Underwater-seal nasogastric tube drainage to relieve gastric distension caused by air swallowing.
Air swallowing can occur as a psychogenic phenomenon, because of abnormal anatomy, or during non-invasive positive pressure ventilation. Gross distension of the stomach with air can have severe consequences for the respiratory and gastrointestinal systems. We report the case of a 62-year-old man with severe dynamic hyperinflation due to chronic obstructive pulmonary disease, who developed respiratory failure requiring intubation a few hours after radical prostatectomy. Following a percutaneous tracheostomy and weaning of sedation on day six, his abdomen began to enlarge progressively. X-rays revealed massive gastric distension due to air swallowing, which continued despite all efforts to optimise therapy. The use of an underwater seal drainage system on a nasogastric tube improved ventilation and ultimately aided weaning from mechanical support.
Department of Anaesthesia and General Intensive Care Unit, St George's Hospital, London, UK.
A W
AW
Solomon
J C
JC
Bramall
J
J
Ball
D000334:Aerophagy / Q000209:etiology / Q000628:therapy*; D004322:Drainage / Q000295:instrumentation / Q000379:methods; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000379:methods; D008297:Male; D008875:Middle Aged; D009296:Nasal Cavity; D011182:Postoperative Care / Q000379:methods; D011468:Prostatectomy; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications; D015300:Ventilator Weaning; D014867:Water
D014867:Water