A Two-Stage Bedside Intubation Method to Improve Success Rate of Post-pyloric Placement of Spiral Nasoenteric Tubes in Critically Ill Patients: A Multi-Center, Prospective Study

Jing Xu; Sinian Li; Xiangyin Chen; Bo Tan; Shenglong Chen; Bei Hu; Zhiqiang Nie; Heng Ye; Cheng Sun; Ruibin Chi; Chunbo Chen

doi:10.3389/fmed.2022.875298

A Two-Stage Bedside Intubation Method to Improve Success Rate of Post-pyloric Placement of Spiral Nasoenteric Tubes in Critically Ill Patients: A Multi-Center, Prospective Study

Front Med (Lausanne). 2022 May 12:9:875298. doi: 10.3389/fmed.2022.875298. eCollection 2022.

Authors

Jing Xu^{1

2

3}, Sinian Li⁴, Xiangyin Chen⁵, Bo Tan⁶, Shenglong Chen², Bei Hu², Zhiqiang Nie⁷, Heng Ye⁸, Cheng Sun², Ruibin Chi⁹, Chunbo Chen^{1

2

3

10}

Affiliations

¹ Department of Intensive Care Unit of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
² Department of Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
³ The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
⁴ Neurological Intensive Care Unit, Maoming People's Hospital, Maoming, China.
⁵ Surgical Intensive Care Unit, Maoming People's Hospital, Maoming, China.
⁶ Department of Emergency, Maoming People's Hospital, Maoming, China.
⁷ Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
⁸ Department of Critical Care Medicine, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China.
⁹ Department of Critical Care Medicine, Xiaolan People's Hospital of Zhongshan, Zhongshan, China.
¹⁰ Department of Critical Care Medicine, Maoming People's Hospital, Maoming, China.

Abstract

Backgrounds: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Trial registration: Chinese Clinical Trial Registry, ChiCTR1900026381. Registered on 6 October 2019.

Keywords: blind bedside; critically ill patients; enteral nutrition; post-pyloric placement; prokinetic agents; self-propelled nasoenteric tubes.