Tracheopulmonary Complications of a Malpositioned Nasogastric Tube

An alternative method to differentiate pleural effusion after leakage of artificial enteral nutrition formula

PURPOSE

This case report highlights a rare but fatal complication of artificial enteral nutrition due to feeding tube misplacement, leading to pleural effusion and respiratory failure. The primary objective was to determine whether enteral nutrition formula leakage contributed to the patient's death and to differentiate the pleural effusion from other possible etiologies, such as chylothorax.

METHODS

A 59-year-old male patient with severe lung disease underwent left-sided partial lung resection and subsequently received enteral nutrition via a nasogastric feeding tube. After suspected feeding tube misplacement and formula leakage into the pleural cavity, autopsy and histological examination were performed. Cytological and chemical analyses, including gas chromatography-mass spectrometry, were employed to identify nutritional components in pleural effusion and to confirm the presence of enteral nutrition formula.

RESULTS

The autopsy revealed milky, turbid pleural effusion, aspiration pneumonia, and a rupture of the right visceral pleura. Cytological analysis confirmed granulocytic pleural empyema with rod-shaped Congo red-positive material resembling the enteral nutrition formula. Gas chromatography-mass spectrometry identified tricaprylin, a unique marker for enteral nutrition formula, confirming nutritional leakage into the pleural cavity.

CONCLUSIONS

This case study emphasizes the necessity for radiological confirmation of feeding tube placement and the implementation of comprehensive diagnostic protocols for suspected cases of nutritional fluid leakage. Gas chromatography-mass spectrometry proved invaluable in distinguishing nutritional effusions from other potential etiologies by enabling the specific identification of enteral formula components. The high specificity and adaptability of gas chromatography-mass spectrometry render it an essential tool for forensic investigations and clinical diagnostics involving complex fluid analyses, facilitating evidence-based conclusions in critical care and postmortem contexts.

Preclinical trial of the effectiveness of a safety nasogastric tube to detect the tube position based on tidal volume and pepsin assay results in the gastrointestinal tract of Macaca fascicularis

BACKGROUND

Tube misplacement into the tracheobronchial tract is associated with pneumothorax in 0.5% of cases. NGT verification only detects the position of the tube at the end of the procedure. Therefore, a safe nasogastric tube (SNGT) was created to detect the NGT position in real time in a simple and inexpensive way. This study aimed to prove the effectiveness of the SNGT prototype in Macaca fascicularis.

RESULT

An SNGT producing 50% of the TV had 100% sensitivity and specificity in detecting the position of the tube at 100% of the TV, with a sensitivity of 100% and a specificity of 87.5%. There was a significant difference between the movement of the SNGT 50% TV and SNGT 100% TV airbags (p ≤ 0.05). However, there was no significant difference between the accuracy of placement of the 50% TV SNGT, 100% TV SNGT, and conventional NGT (p > 0.05). The pepsin enzyme had better sensitivity (100%) than pH paper (91.66%) in detecting the end-of-procedure tube position. This research has the potential to advance into human clinical trials.

CONCLUSION

SNGTs are highly effective in detecting the NGT position inside the respiratory and digestive tracts to prevent misplacement.

Chest X-ray Interpretation: Detecting Devices and Device-Related Complications

This short review has the aim of helping the radiologist to identify medical devices when interpreting a chest X-ray, as well as looking for their most commonly detectable complications. Nowadays, many different medical devices are used, often together, especially in critical patients. It is important for the radiologist to know what to look for and to remember the technical factors that need to be considered when checking each device's positioning.

A Case Report of Esophageal Perforation: Complications of Orogastric Tube Placement

Orogastric tube (OGT) insertion is a routine procedure in medical care. It is often inserted in patients after endotracheal intubation. OGT insertion is often a blind procedure. Misplacement of the tube can cause a variety of complications and can sometimes be life-threatening. We present the case of a 71-year-old male patient who experienced a rare proximal esophageal perforation as a complication of blind insertion of the OGT; he required OGT insertion after receiving endotracheal intubation for hypoxic respiratory failure secondary to COVID-19 infection. The esophageal perforation was revealed on a post-procedural roentgenogram and confirmed by a subsequent computed tomography of the chest. Given the small size of the perforation and the absence of clinical instability, conservative management was pursued leading to improvement of the mediastinitis. Although the complications of OGT insertion are uncommon, their consequences can be potentially serious and require a high degree of suspicion.