Bedside ultrasonic localization of the nasogastric tube in a patient with severe COVID-19:A case report

BACKGROUND The indwelling nasogastric tube is commonly used for supplying enteral nutrition to patients who are unable to feed themselves,and accurate positioning is essential in the indwelling nasogastric tube in the body of the aforementioned patients.In clinical practice,abdominal radiography,auscultation,and clinical determination of the pH of the gastric juice are routinely used by medical personnel to determine the position of the tube;however,those treatments have proved limitations in specific cases.There are few case reports on the precise positioning of the nasogastric tube in patients with coronavirus disease 2019(COVID-19),for whom a supply of necessary nutrition support is significant throughout the process of treatment.CASE SUMMARY A 79-year-old patient,diagnosed with COVID-19 at the stage of combined syndromes with severe bacterial lung infection,respiratory failure,multiple comorbidities,and a poor nutritional status,was presented to us and required an indwelling nasogastric tube for enteral nutrition support.After pre-treatment assessments including observation of the patient’s nasal feeding status and examination of the nasal septal deviation,inflammation,obstruction,nasal leakage of cerebrospinal fluid,and other disorders that might render intubation inappropriate,we measured and marked the length of the nasogastric tube to be placed and delivered the tube to the intended length in the standard manner.Then further scrutiny was conducted to ensure that the tube was not coiled in the mouth,and gentle movements were made to avoid damage to the esophageal mucosa.However,back draw of the gastric juice using an empty needle failed,and the stethoscope could not be used for auscultation due to the specific condition presented by the internal organs of the patient,and the end of the tube was placed in saline with no bubbles spilling out.Therefore,it was not possible to determine whether the nasogastric tube was placed exactly in the stomach and no nutrient infusion was performed for the time being.Subsequently,the ultrasound probe was utilized to view the condition of the patient’s stomach,where the nasogastric tube was found to be translucent and running parallel to the esophagus shaped as“=”.The pre-conditions were achieved and 100 mL nutritional fluid was fed to the patient,who did not experience any discomfort throughout the procedure.His vital signs were stable with no adverse effects.CONCLUSION We achieved successfully used ultrasound to position the nasogastric tube in a 79-year-old patient with COVID-19.The repeatable ultrasound application does not involve radiation and causes less disturbance in the neck,making it advantageous for rapid positioning of the nasogastric tube and worthy of clinical promotion and application.

Response of Lettuce to the Coupling Electrical Conductivity and Circulation Rate of the Nutrient Solution in Hydroponics

The coupling effect of nutrient solution EC （electrical conductivity） levels and CR （circulation rate） on the morphology and quality, in hydroponically grown lettuce was assessed. Lettuce was grown at 5 treatments fi＇om High EC ＆ Low CR to Low EC ＆ High CR. The environmental parameters were controlled in a 20 m^2 plant factory during the hydroponic cultivation with the following values： irradiated by blue and red light-emitting diode lighting with PPFD （photosynthetic photon flux density） value of 150 mol·m^-2·s^-1 for 16 hours per day; Temperature was maintained at 22.0 ℃ during the photoperiod and 16.0 ℃ in dark cycle. The results demonstrate that growing lettuce can be adopted using nutrient solution with lower EC levels and higher CR. The results also indicate that the effect of bi-directional coupled EC and CR resulted in expansion of root length but reducing the root biomass. Nitrate content was significantly reduced.