Acute and Critical Care

Gastroenterology
Nasogastric Tube Syndrome: Why Is It Important in the Intensive Care Unit?: Taehyun Kim, Seong Min Kim, Sung Birm Sohn, Yeon Ho Lee, Sang Youn Lim, Jae Kyeom Sim; Korean J Crit Care Med. 2015;30(3):231-233. Published online August 31, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.3.231

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Although the nasogastric tube (NGT) is widely used in critically ill patients, most intensivists do not give much thought to it or its possible complications. NGT syndrome is a rare but fatal complication characterized by throat pain and vocal cord paralysis in the presence of NGT. Recently, we experienced a case of NGT syndrome developed in an 86-year-old female twelve days after NGT insertion. We immediately removed the NGT and secured the airway by tracheostomy. She was treated successfully with an intravenous antibiotic, steroid and proton pump inhibitor and the syndrome did not recur after reinsertion of the NGT.

Citations

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Nasogastric tube syndrome: A Meta-summary of case reports
Deven Juneja, Prashant Nasa, Gunjan Chanchalani, Ravi Jain
World Journal of Clinical Cases.2024; 12(1): 119. CrossRef

Neurology
Multiple System Atrophy Manifested by Bilateral Vocal Cord Palsy as an Initial Sign: Yuri Seo, Soomin Jeung, Heeyoung Yoon, Min-Chul Kim, Nah Kyum Lee, Byeong Zu Ghang, Sun Ju Chung, Younsuck Koh; Korean J Crit Care Med. 2015;30(2):123-127. Published online May 31, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.2.123

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Abstract PDF: A 71-year-old male initially presented with vocal cord palsy and underwent tracheostomy. After thorough examination, urogenital dysfunction, orthostatic hypotension, and Parkinsonism were found, which led to the diagnosis of multiple system atrophy (MSA). After the tracheostomy, bi-level positive airway pressure ventilation was required during the night due to nocturnal hypoxemia. Nighttime hypoxemia is related to central sleep apnea, which is one of the manifestations of MSA. This is the first case of MSA manifested by bilateral vocal cord palsy as an initial sign in Korea. This case supports the notion that MSA should be taken into consideration when vocal cord paralysis is observed.

A Case of Bilateral Vocal Cord Paralysis Due to Subglottic Pressure Injury after Endotracheal Intubation: A Case Report: Gyu Sik Choi, Sang Hoon Kim, Jae Hyung Lee, You Lim Kim, Ji Hyun Lee, Young Woo Jang, Eun Sun Cheong, Jong Kwan Jung, Byoung Hoon Lee; Korean J Crit Care Med. 2011;26(3):191-195.; DOI: https://doi.org/10.4266/kjccm.2011.26.3.191

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Abstract PDF: Bilateral vocal cord paralysis may occur as a result of mechanical injury during neck surgery, nerve compression by endotracheal intubation or mass, trauma, and neuromuscular diseases. However, only a few cases of bilateral vocal cord paralysis have occurred following short-term endotracheal intubation. We report a case of bilateral vocal cord paralysis subsequent to extubation after endotracheal intubation and mechanical ventilation due to severe pneumonia for 2 days.

Vocal Cord Paralysis after the Coronary Artery Bypass Graft: A Case Report: Kwang Su Kim, Seong Wook Jeong, Sang Hyun Kwak, Myung Ha Yoon, Kyung Yeon Yoo, Chang Young Jeong, Sung Su Chung; Korean J Crit Care Med. 2005;20(2):170-173.

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Abstract PDF: Surgical trauma has long been recognized as the most common cause of unilateral and bilateral vocal cord paralysis. We experienced a case of bilateral vocal cord paralysis after off-pump coronary artery bypass graft. The patient was repeated intubation and extubation after operation in surgical intensive care unit. Fiberoptic bronchoscopy revealed bilateral vocal cord paralysis in the patient. The patient recovered after permanent tracheotomy. We reported a case of vocal cord paralysis after coronary artery bypass graft.

Misconception of Bilateral Vocal Cord Paralysis as Laryngeal Spasm after Endotracheal Extubation: Bong Jae Lee, Jae Yong Jeong, Doo Ik Lee, Dong Soo Kim; Korean J Crit Care Med. 1999;14(1):47-51.

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Abstract PDF: We recently experienced an unexpected episode of bilateral vocal cord paralysis following endotracheal extubation after uvulopalatopharyngoplasty and tonsillectomy in 64-year-old man. The patient had no any other clinical manifestations regarding larynx or vocal cord except sleep apnea syndrome prior to this operation. The surgical procedure lasted almost 120 minutes and surgery and anesthesia was uneventful. After restoration of his spontaneous respiration, we tried extubation as usual method. Regardless his effort of spontaneous respiration for several times, he was suddenly apneic and showed declining of arterial oxygen saturation on the pulse oximeter (SpO2). Then we tried reintubation as a decision of laryngeal spasm. This alternative episode of extubation and reintubation was tried again and the causative factor of this respiratory impairment was confirmed as bilateral vocal cord paralysis by fiberoptic bronchoscopic examination in the operating room. Almost two thirds of vocal cord function was restored after six months of operation.

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