Archives of Anesthesiology and Critical Care 2017. 3(3):359-362.

The Relationship Between the Location of the Nasogastric Tube and Ventilator-Associated Pneumonia in Patients Hospitalized in the Intensive Care Unit
Sُhahram Seifi, Shahrbanoo Latifii, Seyed Taghi Hamidian, Farbod Zahedi Tajrishi


Background: It is recommended to start nutrition early in critically ill patients and the preferred method to do so is enteral nutrition which in most cases is achieved by inserting a feeding tube during the first 24 hours. These tubes are placed blindly so the tip of the tube can be placed in different locations. The authors had predicted that placing the tip of the feeding tube in various locations could produce different results in terms of the prevalence of ventilator-associated pneumonia.

Methods: We performed this cross-sectional study on 147 patients admitted to the intensive care unit of the Rohani hospital and intubated for at least 5 days receiving enteral feeding via nasogastric (NGT) or gastric tube. Patients were divided into two groups based on the location of the tip of the feeding tube- esophagus or stomach. They were compared in terms of early ventilator-associated pneumonia (VAP) within the first 3-5 days and nasogastric complications such as bleeding, sinusitis and obstruction of the feeding tube.

Results: Based on our findings, VAP occurred in 12.2%of the patients. This rate was 9.6% when we placed the nasogastric tube into the stomach and 27.2% when in the esophagus. This difference between the two groups was statistically and clinically significant, while the rate of bleeding, sinusitis and nasogastric tube obstruction was the same between them.

Conclusion: The rate of VAP is significantly different when we feed the patients by a nasogastric tube inserted into the stomach (9.6%) and when we do so by placing the tube into the esophagus (27.2%).


ventilator-associated pneumonia; endotracheal tube; nasogastric tube

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Bigatello LM, Alam H, Allain RM. Critical care handbook of the Massachusetts General Hospital: Lippincott Williams & Wilkins; 2010.

Alp E, Voss A. Ventilator associated pneumonia and infection control. Ann Clin Microbiol Antimicrob. 2006; 5(1):7.

Vincent J-L, Abraham E, Kochanek P, Moore FA, Fink MP. Textbook of critical care: Elsevier Health Sciences; 2011.

Zhang Z, Xu X, Ding J, Ni H. Comparison of Postpyloric Tube Feeding and Gastric Tube Feeding in Intensive Care Unit Patients A Meta-Analysis. Nutr Clin Pract. 2013; 28(3):371-80.

Sorokin R, Gottlieb JE. Enhancing patient safety during feeding-tube insertion: a review of more than 2000 insertions. JPEN J Parenter Enteral Nutr. 2006; 30(5):440-5.

Pillai JB, Vegas A, Brister S. Thoracic complications of nasogastric tube: review of safe practice. Interact Cardiovasc Thorac Surg. 2005; 4(5):429-33.

Metheny NA. Preventing respiratory complications of tube feedings: evidence-based practice. Am J Crit Care. 2006;15(4):360-9.

Yu MK, Freeman LM, Heinze CR, Parker VJ, Linder DE. Comparison of complication rates in dogs with nasoesophageal versus nasogastric feeding tubes. J Vet Emerg Crit Care (San Antonio). 2013; 23(3):300-4.

Metheny NA, Meert KL, Clouse RE. Complications related to feeding tube placement. Curr Opin Gastroenterol. 2007;23(2):178-82.

Metheny NA, Schnelker R, McGinnis J, Zimmerman G, Duke C, Merritt B, et al. Indicators of tubesite during feedings. J Neurosci Nurs. 2005; 37(6):320-5.

Metheny NA, Spies M, Eisenberg P. Frequency of nasoenteral tube displacement and associated risk factors. Res Nurs Health. 1986; 9(3):241-7.

Seguin P, Le Bouquin V, Aguillon D, Maurice A, Laviolle B, Malledant Y, editors. Testing nasogastric tube placement: evaluation of three different methods in intensive care unit. Ann Fr Anesth Reanim; 2005; 24(6):594-9.

Nakajima M, Kimura K, Inatomi Y, Terasaki Y, Nagano K, Yonehara T, et al. Intermittent oro‐esophageal tube feeding in acute stroke patients–a pilot study. Acta Neurol Scand. 2006; 113(1):36-9.

Tablan OC, Anderson LJ, Besser R, Bridges C, Hajjeh R. Guidelines for Preventing Health-CareAssociated Pneumonia. InAtlanta, GA: US National Centers for Infectious Disease, MMWR 53/RR-3 2003.


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