NG tube utility in bowel obstruction

7 May

dsc_1700another food-for-thought tidbit after a bit of a long layoff…

 

Best BETs from the Manchester Royal Infirmary. BET 1: Is routine nasogastric decompression indicated in small bowel occlusion?

–found all of one useful/relevant paper (below)

 

Fonseca et al: Routine nasogastric decompression in small bowel obstruction: is it really necessary?

  • Key points:
    • 65-80% of SBOs (small bowel obstructions) are treated non-operatively (bowel rest, IVF, obs)
    • NG (nasogastric) tube often used for decompression
    • NG tube complications can include: pneumothorax/perf, pneumonia, nasal trauma/infection, patient discomfort, etc.
  • Retrospective study highlights:
    • 290 patients >18 yo with SBO
    • causes included adhesions, malignancy, unknown (excluded incarcerated hernias)
    • 235 patients got NG tubes (so 55 didn’t)
    • NG tube was not associated with avoidance of surgery
      • 37% (87/235) with NG tubes needed OR intervention
      • 24% (13/55) without NG tube needed OR intervention
    • Days to resolution (average)
      • 3.55 days in NG tube group
      • 1.67 days in non-NG tube group
    • Hospital length of stay (average)
      • 10.16 days in NG tube group
      • 3.18 days in non-NG tube group
      • similar trend excluding the patients who needed OR intervention
    • Significantly higher rate of pneumonia in the NG tube group (11.59% vs. none, P=0.007)
    • author conclusion: “…we recommend the judicious use of NGT, especially in patients presenting without emesis.”

 

old article, but often cited: Singer et al: Comparison of patient and practitioner assessments of pain from commonly performed emergency department procedures

  • most painful procedures according to patients (in descending order)
    • nasogastric intubation
    • abscess drainage
    • fracture reduction
    • urethral catheterization

 

Food for thought.

 

References: Best bet article, Fonseca article, Singer article, picture

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