The nasogastric tube syndrome: Two case reports and review of the literature

Background. The nasogastric tube syndrome is a potentially life-threatening complication of an indwelling nasogastric (NG) tube. The syndrome is thoug ht to result from ulceration and infection of the posterior cricoid region with subsequent dysfunction of vocal cord abduction. This dysfunction may p resent as complete loss of vocal cord abduction manifested as serious airwa y compromise. Reports of this syndrome are infrequent, with only 29 cases p ublished to date. Methods. Two additional cases of nasogastric tube syndrome diagnosed at the University of Iowa Hospitals and Clinics over a 2-year period are presente d. A search of MEDLINE (1966 through February 1999), including review of th ose articles' references identified seven previous publications, including 29 case reports. These 29 cases are reviewed and the findings summarized. Results. Twenty-nine cases of NG tube syndrome are identified, with 16 of t hese occurring in the preantibiotic period. Including the two cases present ed here, 15 contemporary patients are examined. Among these 15 cases, 10 re quired tracheostomy, on average 8.5 days after NG tube placement. Conclusion. Although the fully manifested syndrome presents quite dramatica lly, we suspect that a clinical spectrum of severity exists with less sever e cases going unrecognized. Consistent with previous reports, we found that direct visualization of the postoricoid region is required to rule out the diagnosis and recommend such action be taken whenever the diagnosis is sus pected. Treatment should include establishment of a safe airway, removal of the tube whenever possible, antibiotic therapy, and antireflux therapy. (C ) 2000 John Wiley & Sons, Inc.