RADIOGRAPHIC DETECTION OF INTRABRONCHIAL MALPOSITIONS OF NASOGASTRIC TUBES AND SUBSEQUENT COMPLICATIONS IN INTENSIVE-CARE UNIT PATIENTS

Objective: The aim of our study was to illustrate the radiographic spe ctrum of the intrabronchial malposition of nasogastric tubes and subse quent complications, and to discuss the role of radiography in the det ection of such malpositions. Design: Retrospective clinical investigat ion. Setting: Tertiary care university teaching hospital. Patients and methods: We reviewed chest radiographs of 14 intensive care patients with nasogastric tubes malpositioned in the tracheobronchial tree. The site and anatomic location of the malposition were recorded. Complica tions due to tube malpositioning were monitored on follow-up radiograp hs and on computed tomographic examinations, which were available in 4 patients. Results: Nine of 14 nasogastric tubes were inserted in the right and 5 in the left tracheobronchial tree. Tube tips were malposit ioned in the lower lobe bronchi (50 %), the intermediate bronchus (36 %), and the main bronchi (14 %). There was perforation of the bronchia l system with subsequent pneumothorax in 4 patients. In 4 other patien ts, pneumonia developed at the former site of the malpositioned tube t ip. Radiographic detection of nasogastric tube malpositioning was prom pt in 9 patients and delayed in 5 patients. Conclusions: Whereas clini cal signs of nasogastric tube malpositioning in intensive care patient s may be absent or misleading, chest radiography can accurately detect nasogastric tube malpositions in the tracheobronchial tree, may preve nt complications, and avoid the use of further costly or invasive diag nostic techniques.