Smithard David, Barrett Nicholas A, Hargroves David, Elliot Stuart
King's College, London, UK,
Dysphagia. 2015 Jun;30(3):275-85. doi: 10.1007/s00455-015-9607-4. Epub 2015 May 6.
Enteral feeding is the nutritional support of choice for acutely ill patients with functional gastrointestinal tracts who are unable to swallow. Several benefits including reduced mortality and length of hospital stay have been associated with early initiation of enteral feeding. However, misplacement of conventional nasoenteric tubes is relatively common and can result in complications including pneumothorax. In addition, the need to confirm the position by X-ray can delay the start of using the tube. Eliminating these delays can help patients start feeding, and minimise the adverse impact on initiating hydration and medication. The purpose of this review was to critically examine whether electromagnetic sensor-guided enteral access systems (EMS-EAS) can help overcome the challenges of conventional nasoenteric feeding tube placement and confirmation. The Royal Society of Medicine's library performed two searches on Medline (1946-March 2014) and Embase (1947-March 2014) covering all papers on Cortrak or electromagnetic or magnetic guidance systems for feeding tubes in adults. Results from the literature search found an agreement between the radiographic and EMS-EAS confirmation of placement. EMS-EAS virtually eliminated the risk of misplacement and pneumothorax was not reported. In addition, studies showed a small decrease in the number of X-rays with EMS-EAS and a reduced average time to start feeding compared with blind placement. This review suggests that EMS-EAS reduces several complications associated with the misplacement of nasoenteric feeding tubes, and that there could be considerable improvements in mortality, morbidity, patient experience and cost if EMS-EAS is used instead of conventional methods.
肠内营养喂养是无法吞咽的急性病且胃肠道功能正常患者的营养支持首选方式。早期开始肠内营养喂养与包括降低死亡率和缩短住院时间在内的多项益处相关。然而，传统鼻肠管放置错位相对常见，可能导致包括气胸在内的并发症。此外，通过X射线确认位置的需求可能会延迟鼻肠管的使用开始时间。消除这些延迟有助于患者开始喂养，并将对开始补液和用药的不利影响降至最低。本综述的目的是严格审查电磁传感器引导的肠内通路系统（EMS-EAS）是否有助于克服传统鼻肠喂养管放置和确认的挑战。皇家医学院图书馆在Medline（1946年 - 2014年3月）和Embase（1947年 - 2014年3月）上进行了两次检索，涵盖了所有关于Cortrak或电磁或磁导向系统用于成人喂养管的论文。文献检索结果发现，X射线检查与EMS-EAS对放置的确认结果一致。EMS-EAS几乎消除了放置错位的风险，且未报告气胸情况。此外，研究表明，与盲目放置相比，使用EMS-EAS时X射线检查次数略有减少，开始喂养的平均时间缩短。本综述表明，EMS-EAS减少了与鼻肠喂养管放置错位相关的多种并发症，并且如果使用EMS-EAS而非传统方法，在死亡率、发病率、患者体验和成本方面可能会有显著改善。
