A Two-Stage Bedside Intubation Method to Improve Success Rate of Post-pyloric Placement of Spiral Nasoenteric Tubes in Critically Ill Patients: A Multi-Center, Prospective Study

Abstract

BackgroundsProkinetic agents could improve the success rate of post-pyloric placement of self-propelled spiral nasoenteric tubes (NETs), and bedside blind technique might apply as a rescue therapy subsequent to spontaneous transpyloric migration failure. The objective of this study was to investigated the validity and safety of these two bedside intubation methods as a sequential procedure for post-pyloric placement of spiral NETs in critically ill patients.MethodsThe multicenter, prospective study was conducted in intensive care units of four tertiary hospitals (June 2020 to January 2021). Eligible patients received self-propelled spiral NET placements, promoted by prokinetic agents (Stage 1). An abdominal X-ray performed 24 h post-intubation confirmed the position of the tube tip. Patients with a failed transpyloric migration entered Stage 2, where beside blind intubation was conducted (reconfirmed by X-ray). The primary end point was the overall success rate of post-pyloric placement.ResultsThe overall success rate of post-pyloric placement of the spiral NET was 91.1% (73.4% in the third portion of the duodenum [D3] or beyond). The total adverse event rate was 21.0%, without any serious adverse events. In Stage 1, 55.6% of participants achieved transpyloric migration, of these, 44.4% migrated to D3 or beyond. The median time from decision to intubate to the initiation of enteral nutrition (EN) was 25 h. In Stage 2, 83.0% of patients had successful post-pyloric intubation (67.9% in D3 or beyond). The median time from decision to EN initiation after the two-stage process was 36 h.ConclusionsProkinetic agents-assisted self-propelled intubation and remedial bedside blind technique as a sequential procedure for post-pyloric placement of spiral NETs were effective and safe, and this two-stage process did not affect the implementation of early EN in critically ill patients.Trial RegistrationChinese Clinical Trial Registry, ChiCTR1900026381. Registered on 6 October 2019.

Comparison between the NUTRIC score and modified NUTRIC score to predict hospital mortality in cardiac surgery patients: A retrospective study

“…Similarly, an international study found that nutritional support for CS patients was the least adequate compared with other types of surgery [25]. Clinical physicians have carried out many studies to try to improve this poor nutritional status in a variety of ways, including developing nutrition assessment tools [26-28], optimizing nutrition support pathways [29][30][31][32], and exploring the best combination of nutrients [33,34].…”

Blind versus endoscopy‐guided postpyloric feeding tube placement in adults with ischemic stroke: A retrospective cohort study

“…However, this technique demands adequate training and advanced clinical skill, otherwise it is difficult to perform. 16 Another method is to place a feeding tube under endoscopic guidance, which has a higher success rate but is relatively expensive. 17 The purpose of this study is to compare the one-time success rate of blind and endoscopy-guided postpyloric feeding tube placement after implementing a comprehensive nursing scheme of intestinal blind placement.…”

“…Blind bedside insertion is a widely used technique for postpyloric placement in developing countries because it does not require expensive and sophisticated medical equipment. However, this technique demands adequate training and advanced clinical skill, otherwise it is difficult to perform 16 . Another method is to place a feeding tube under endoscopic guidance, which has a higher success rate but is relatively expensive 17 .…”