Malposition of a Nasogastric Feeding Tube Into the Right Pleural Cavity of a Nasopharyngeal Carcinoma Patient After Radiotherapy and Chemotherapy: A Case Report

Background: Nasogastric feeding tube plays an important role in nutrition intake, drug administration, and stomach emptying for patients with severe dysphagia. However, inserting nasogastric tubes is not absolutely harmless. Inadvertent malposition into the trachea or the pleural cavity could result in severe pulmonary complications. Case presentation: We present a case of a 67-year-old patient with a history of nasopharyngeal carcinoma and after the treatment of radiotherapy and chemotherapy. Nasogastric tubes have to be placed for enteral nutrition and avoiding aspiration owing to his severe dysphagia. Unfortunately, he experienced a malposition of nasogastric tube into the right pleura cavity after blind replacement by nurse, whereas the nurses and physicians did not recognize this fault, even the bedside chest radiography (X-ray) was performed twice after intubation. A week later, his condition deteriorated so rapidly that he had to undergo tracheotomy, and the tube was finally found in his trachea.Conclusions: The Nasopharyngeal carcinoma patients after radiotherapy and chemotherapy should be fully evaluated before the nasogastric tube placement whether the blind insertion is suitable or not. Meanwhile, we should not feed immediately unless we have a radiograph to verify the right position of NG tube. Furthermore, careful monitoring of both typical and untypical symptoms of malposition is essential during tube feeding.

Risk Score for Predicting Dysphagia in Patients After Neurosurgery: A Prospective Observational Trial

Background: Acquired dysphagia is common in patients with tracheal intubation and neurological disease, leading to increased mortality. This study aimed to ascertain the risk factors and develop a prediction model for acquired dysphagia in patients after neurosurgery.Methods: A multicenter prospective observational study was performed on 293 patients who underwent neurosurgery. A standardized swallowing assessment was performed bedside within 24 h of extubation, and logistic regression analysis with a best subset selection strategy was performed to select predictors. A nomogram model was then established and verified.Results: The incidence of acquired dysphagia in our study was 23.2% (68/293). Among the variables, days of neurointensive care unit (NICU) stay [odds ratio (OR), 1.433; 95% confidence interval (CI), 1.141–1.882; P = 0.005], tracheal intubation duration (OR, 1.021; CI, 1.001–1.062; P = 0.175), use of a nasogastric feeding tube (OR, 9.131; CI, 1.364–62.289; P = 0.021), and Acute Physiology and Chronic Health Evaluation (APACHE)-II C score (OR, 1.709; CI, 1.421–2.148; P < 0.001) were selected as risk predictors for dysphagia and included in the nomogram model. The area under the receiver operating characteristic curve was 0.980 (CI, 0.965–0.996) in the training set and 0.971 (0.937–1) in the validation set, with Brier scores of 0.045 and 0.056, respectively.Conclusion: Patients who stay longer in the NICU, have a longer duration of tracheal intubation, require a nasogastric feeding tube, and have higher APACHE-II C scores after neurosurgery are likely to develop dysphagia. This developed model is a convenient and efficient tool for predicting the development of dysphagia.