Initial gastric volume, nasogastric tube and pneumonia incidence in trauma patients

Introduction

Gastric emptying is often delayed in major trauma patients. These patients are at risk of regurgitation and aspiration during rapid sequence induction or during coma. We hypothesized that an early naso-gastric tube (NGT) would reduce the gastric residuals. We also checked whether gastric volume at admission was associated with aspiration pneumonia.

Methods

Data from consecutive trauma patients that underwent a full body CT scan from January 2006 to August 2009 were retrospectively analyzed. Gastric gas, liquid/solid and total volume were measured using 3D contouring on the CT scan performed at admission. Secondarily referred trauma patients and patients hospitalized for less than 24 hours were excluded from the study. Onset time and occurrence of pneumonia were extracted from the hospital's database; patients who died during the first 48 hours were then excluded. Patients staying for 2 days or longer in the ICU were divided into two groups (with or without NGT) and analyzed separately.

Results

One hundred and fifty-six patients were analyzed. CT scan showed a NGT in 30 patients (one malposition in the medium esophagus). Gastric gas, liquid/solid and total volume were not different in patients with and without NGT (Z test; gas: 54 ± 147 vs 95 ± 168 ml, P = 0.179; liquid/solid: 226 ± 282 vs 199 ± 237, P = 0.626; Total: 280 ± 311 vs 295 ± 320, P = 0.824). Twenty out of 153 patients developed a pneumonia in the first 7 days, five of which with NGT and 15 without (chi-squared, P = 0.459). There was no difference in gastric residuals between these patients and the 133 others (Mann-Whitney; Q1-median-Q3; Gas: 11-25-126 vs 14-43-90 ml, P = 1; liquid/solid: 16-63-432 vs 22-115-290 ml, P = 0.799; Total: 29-252-661 vs 68-186-371 ml, P = 0.873). Seventy-three patients were admitted to the ICU, of which 23 had a NGT and 20 developed pneumonia. There was no difference between gastric residuals of the 23 who had a NGT and the 50 others. A pneumonia developed in the first 3 days in 1/23 patients with NGT vs 9/50 without NGT (chi-squared-Yates, P = 0.226); in the first 7 days in 5/23 patients with NGT vs 15/50 without NGT (chi-squared, P = 0.462). There was no difference in gastric residuals between patients who developed early pneumonia (at 3 and 7 first days) and those who did not. There was no difference in ICU length of stay (10.8 vs 12.7 days, P = 0.825) and onset time of pneumonia (4.2 vs 3.3 days, P = 0.234).

Conclusions

Our results suggest that gastric volume is high at admission of trauma patients, irrespective of NGT presence. In this study, pneumonia incidence was related neither with high gastric volume, nor with NGT usage.