Effect of Nasogastric Tubes on Incidence of Aspiration

Leder SB, Suiter DM. Effect of nasogastric tubes on incidence of aspiration. Objective: To determine what effect, if any, a nasogastric (NG) tube has on occurrence of anterograde aspiration during objective evaluation of swallowing using both liquid and puree bolus consistencies. Design: Prospective, consecutive. Setting: Large, urban, tertiary care, teaching hospital. Participants: Referred sample of 1260 consecutively enrolled inpatients. Group 1 (n=630; 346 male, 284 female) had an NG tube and group 2 (n=630; 360 male, 270 female) did not have an NG tube at time of referral for dysphagia evaluation. Intervention: Fiberoptic endoscopic evaluation of swallowing (FEES). Main Outcome Measure: Aspiration status. Results: A Pearson chi-square indicated no significant differences (P>.05) for aspiration of either liquid or puree food consistencies dependent on presence of an NG tube. Separate binary logistic regression analyses were used to determine if the presence of an NG tube interacted with participants' age to affect the dependent variables of liquid and puree aspiration. There were no significant effects for liquid aspiration (odds ratio [OR]=1.004, P>.05; 95% confidence interval [CI], 0.987-1.021) or puree aspiration (OR=0.992, P>.05; 95% CI, 0.971-1.014). In addition, no significant interactions (P>.05) were found between NG tube status and sex, age, or diagnostic category, and presence of an NG tube did not significantly increase the odds of either liquid aspiration (OR=1.092, P>.05; 95% CI, 0.842-1.418) or puree aspiration (OR=0.975, P>.05; 95% CI, 0.713-1.333). Last, subjects between 60 and 90 years of age, regardless of NG tube status, aspirated more frequently than younger subjects. Conclusions: No statistically significant differences were found regarding aspiration status for liquid or puree food consistencies between 2 separate but comparable groups, that is, one with and one without an NG tube, regardless of sex, age, or diagnostic category. Because objective swallowing evaluation, for example, FEES, can be performed with an NG tube in place, it is not necessary to remove an NG tube to evaluate dysphagia. Similarly, there is no contraindication to leaving an NG tube in place to supplement oral alimentation.