Nasogastric Tube Syndrome: Why Is It Important in the Intensive Care Unit?

Abstract

Although the nasogastric tube (NGT) is widely used in critically ill patients, most intensivists do not give much thought to it or its possible complications. NGT syndrome is a rare but fatal complication characterized by throat pain and vocal cord paralysis in the presence of NGT. Recently, we experienced a case of NGT syndrome developed in an 86-year-old female twelve days after NGT inser-tion. We immediately removed the NGT and secured the airway by tracheostomy. She was treated successfully with an intravenous antibiotic, steroid and proton pump inhibitor and the syndrome did not recur after reinsertion of the NGT. Nasogastric tube (NGT) insertion is a universal procedure in intensive care units (ICUs) for gastric decompression or en-teral nutrition (EN). Although indwelling tubes are easy to place and safe, serious complications can occur. NGT syndrome is characterized by throat pain and bilateral vocal cord paralysis, which can cause upper airway obstruction. Despite its life-threatening potential, NGT syndrome is not well-known. Here we present a case of an elderly woman with NGT syndrome and highlight its significance in ICUs. Case Report An 86-year old woman was admitted to the ICU for pneumonia and septic shock. She had a history of hypertension, diabetes mellitus, and Parkinson's disease. We managed hypoxia with a simple oxygen mask. Due to her altered mental state, oral feed-ing was not possible and an NGT was inserted. EN was initiated on hospital day 2 but withheld from hospital day 5 through 11 due to cholecystitis. An NGT was kept in place throughout this period. Her clinical course was initially favorable. However, her body temperature and inflammatory markers became elevated again on day 13, and she made a grimace. Two days later, stridor was heard and her blood oxygen saturation began to fall. A laryngoscopic examination revealed impaired abduc-tion of the vocal cords, whose internal diameter was reduced to 10% of the normal. We subsequently performed bron-choscope-guided intubation and percutaneous dilatational tracheostomy. A computed tomography scan of the neck did not show any abnormal findings. We removed the NGT and cc This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/ licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.