Development and validation of a nomogram for predicting self-propelled postpyloric placement of spiral nasoenteric tube in the critically ill: Mixed retrospective and prospective cohort study

Hu, Linhui; Nie, Zhiqiang; Zhang, Yichen; Zhang, Yanlin; Ye, Heng; Chi, Ruibin; Hu, Bei; Lv, Bo; Chen, Lifang; Zhang, Xiunong; Wang, Huajun; Chen, Chunbo

doi:10.1016/j.clnu.2018.12.008

Cited by 14 publications

(9 citation statements)

References 33 publications

(29 reference statements)

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“…Nomograms thrive in various environments because they allow fast and accurate calculations without the need for calculators. Predictive nomograms are derived from clinically available factors and provide a viewable, easy-to-use scale for predicting probability (36). Nomograms produce reliable results very rapidly, requiring only one or more lines to be drawn without substituting numbers into the equation.…”

Section: Discussionmentioning

confidence: 99%

Development and Validation of a Nomogram Incorporating Colloid Osmotic Pressure for Predicting Mortality in Critically Ill Neurological Patients

Hu²,

Fang

et al. 2021

Front. Med.

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Backgrounds: The plasma colloid osmotic pressure (COP) values for predicting mortality are not well-estimated. A user-friendly nomogram could predict mortality by incorporating clinical factors and scoring systems to facilitate physicians modify decision-making when caring for patients with serious neurological conditions.Methods: Patients were prospectively recruited from March 2017 to September 2018 from a tertiary hospital to establish the development cohort for the internal test of the nomogram, while patients recruited from October 2018 to June 2019 from another tertiary hospital prospectively constituted the validation cohort for the external validation of the nomogram. A multivariate logistic regression analysis was performed in the development cohort using a backward stepwise method to determine the best-fit model for the nomogram. The nomogram was subsequently validated in an independent external validation cohort for discrimination and calibration. A decision-curve analysis was also performed to evaluate the net benefit of the insertion decision using the nomogram.Results: A total of 280 patients were enrolled in the development cohort, of whom 42 (15.0%) died, whereas 237 patients were enrolled in the validation cohort, of which 43 (18.1%) died. COP, neurological pathogenesis and Acute Physiology and Chronic Health Evaluation II (APACHE II) score were predictors in the prediction nomogram. The derived cohort demonstrated good discriminative ability, and the area under the receiver operating characteristic curve (AUC) was 0.895 [95% confidence interval (CI), 0.840–0.951], showing good correction ability. The application of this nomogram to the validation cohort also provided good discrimination, with an AUC of 0.934 (95% CI, 0.892–0.976) and good calibration. The decision-curve analysis of this nomogram showed a better net benefit.Conclusions : A prediction nomogram incorporating COP, neurological pathogenesis and APACHE II score could be convenient in predicting mortality for critically ill neurological patients.

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Section: Discussionmentioning

confidence: 99%

Development and Validation of a Nomogram Incorporating Colloid Osmotic Pressure for Predicting Mortality in Critically Ill Neurological Patients

Hu²,

Fang

et al. 2021

Front. Med.

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“…Unfortunately, neither Silva's meta-analysis nor our results demonstrated the e cacy of metoclopramide, even though three RCTs were newly included in this updated meta-analysis. Several clinical heterogeneity deriving from participants (e.g., age, comorbidities, and concomitant medication) [28][29][30], operators (e.g., years of training, profession status, and educational degree of operators) [15,31], intervention (e.g., the timing of medication, the dosage of metoclopramide, and the type of feeding tube) [12][13][14][15][16][17][18], outcome assessment (e.g., the follow-up period and the assessment personnel) [12][13][14][15][16][17][18] and the like, as well as insu cient sample sizes, may be liable for failing to establish metoclopramide's bene cial effects.…”

Section: Discussionmentioning

confidence: 99%

Is metoclopramide beneficial for the post-pyloric placement of nasoenteric tubes? A systematic review and meta-analysis of randomized controlled trials

