Prospective, randomized evaluation of early removal of nasogastric tubes in postceliotomy trauma patients

The objective of this study is to compare early (24-hour) removal of nasoga stric tubes (NGTs) in trauma patients who have undergone emergency celiotom y to removal based on clinical signs of return of bowel function. All traum a patients who underwent an emergency celiotomy between November 1994 and A ugust 1997 were randomized to 24-hour NGT removal, or removal when flatus a nd decreased NG output indicated. Exclusion criteria included patients with duodenal or esophageal injuries, those with airway intubations that were > 24 hours, or those who had undergone same-hospitalization repeat celiotomy. Gastric or severity of intestinal injury were not exclusion criteria. Fail ure of NGT removal was defined as pain, abdominal distention, and vomiting. Mechanisms of injury, Injury Severity Score, operative findings, NGT remov al times, morbidity, laboratory data, and reasons for failure were evaluate d. A total of 177 patients qualified for the study. Two patients were inapp ropriately randomized and subsequently excluded. Of the remaining 175 patie nts, 151 sustained penetrating injuries and 24 sustained blunt injuries. Of the 151 patients in the penetrating injury group, 68 were randomized to th e 24-hour pull (study) group and 83 were randomized to the clinical pull (c ontrol) group. There were three failures in the study group [3 of 68 patien ts (4.4%)] and three failures in the control group [3 of 83 patients (3.6%) ]. Of the 24 blunt injury patients, 10 were randomized to the study group a nd 14 were randomized to the control group. There was one failure in the st udy group [1 of 10 patients (10.0%)] and one failure in the control group [ 1 of 14 patients (7.1%)]. Overall failure rate for the study group was 5.1 per cent [(3+1)/(68+10) = 5.1%] versus 4.1 per cent for the control group. Overall failure for all patients in the study was 4.6 per cent. Injury seve rity score, morbidity, and lab values were not significantly different. It is safe to remove NGTs at 24 hours in most trauma patients regardless of th e severity of injury (failure rate, 5.1%). The surgical dogma of the need t o have an NGT in longer for blunt trauma was not revealed in this study, ho wever, a larger study would be needed to determine this with significance.