title: Randomized clinical trial to determine the effect of nasogastric drainage on tracheal acid aspiration following oesophagectomy.
abstract: BACKGROUND
  The aim of this study was to investigate tracheal acid aspiration after oesophagectomy and to determine whether it is influenced by nasogastric (NG) drainage.
  
  
  METHODS
  Thirty-four patients undergoing oesophagectomy were randomized to one of three methods of NG drainage: a single-lumen tube with free drainage and 4-hourly aspiration, a sump-type tube on continuous suction drainage, or no NG tube. A tracheal pH probe was used to collect information on acid aspiration for 48 h after surgery. A pH < 5.5 was considered abnormal (normal pH 6.8-7.2). Total time with tracheal pH < 5.5, number of reflux episodes and longest reflux time were compared between groups.
  
  
  RESULTS
  There was significant and persistent tracheal acid aspiration in all patients. Patients with a sump-type tube had a significantly shorter total time with tracheal pH < 5.5 than those in the other groups (sump-type tube versus single-lumen tube, P = 0.0069; sump-type tube versus no tube, P = 0.0071). Patients randomized to no NG tube experienced more respiratory complications after surgery than those who had either single-lumen or sump-type tubes (seven of 12 versus four of 22 patients; P = 0.023). Insertion of a NG tube was necessary in the first week after surgery in seven of 12 patients in this group.
  
  
  CONCLUSIONS
  Routine NG drainage after oesophagectomy is necessary. A sump-type NG tube is better at preventing tracheal acid aspiration and may reduce the incidence of respiratory complications.
authors.affiliation: Department of Thoracic Surgery, The Cardiothoracic Centre, Thomas Drive, Liverpool L14 3PE, UK.
authors.forename: M J
authors.initials: MJ
authors.lastname: Shackcloth
authors.forename: E
authors.initials: E
authors.lastname: McCarron
authors.forename: J
authors.initials: J
authors.lastname: Kendall
authors.forename: G N
authors.initials: GN
authors.lastname: Russell
authors.forename: S H
authors.initials: SH
authors.lastname: Pennefather
authors.forename: J
authors.initials: J
authors.lastname: Tran
authors.forename: R D
authors.initials: RD
authors.lastname: Page
mesh_terms: D000143:Acids / Q000032:analysis*; D004322:Drainage / Q000379:methods*; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology; D014132:Trachea / Q000737:chemistry*
chemical_list: D000143:Acids