INTRACRANIAL NASOGASTRIC TUBE MISPLACEMENT: A SYSTEMATIC REVIEW AND PROPOSAL OF THE MOHAN SAFE-NG PROTOCOL

Abstract

Background: Intracranial nasogastric tube (NGT) misplacement is a rare but potentially catastrophic complication of a commonly performed bedside procedure. Risk is increased when skull-base anatomy is disrupted or when patients have altered sensorium. Objective: To summarize reported cases of intracranial NGT misplacement, characterize risk factors, anatomical routes, complications and outcomes, and propose an ICU-oriented safety framework. Methods: A systematic review of published human reports was undertaken. Peer-reviewed English-language reports published from 1980 to 2024 were considered; duplicate reports, animal studies and reports lacking adequate clinical detail were excluded. Data were summarized descriptively. Results: Sixty-two cases from 50 studies were reported. ICU patients accounted for 79%, altered sensorium was present in 67.7%, and the cribriform plate was the most frequent route (64.5%). Meningitis/encephalitis occurred in 45.2%, intracranial hemorrhage in 19.4%, persistent neurological deficits in 25.8%, and mortality was 12.9%. Conclusion: Intracranial NGT misplacement carries substantial morbidity and mortality. The MOHAN SAFE NG Protocol provides a structured framework emphasizing risk assessment, oral visualization, correct measurement, airway exclusion, ultrasound as an adjunct, skull-base screening, cautious advancement, radiological confirmation and governance. Prospective validation is required.