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

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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 (PASNGT-in − PASNGT-out), 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 (PASNGT-in, 2.45 ± 2.40; PASNGT-out, 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.

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Authors and Affiliations

  1. Department of Rehabilitation Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Baengnyeong-ro 156, Chuncheon, Gangwon, 24289, South Korea

    Gowun Kim, Sora Baek, Hee-won Park, Eun Kyoung Kang & Gyuhyun Lee

  2. Gangwon-do Rehabilitation Hospital, Chuncheon, South Korea

    Hee-won Park

Authors
  1. Gowun Kim
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  2. Sora Baek
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  3. Hee-won Park
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  4. Eun Kyoung Kang
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  5. Gyuhyun Lee
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Correspondence to Sora Baek.

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The authors declare that they have no conflict of interest.

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None of the authors has any proprietary interests in the materials described in this article. This study protocol was approved by our institutional review board.

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We retrospectively reviewed the medical records, and informed consent was waived.

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Kim, G., Baek, S., Park, Hw. et al. Effect of Nasogastric Tube on Aspiration Risk: Results from 147 Patients with Dysphagia and Literature Review. Dysphagia 33, 731–738 (2018). https://doi.org/10.1007/s00455-018-9894-7

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