A comparison of nasogastric tube insertion by SORT maneuver (sniffing position, NGT orientation, contralateral rotation, and twisting movement) versus neck flexion lateral pressure in critically ill patients admitted to ICU: a prospective randomized clinical trial

Abstract

Background: Although many techniques have been introduced to facilitate nasogastric tube (NGT) insertion using anatomic landmarks and a group of devices, there is a lack of general consensus regarding a standard method. The current study purposed to investigate if SORT maneuver (sniffing position, NGT orientation, contralateral rotation, and twisting movement) increases the success rate of NGT correct placement versus neck flexion lateral pressure (NFLP) method. Methods: A randomized controlled trial study was conducted in two university affiliated intensive care units (tertiary referral center). Three hundred and ninety-six critically ill patients older than 18 years of age were randomly divided into SORT (n = 200) and NFLP (n = 196) groups. The technique was classified as "failed" after the third unsuccessful attempt. Patient characteristics, success rate for the first attempt, time required for the successful first attempt and overall successful insertion time, various complications including kinking, coiling and bleeding and ease of insertion were noted as main outcomes measured. Results: Ease of insertion was significantly better in the SORT group compared to the NFLP group (P < 0.001). The number of failed attempts was significantly higher in the NFLP group (7.5%) vs the SORT group (3.0%) (P = 0.046). The pattern of complications was not different between two study groups (P = 0.242). The odds of stage II (odds ratio (OR) = 49.9; 95% confidence interval (CI) 25.2 to 98.6), stage III (OR = 67.1; 95% CI 14.9 to 302.8)) and stage IV (OR = 11.8; 95% CI 3.4 to 41.2) ease of insertion were much higher in NFLP compared to SORT group, after adjusting for age and body mass index (BMI). The odds of failure was not significantly different in NFLP group compared to SORT group (OR = 2.3; 95% CI 0.85 to 6.3), after adjusting for age and BMI.

Gastrointestinal Tube Insertion Techniques in Critical Patients: Scoping Review

“…For this, methods without the aid of instruments are described, i.e. : head flexion 28 , lateral neck pressure 29 , tube freezing 20 , measurement with corrected formula of the tip of the ear-lobe to the xiphoid process , reverse Sellick´s maneuver 20 , compression on the cricoid cartilage [28][29] , sort maneuver 19 and gastric insufflation 41 .…”

Nasogastric tube insertion in anesthetized, intubated adult patients: A comparison between conventional blind insertion technique and “throat pack in situ” technique

“…Broadly, the methods can be classified as "device based" and "manipulation of posture" or maneuvers. 5 Many modifications of blind technique, such as "neck flexion" 1 "neck flexion with lateral pressure" technique, 6 reverse Sellick's manoeuvre, 7 and frozen NGT technique 8 have been used to facilitate NGT insertion with variable success. In the recent past, there is a brief mention that insertion of NGT after placement of throat pack is possible.…”

Improving the safety of nasogastric tube insertion by the “SORT maneuver” during the novel coronavirus pandemic (COVID-19)

“…Feasibility of NGT insertion and the number of attempts for intubation matter as well, when it comes to a safe bedside practice. The first clinical trial reporting successful employment of SORT maneuver for NGT insertion in unconscious patients admitted to intensive care unit was just recently published with promising results [ 6 ]. This study showed that ease of insertion was considerably greater and success rate was much higher for SORT maneuver than the other conventional technique of neck flexion and lateral pressure.…”