Placement of a nasogastric tube

I recently read the article “Brain Tissue Oxygen Monitoring in Severe Brain Injury, II (August 2003:29–44). I found this article very insightful, but I must disagree (clarify) one point. Table 1 calls for the placement of a nasogastric tube; however, traumatically brain-injured patients may also have basilar skull fractures (the periorbital ecchymosis or Battle’s sign may not manifest itself for a few hours) and there may be associated facial fractures. Therefore, we teach that an orogastric tube should be inserted in the face of traumatically brain-injured patients. This article was cited recently during a discussion we were having in our surgical intensive care unit. Gastric decompression is important, but the nasal route should be avoided initially until all other injuries are ruled out.

The reader raises a point that needs clarification. According to ATLS and ATCN guidelines, placement of a tube to the stomach for gastric decompression in a severely...