Prevalence and risk factors of nasal pressure ulcers related to nasogastric intubation: an observational study

Background: Pressure ulcers related to nasogastric tubes (NGT) are underestimated in clinical practice and rarely reported in the literature. Improper tube fixation around the nostril quickly induces tissue ischemia, possibly leading to skin ulcers and permanent full-thickness lesions. Epidemiological and clinical studies on this subject are lacking. Methods: This was an observational, cross-sectional study performed in a tertiary-care hospital. Consecutive hospital records of patients undergoing elective surgical procedures under general anesthesia, with an NGT inserted before or during surgery and maintained in place after the operation, were examined. Demographic and clinical data were extracted to investigate factors possibly associated with the occurrence of pressure ulcers of the nostril. Results: Between 2011 and 2015, 2131 patients underwent elective surgical procedures. The overall prevalence of NGT-induced ulcers was 4.8%, with esophagectomy being the most common index operation. Univariate analysis did not show a statistically significant association between the presence of ulcers and the examined variables, with the exception of operative time (p < 0.012). The prevalence of nostril ulcers statistically differed across operative procedure time (p < 0.001), with a positive significant linear trend (p < 0.001), and lesions were significantly more frequent when the operative procedure lasted longer than 4 h (Confidence interval [CI] 9.2–17.1). Twenty-one (20.5%) patients required plastic surgery consultation due full-thickness lesions with severe cosmetic sequelae. Conclusions: Nostril pressure ulcers related to NGT are common in clinical practice and necessitate a high index of suspicion and vigilance during the perioperative period. The only factor significantly associated with NGT-induced pressure ulcers was the length of the operative procedure.