Xu Jing, Li Sinian, Chen Xiangyin, Tan Bo, Chen Shenglong, Hu Bei, Nie Zhiqiang, Ye Heng, Sun Cheng, Chi Ruibin, Chen Chunbo
Department of Intensive Care Unit of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
Department of Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
Front Med (Lausanne). 2022 May 12;9:875298. doi: 10.3389/fmed.2022.875298. eCollection 2022.
Prokinetic 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.
The 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.
The 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.
Prokinetic 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.
Chinese Clinical Trial Registry, ChiCTR1900026381. Registered on 6 October 2019.
促动力药物可提高自推进式螺旋鼻肠管（NETs）幽门后置管的成功率，床边盲插技术可作为自发经幽门迁移失败后的补救治疗方法。本研究的目的是探讨这两种床边插管方法作为重症患者螺旋NETs幽门后置管序贯程序的有效性和安全性。
这项多中心前瞻性研究在四家三级医院的重症监护病房进行（2020年6月至2021年1月）。符合条件的患者接受促动力药物辅助的自推进式螺旋NETs置管（第1阶段）。插管后24小时进行腹部X线检查以确认管尖位置。经幽门迁移失败的患者进入第2阶段，在此阶段进行床边盲插（经X线再次确认）。主要终点是幽门后置管的总体成功率。
螺旋NETs幽门后置管的总体成功率为91.1%（十二指肠第三部[D3]或更远部位为73.4%）。总不良事件发生率为21.0%，无严重不良事件。在第1阶段，55.6%的参与者实现了经幽门迁移，其中44.4%迁移至D3或更远部位。从决定插管到开始肠内营养（EN）的中位时间为25小时。在第2阶段，83.0%的患者幽门后置管成功（D3或更远部位为67.9%）。两阶段过程后从决定到开始EN的中位时间为36小时。
促动力药物辅助的自推进式插管和补救性床边盲插技术作为螺旋NETs幽门后置管的序贯程序是有效且安全的，并且这一两阶段过程不影响重症患者早期EN的实施。
中国临床试验注册中心，ChiCTR1900026381。于2019年10月6日注册。
