Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India.
Eur J Emerg Med. 2022 Dec 1;29(6):431-436. doi: 10.1097/MEJ.0000000000000962. Epub 2022 Jul 14.
The complications of a blind procedure for gastric tube placement are well documented. POCUS has been widely used to confirm the position of blindly inserted gastric tubes, and it does not prevent complications caused by the blind method. We performed a randomized controlled trial to compare gastric tube insertion with real-time oesophagus visualization using POCUS to the standard technique.
The primary goal of this study was to compare the accuracy of real-time POCUS-guided nasogastric tube (NGT) insertion and confirmation to that of the standard technique.
It was a prospective, parallel-group, open-label randomized controlled trial with a superiority design. All patients requiring NGT were screened for inclusion and exclusion criteria, and 120 patients were randomly assigned to one of two groups: POCUS ( n = 60) or control ( n = 60). Following the procedures, confirmatory chest radiographs were obtained in both groups.
As per protocol, 118 patients were analyzed. In POCUS group, the oesophagus was visualized on POCUS in 56 of 58 patients (96.5%). In 55 of 58 cases (94.8%), an NGT was inserted in real time. Despite visualizing the oesophagus, we fail to insert the tube in one (1.8%). The oesophagus could not be seen on the scan in two cases (3.4%). Chest radiographs confirmed the tube in the stomach in 55 (98.2%). The chest radiograph revealed the tip of the NGT in the stomach in 52 of 60 (86.6%) patients. In seven cases (11.7%), we were unable to insert NGT. On a chest radiograph, one (1.6%) tip of the tube was seen in the right lung and was safely removed. The ultrasound-guided gastric tube insertion had a sensitivity of 96.5% (95% CI, 88-99.6%) and a positive predictive value (PPV) of 98.2% (95% CI, 98.1-98.3%). The conventional technique had 88% (95% CI, 77-95%) sensitivity and a PPV of 98% (95% CI, 97.9-98.2%).
POCUS enables real-time insertion of a gastric tube with high sensitivity, in a short time with high first-attempt success rate and limited passage-related complications. POCUS should be utilized for NGT insertion whenever expertise is available on the bedside.
胃管放置的盲目操作会引发多种并发症，这是有据可查的。POCUS 已广泛用于确认盲目插入的胃管的位置，但并不能预防盲目方法引起的并发症。我们进行了一项随机对照试验，比较了使用 POCUS 实时可视化食管与标准技术对胃管插入的效果。
本研究的主要目的是比较实时 POCUS 引导下鼻胃管（NGT）插入和确认与标准技术的准确性。
这是一项前瞻性、平行组、开放标签的随机对照试验，采用优效性设计。所有需要 NGT 的患者均进行了纳入和排除标准的筛查，120 名患者被随机分配到两组之一：POCUS 组（n=60）或对照组（n=60）。两组均在操作后进行确认性胸部 X 线检查。
按照方案，对 118 名患者进行了分析。在 POCUS 组中，58 名患者中有 56 名（96.5%）在 POCUS 上观察到食管。在 58 例中有 55 例（94.8%）实时插入了 NGT。尽管观察到食管，但我们仍有 1 例（1.8%）未能插入管。有 2 例（3.4%）扫描未观察到食管。55 例（98.2%）的胸部 X 线证实管在胃内。胸部 X 线显示 60 例中有 52 例（86.6%）的 NGT 尖端在胃内。在 7 例（11.7%）中，我们无法插入 NGT。在胸部 X 线上，1 例（1.6%）管的尖端出现在右肺中，并且安全地取出。超声引导胃管插入的灵敏度为 96.5%（95%CI，88-99.6%），阳性预测值（PPV）为 98.2%（95%CI，98.1-98.3%）。传统技术的灵敏度为 88%（95%CI，77-95%），PPV 为 98%（95%CI，97.9-98.2%）。
POCUS 能够实时插入胃管，具有高灵敏度、短时间、高首次尝试成功率和有限的通道相关并发症。只要床边具备专业知识，就应使用 POCUS 进行 NGT 插入。
