Tube feeding and lethal aspiration in neurological patients: a review of 720 autopsy cases.

Tube Feeding and Lethal Aspiration in Neurological Patients: A Review of 720 Autopsy Cases • A study of 720 autopsy cases from the Instituto Nacional de Neurologia, SSA (INN) and the Centro Hospitalario 20 de Noviembre ISSTE (CH 20 N) was made in order to investigate the frequency of aspiration in postmortem material of neurological cases. Aspiration occurred in 12.5% and 6.5%, respectively, of the cases under study. The clinical features of both groups were quite similar, and slight differences could not account for the uneven proportion of aspiration. When correlating the presence or absence of aspiration in both groups with and without the use of a gastric tube, a significant correlation was found between the use of a tube and the postmortem finding of aspiration. Gastric tube (tube feeding) increases the risk of aspiration six times. Our results support the view that opposes the early, indiscriminate and incautious use of tube feeding in the comatose patient. Additional Key Words gastric tube aspiration coma nursing care of the comatose patient D Aspiration is an ominous complication of the state of unconsciousness. 1 " 5 Its mechanisms have been carefully investigated and include the loss of cough reflex and the retrograde emptying of the stomach. 68 It is practically unavoidable in some cases where general anesthesia must be induced without proper knowledge of the time of the subject's last meal. 913 In these cases a full stomach is an obligated prerequisite of the aspiration. The relative importance of this factor in other types of aspiration such as those occurring in comatose patients has not been established, although it seems logical that aspiration cannot occur in these patients unless there is some kind of stomach content. The subject of aspiration should be of interest to the neurologist, who often treats patients who remain unconscious for prolonged periods of time. In spite of this, there is hardly any reference in neurological literature to the problem, which has been dealt with mainly by the anesthesiologist. Neurological textbooks do not devote much space to the problem, and seem to give tacit approval to the use of tube feeding for the comatose patient. 14 ' 15 The present study aims to establish the frequency of the complication as a postmortem finding in neurology, and the importance that certain factors may have in its production. Dramatic experiences with tube-fed comatose individuals who vomit, become cyanosed and die …