Pneumothorax due to nasogastric feeding tubes. Report of four cases, review of the literature, and recommendations for prevention

Intrapulmonary placement of small-bore nasogastric feeding tubes caused pneumothoraces in four patients. Review of the literature discloses another 106 cases of the same complication. Risk factors for intrapulmonary complications include endotracheal intubation or tracheostomy (60% of reported cases 95% confidence interval, 44% to 80%), and altered mental status (36% of reported cases 95% confidence interval, 24% to 53%). We propose a simple, two-step method of feeding tube insertion designed to prevent such complications in high-risk patients.