Tsolaki Vasiliki, Zakynthinos George E, Zygoulis Paris, Bardaka Fotini, Malita Aikaterini, Aslanidis Vasileios, Zakynthinos Epaminondas, Makris Demosthenes
Critical Care Department, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, Mezourlo, 41335 Larissa, Greece.
J Pers Med. 2022 Feb 23;12(3):337. doi: 10.3390/jpm12030337.
Nasogastric tube (NGT) placement is a daily routine in the Intensive Care Unit (ICU), and misplacement of the NGT can cause serious complications. In COVID-19 ARDS patients, proning has emerged the need for frequent NGT re-evaluations. The gold standard technique, chest X-ray, is not always feasible. In the present study we report our experience with the use of ultrasonographic confirmation of NGT position.
A prospective study in 276 COVID-19 ARDS patients admitted after intubation in the ICU. Ultrasonographic evaluation was performed using longitudinal or sagittal epigastric views. Examinations were performed during the initial NGT placement and every time the patients returned to the supine position after they had been proned or whenever critical care physicians or nurses considered that reconfirmation was necessary.
Ultrasonographic confirmation of correct NGT placement was feasible in 246/276 (89.13%) patients upon ICU admission. In 189/246 (76.8%) the tube could be visualized in the stomach (two parallel lines), in 172/246 (69.9%) the ultrasonographic whoosh test ("flash" due to air instillation through the tube, seen with ultrasonography) was evident, while in 164/246 (66.7%) both tests confirmed correct NGT placement. During ICU stay 590 ultrasonographic NGT evaluations were performed, and in 462 (78.14%) cases correct NGT placement were confirmed. In 392 cases, a chest X-ray was also ordered. The sensitivity of ultrasonographic NGT confirmation in these cases was 98.9%, specificity 57.9%, PPV 96.2%, and NPV 3.8%. The time for the full evaluation was 3.8 ± 3.4 min.
Ultrasonographic confirmation of correct NGT placement is feasible in the initial placement, but also whenever needed thereafter, especially in the COVID-19 era, when changes in posture have become a daily practice in ARDS patients.
鼻胃管（NGT）置入是重症监护病房（ICU）的日常工作，而NGT误置会导致严重并发症。在新型冠状病毒肺炎（COVID-19）急性呼吸窘迫综合征（ARDS）患者中，俯卧位通气使得需要频繁重新评估NGT。金标准技术胸部X线检查并不总是可行的。在本研究中，我们报告了使用超声确认NGT位置的经验。
对276例在ICU插管后收治的COVID-19 ARDS患者进行前瞻性研究。使用上腹部纵切面或矢状切面进行超声评估。在初次置入NGT时以及患者俯卧位后每次恢复仰卧位时，或在重症监护医师或护士认为有必要重新确认时进行检查。
276例患者中，246例（89.13%）在入住ICU时通过超声确认NGT置入正确。在246例中的189例（76.8%）中，可在胃内看到胃管（两条平行线），172例（69.9%）超声“呼呼”试验（通过胃管注入空气时超声可见“闪烁”）明显，而164例（66.7%）两种检查均确认NGT置入正确。在ICU住院期间，共进行了590次超声NGT评估，其中462例（78.14%）确认NGT置入正确。在392例中还进行了胸部X线检查。这些病例中超声确认NGT的敏感性为98.9%，特异性为57.9%，阳性预测值为96.2%，阴性预测值为3.8%。完整评估所需时间为3.8±3.4分钟。
超声确认NGT正确置入在初次置入时是可行的，此后在需要时也可行，尤其是在COVID-19时代，此时ARDS患者改变体位已成为日常操作。
