title: Endotracheal tube-assisted orogastric tube insertion in intubated patients in an ED.
abstract: OBJECTIVE
  Inserting a nasogastric tube (NGT) in intubated patients may be difficult because they cannot follow swallowing instructions, resulting in a high rate of first-attempt failure. We introduce a simple technique for inserting an orogastric tube in an emergency department (ED).
  
  
  METHODS
  Fifty-six patients in the ED, who were intubated and required NGT insertion, were randomly allocated to 2 groups. We inserted the NGT using a conventional technique from the nostril (control group) and an endotracheal tube (ET)-assisted technique from the mouth (ET group). The procedures' success rate, insertion duration, and complications were compared between the groups.
  
  
  RESULTS
  There was a significantly higher overall success rate in the ET group than the control group (100% vs 64%, P<.001). Endotracheal tube group showed 100% first-attempt success rate, but 50% of the control group failed at first attempt. Mean duration of the first trial was not significantly different between the ET and control groups (58.0±16.9 vs 57.3±29.5 seconds, P=.903), but total time for successful insertion was longer in the control group than the ET group (58.0±16.9 vs 111.7±74.5 seconds, P<.001). There was less NGT kinking and more mucosal bleeding in the ET group than in the control group (0% vs 16%, P=.019; 16% vs 7%, P=.225, respectively).
  
  
  CONCLUSIONS
  Endotracheal tube-assisted orogastric tube insertion technique showed a higher rate of successful insertion and shorter total duration. With this result, ET-assisted orogastric tube insertion would be useful in ED.
authors.affiliation: Department of Emergency Medicine, School of Medicine, Hallym University, 445 Gil-dong, Gang-dong gu, Seoul, 134-701, Korea.
authors.forename: Oh Sung
authors.initials: OS
authors.lastname: Kwon
authors.affiliation: Department of Emergency Medicine, School of Medicine, Hallym University, 445 Gil-dong, Gang-dong gu, Seoul, 134-701, Korea. Electronic address: emdrcho@empal.com.
authors.forename: Gyu Chong
authors.initials: GC
authors.lastname: Cho
authors.affiliation: Department of Emergency Medicine, School of Medicine, Hallym University, 445 Gil-dong, Gang-dong gu, Seoul, 134-701, Korea.
authors.forename: Choong Hyun
authors.initials: CH
authors.lastname: Jo
authors.affiliation: Department of Emergency Medicine, School of Medicine, Hallym University, 445 Gil-dong, Gang-dong gu, Seoul, 134-701, Korea.
authors.forename: Young Suk
authors.initials: YS
authors.lastname: Cho
mesh_terms: D000368:Aged; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000295:instrumentation / Q000379:methods*; D007442:Intubation, Intratracheal / Q000295:instrumentation / Q000379:methods*; D008297:Male; D013997:Time Factors