From the Guidelines
Nasogastric tubes are generally preferred over orogastric tubes in most clinical situations, particularly in stroke patients, due to their benefits in reducing the risk of aspiration pneumonia, improving patient comfort, and allowing for easier speech, eating, and drinking. The use of nasogastric tubes in stroke patients has been supported by several studies, including the FOOD-trial, which showed that patients with nasogastric tubes had a significantly lower risk of the combined endpoint "death and/or impaired functional status" compared to patients with early PEG feeding 1. Additionally, nasogastric tubes have been found to be safe and effective in delivering full enteral nutrition, with a lower risk of internal pressure sores and a reduced need for frequent reinsertion 1. However, it is essential to consider the individual patient's needs and contraindications, such as nasal fractures, severe coagulopathy, or basal skull fractures, in which case orogastric tubes may be the preferred option. Some key benefits of nasogastric tubes include:
- Reduced risk of aspiration pneumonia
- Improved patient comfort
- Easier speech, eating, and drinking
- More direct path to the stomach with less risk of coiling in the oropharynx
- Lower risk of internal pressure sores
- Reduced need for frequent reinsertion It is also important to note that the placement of nasogastric tubes should be done by trained and technically experienced medical staff, and the correct position should be controlled before the application of tube feed 1. Overall, the use of nasogastric tubes in stroke patients can improve outcomes and quality of life, and should be considered as a first-line option for enteral nutrition.
From the Research
Comparison of Nasogastric and Orogastric Tubes
- The benefits of nasogastric tubes over orogastric tubes are not clearly established in terms of reducing gastroesophageal reflux 2, 3, 4.
- Studies have shown that the size of the nasogastric tube does not significantly affect gastroesophageal reflux in intubated patients 2 or normal volunteers 3, 4.
- One study found that shifting from a nasogastric tube to a percutaneous endoscopic gastrostomy (PEG) tube resulted in a small but significant reduction in gastroesophageal reflux 5.
- The presence of a nasogastric tube, regardless of size, did not cause reflux in normal subjects during short-term intubation 4.
Gastroesophageal Reflux and Tube Size
- Research suggests that the size of the nasogastric tube is not a significant determinant of gastroesophageal reflux in normal subjects 3, 4.
- Studies have compared the effects of small-bore and large-bore nasogastric tubes on gastroesophageal reflux, with no significant differences found 2, 4.
- The use of a nasogastric tube, regardless of size, did not promote an increase in postprandial supine gastroesophageal reflux in normal volunteers 3.
Clinical Implications
- The choice between nasogastric and orogastric tubes should be based on individual patient needs and clinical judgment, rather than solely on the potential for reducing gastroesophageal reflux 2, 3, 4.
- Further research is needed to fully understand the relationship between nasogastric tubes and gastroesophageal reflux, as well as the potential benefits and risks of different tube sizes and types 5.