Ouyang

Hu³

et al. 2020

Preprint

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BackgroundMetoclopramide is frequently prescribed as an adjuvant for the post-pyloric placement of nasoenteric tubes (NETs). However, the efficacy and safety of metoclopramide remain controversial. The latest meta-analysis showed that metoclopramide was not beneficial in adults. Thus, this study aimed to reevaluate the effect of metoclopramide on the post-pyloric placement of NETs.MethodsA systematic search of PubMed, Embase, the Cochrane Library, Web of Science, Chinese National Knowledge Infrastructure (CNKI), and Wanfang data was conducted up to August 2020 for randomized controlled trials (RCTs) comparing metoclopramide with placebo or no intervention. The effect sizes of eligible studies were pooled using the relative risk (RR) and 95% confidence interval (CI) in a random-effects model. Trial sequential analysis (TSA) was used for the primary outcomes (the success rate of the post-pyloric placement of NETs).ResultsSeven eligible RCTs that included 520 participants were identified. The results of the pooled effect sizes showed that metoclopramide significantly facilitated the post-pyloric placement of NETs (RR, 1.48; 95% CI, 1.11–1.97; P = 0.007; I2 = 37%). However, the risk of bias assessment and the TSA results indicated that the qualities of the RCTs and the sample sizes were insufficient to confirm the efficacy of metoclopramide. Further subgroup analysis revealed that successful post-pyloric placement was more pronounced in studies in which spiral NETs were employed (RR, 1.85; 95% CI, 1.41–2.43; P < 0.001; I2 = 0%). Additionally, a significant increase in the success rate was also observed for post-D1 (reaching the second portion of the duodenum or beyond), post-D2 (reaching the third portion of the duodenum or beyond), and post-D3 (reaching the fourth portion of the duodenum or beyond) placement of spiral NETs. Overall adverse events were minimal.ConclusionsThe evidence accumulated so far was not strong enough to demonstrate metoclopramide’s beneficial effects on the post-pyloric placement of NETs; however, it might be effective for spiral NETs. Further high-quality, large-sample RCTs are required to elucidate the effects of metoclopramide.Trial registrationPROSPERO CRD42019123424 (10 July 2019)

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“…The inclusion of this rescue therapy in standardized teaching programmes would publicize its benefits and its utility in substantially improving the relatively low success rate of spontaneous transpyloric spiral NET placement despite the use of prokinetic drugs. 26,30–32 Elucidation of the learning curve could help intensivists to learn this rescue technique. It could also benefit patients; approximately 90% of patients in this cohort were AGI grade II or III, for whom the guidelines 33 recommend that initiation of postpyloric feeding should be considered when prokinetic medication is inadequate.…”

Section: Discussionmentioning

confidence: 99%

The learning curve in blind bedside postpyloric placement of spiral tubes: data from a multicentre, prospective observational study

Sun

Zheng

et al. 2019

J Int Med Res

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Objective This study sought to quantify the learning curve for the blind bedside postpyloric placement of a spiral tube in critically ill patients. Methods We retrospectively analysed 127 consecutive experiences of three intensivists who performed comparable procedures of blind bedside postpyloric placement of a spiral tube subsequent to failed self-propelled transpyloric migration in a multicentre study. Each intensivist’s cases were divided chronologically into two groups for analysis. The assessment of the learning curve was based on efficiency and safety outcomes. Results All intensivists achieved postpyloric placement for over 80% of their patients. The junior intensivist showed major improvement in both efficiency and safety outcomes, and the learning curve for both outcomes was approximately 20 cases. The junior intensivist showed a significant increase in the success rate of proximal jejunum placement and demonstrated a substantial decrease in the major adverse tube-associated events rate. The time to insertion significantly decreased in each intensivist as case experience accumulated. Conclusions Blind bedside postpyloric placement of a spiral tube involves a significant learning curve, indicating that this technique could be readily acquired by intensivists with no previous experience using an adequate professional training programme.

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Development and validation of a nomogram for predicting self-propelled postpyloric placement of spiral nasoenteric tube in the critically ill: Mixed retrospective and prospective cohort study

Abstract: Conclusions: A prediction nomogram that incorporates primary diagnosis, together with APACHE II score and AGI grade can be conveniently used to facilitate the pre-insertion individualized prediction of postpyloric nasoenteric tube placement in critically ill patients.

Cited by 14 publications

References 33 publications

Development and Validation of a Nomogram Incorporating Colloid Osmotic Pressure for Predicting Mortality in Critically Ill Neurological Patients

Development and Validation of a Nomogram Incorporating Colloid Osmotic Pressure for Predicting Mortality in Critically Ill Neurological Patients

Is metoclopramide beneficial for the post-pyloric placement of nasoenteric tubes? A systematic review and meta-analysis of randomized controlled trials

The learning curve in blind bedside postpyloric placement of spiral tubes: data from a multicentre, prospective observational study

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