Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China.
Department of Neurosurgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China.
J Crit Care. 2018 Dec;48:216-221. doi: 10.1016/j.jcrc.2018.09.001. Epub 2018 Sep 6.
We aimed to compare the effectiveness of EM-guided and endoscopic nasoenteral feeding tube placement among critically ill patients.
We performed a single-center, randomized controlled trial among 161 adult patients admitted to intensive care units (ICUs) requiring nasoenteral feeding. Patients were randomly assigned to EM-guided or endoscopic nasoenteral feeding tube placement (1:1). The primary end point was the total success rate of correct jejunal placement.
This was achieved in 74/81 and 76/80 patients who underwent EM-guided and endoscopic jejunal tube placements, respectively (91.4% vs. 95%; relative risk, 0.556; [CI], 0.156-1.980; P = 0.360). The EM-guided group had more placement attempts, longer placement time, and shorter inserted nasal intestinal tube length. However, they had shorter total placement procedure duration and physician's order-tube placement and order-start of feeding intervals. The EM-guided group had higher discomfort level and recommendation scores and lesser patient costs. This trial is registered at Chinese Clinical Trials Registry (ChiCTR-IOR-17011737).
Bedside EM-guided placement is as fast, safe, and successful as endoscopic placement and may be considered the preferred technique in critically ill patients.
比较在危重症患者中，经电磁导航（EM）引导与内镜下鼻肠管置管的效果。
我们开展了一项单中心、随机对照试验，纳入了 161 例需接受肠内营养的 ICU 成年患者。患者被随机分配至 EM 引导或内镜下鼻肠管置管（1:1）。主要终点是正确置入空肠的总成功率。
分别有 74/81 例和 76/80 例接受 EM 引导和内镜下空肠置管的患者达到了这一终点（91.4% vs. 95%；相对风险，0.556；[CI]，0.156-1.980；P=0.360）。EM 引导组的置管尝试更多，置管时间更长，置入的鼻肠管长度更短。然而，其总置管操作时间和医生下置管医嘱至开始喂养医嘱的时间更短。EM 引导组的不适感评分和推荐度更高，患者费用更低。本试验已在中国临床试验注册中心（ChiCTR-IOR-17011737）注册。
床旁 EM 引导置管与内镜下置管同样快速、安全且有效，可作为危重症患者的首选技术。
