Gastric myoelectrical activities in elderly severe tetanus: Useful marker to increase volume and calorie of nasogastric tube feeding

Summary Background & aims Early high nasogastric tube feeding (NTF) is effective for improving the nutritional status of critical illness. However, potential complications of NTF in tetanus include aspiration pneumonia because of dysphagia and gastrointestinal dysfunction induced by over-activity of autonomic nervous system. Methods We serially evaluated gastric myoelectrical activities using electrogastrogram (EGG) recorder in 4 elderly severe tetanus patients, and assessed its potential as a marker to increase volume and calorie of NTF. Results Although dominant frequencies of EGG in all patients (1.8 ± 0.6 cycle/min (cpm)) were lower than those in healthy volunteers (2.9 ± 0.2 cpm) at least until 12th hospital day, it tended to improve from 14–24th hospital day and reached the same levels in healthy volunteers at least until 28th hospital day. We transferred total NTF along their metabolic costs when the timing of dominant frequency tended to improve in each patient (17–24th hospital day). No aspiration pneumonia and malnutrition occurred in their hospital days. Conclusion EGG data may be a useful marker to know the level of over-activity of autonomic nervous system and to guess the best timing to increase volume and calorie of NTF especially in elderly severe tetanus.