Yokose Masashi, Takaki Shunsuke, Saigusa Yusuke, Mihara Takahiro, Ishiwata Yoshinobu, Kato Shingo, Horie Keiichi, Goto Takahisa
Department of Anesthesiology and Critical Care Medicine, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, Japan.
Department of Biostatistics, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
J Intensive Care. 2023 May 30;11(1):25. doi: 10.1186/s40560-023-00673-4.
Post-pyloric enteral feeding reduces respiratory complications and shortens the duration of mechanical ventilation. Blind placement of post-pyloric enteral feeding tubes (EFT) in patients with critical illnesses is often the first-line method because endoscopy or fluoroscopy cannot be easily performed at bedside; however, difficult placements regularly occur. We reported an association between the stomach position caudal to spinal level L1-L2, evaluated by abdominal radiographs after placement, and difficult placement; however, this method could not indicate difficulty before EFT placement. The aim of our study was to evaluate the association between stomach position, estimated using computed tomography (CT) images taken before the blind placement of the post-pyloric EFT, and the difficulty of EFT placement.
Data from patients aged ≥ 20 years who underwent post-pyloric EFT in our intensive care unit were obtained retrospectively. Logistic regression analysis was used to evaluate the association between successful initial EFT placement and explanatory variables, including stomach position estimated by CT. Two cut-off values were used: caudal to L1-L2 based on a previous study and the best cut-off value calculated by the receiver operating characteristic curve. Variable selection was performed backward stepwise using Akaike's Information Criterion.
Of the total of 453 patients who were enrolled, the success rate of the initial EFT placement was 43.5%. The adjusted odds ratio for successful initial EFT placement of the stomach position caudal to L1-L2 was 0.61 (95% confidence interval: 0.41-1.07). Logistic regression analysis, including the stomach position caudal to L2-L3, calculated as the best cut-off value, indicated that stomach position was an independent factor for failure of initial EFT placement (adjusted odds ratio, 0.55; 95% confidence interval: 0.33-0.91).
Stomach position evaluated using CT images was associated with successful initial post-pyloric EFT placement. The best cut-off value of the greater curvature of the stomach to predict the success or failure of the first attempt was spinal level L2-L3. Trial registration University Hospital Medical Information Network Clinical Trials Registry (UMIN000046986; February 28, 2022). https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000052151.
幽门后肠内营养可减少呼吸系统并发症并缩短机械通气时间。对于危重症患者，盲插幽门后肠内营养管（EFT）通常是一线方法，因为床边难以轻易进行内镜检查或透视检查；然而，插管困难情况经常发生。我们报告了放置后通过腹部X线片评估的胃位置低于脊柱L1 - L2水平与插管困难之间的关联；然而，这种方法无法在放置EFT之前提示困难情况。我们研究的目的是评估在幽门后EFT盲插之前使用计算机断层扫描（CT）图像估计的胃位置与EFT放置难度之间的关联。
回顾性收集了我们重症监护病房中年龄≥20岁且接受幽门后EFT的患者数据。采用逻辑回归分析评估首次EFT放置成功与解释变量之间的关联，包括通过CT估计的胃位置。使用了两个截断值：基于先前研究的低于L1 - L2以及通过受试者工作特征曲线计算出的最佳截断值。使用赤池信息准则进行反向逐步变量选择。
在纳入的453例患者中，首次EFT放置成功率为43.5%。胃位置低于L1 - L2时首次EFT放置成功的调整优势比为0.61（95%置信区间：0.41 - 1.07）。逻辑回归分析包括将低于L2 - L3的胃位置计算为最佳截断值，结果表明胃位置是首次EFT放置失败的独立因素（调整优势比，0.55；95%置信区间：0.33 - 0.91）。
使用CT图像评估的胃位置与首次幽门后EFT放置成功相关。预测首次尝试成功或失败的胃大弯最佳截断值为脊柱L2 - L3水平。试验注册大学医院医学信息网络临床试验注册中心（UMIN000046986；2022年2月28日）。https://center6.umin.ac.jp/cgi - open - bin/ctr/ctr_view.cgi?recptno = R000052151。
