma patients.…”

“…Moreover, the widespread use of (macrolide) antibiotics has not prevented a clear increase in asthma prevalence. On the contrary, it seems that a decrease in hospitalisation and mortality is strongly associated with an increase in the use of inhaled steroids [3], and there is no indication that this is associated with the use of antibiotics.…”

“…There is growing evidence that oropharyngeal dysphagia plays a critical role in aspiration pneumonia and VAP in mechanically ventilated patients [3,4]. Brain injury, severe stroke and unconsciousness, due to sedatives and hypnotics, disturb the swallowing reflex.…”

“…The presence of a nasogastric tube has been identified as an independent risk factor for VAP, mainly because of gastrooesophageal reflux and aspiration [1,2]. Aspiration is probably due to loss of anatomical integrity of the lower oesophageal sphincter, increased frequency of transient sphincter relaxation and oropharyngeal dysphagia via desensitisation of the pharyngoglottal adduction reflex [3,4].…”