Aspiration And Feeding Tubes

Feeding tubes do not protect from bronchoaspiration; this is true for naso-gastric tubes (NGT) and percutaneous enterogastric (PEG) tubes. In fact, feeding tubes are associated with an increased rate of pneumonia and death from pneumonia (Strong et al., 1992; Croghan et al., 1994; Marik, 2001).

The use of a NGT or a PEG tube appears to alter the oro-pharyngeal ecosystem, and increases upper airway colonization by P. aeruginosa, other GNB, and S. aureus (Leibovitz et al., 2003a; Leibovitz et al., 2003b; Leibovitz et al., 2003c). In a study of 215 nursing-home patients (78 patients with a NGT, 57 with a PEG, and 80 patients fed orally), P. aeruginosa was recovered from the oropharyngeal flora of 31% of patients with NGT, and 10% of those with PEG, vs. 0% of controls; GNB were recovered from 71% of patients with NGT, 44% of those with PEG vs. only 7.5% of controls. Globally, the upper airways of 81% of patients with NGT were colonized by potential respiratory pathogens vs. 51% of patients with PEG, and 17.5% of controls. Decreased mechanical clearance of organisms by chewing and swallowing, and appearance of a bio-film on the NGT itself probably contribute to upper airway colonization by GNB. The biofilm may facilitate growth and colonization by P. aeruginosa. The reason for the important upper airway colonization by S. aureus and GNB in patients with PEG is unclear.

In summary, aspiration is an important pathogenic mechanism for pneumonia in the elderly; in patients with neurologic impairment of the glottic barrier, the use of a NGT or PEG does not abolish and may in fact increase the risk of pneumonia.

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