超声在重症监护中确定鼻胃管正确位置的准确性

CHEST critical care Pub Date : 2025-05-29 DOI:10.1016/j.chstcc.2025.100181

Alessandro F. Chiesa MD , Giulia Nenna MD , Christian Nicole , Francesco Caronni MD , Michael Llamas MD , Elisa Racina MD , Marco Previsdomini MD , Andrea Garbagnati MD , Alberto Pagnamenta MD

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引用次数: 0

摘要

背景：鼻胃管（NGTs）在icu中被频繁使用。射线照相确认正确的放置位置是最佳的可用标准。根据Cochrane最近发表的一篇系统综述，超声检查作为一种单一的检查，在确认正确的位置方面准确性不足。研究问题：在两步的方法中，超声检查与胃上水平的动态雾化测试是否可靠，以确定正确的NGT位置？研究设计与方法本研究在瑞士的4个icu进行。超声检查包括2部分：颈部扫描和上腹部扫描加注射试验。出于安全考虑，只有在食管可见NGT的患者进行了注射检查的胃壁成像。我们考虑了3种注射试验结果：正确放置，不正确放置或不确定放置在胃中。诊断试验与参考标准的比较允许评估敏感性、特异性、阳性预测值、阴性预测值和准确性。结果有182例患者符合研究条件。平均年龄68岁，男性122例，肥胖42例，机械通气120例。10例患者因违反方案或未能观察到食管内的NGT而被排除在最终分析之外。动态雾化检测结果分别为阳性125例（73%）、阴性39例（22%）和不确定8例（5%）。排除不确定的结果，该试验灵敏度为79% (95% CI, 71.4% ~ 84.7%)，特异性为100% (95% CI, 47.8% ~ 100%)，阳性预测值为100% (95% CI, 97.1% ~ 100%)，阴性预测值为13% (95% CI, 4.3% ~ 27.4%)，准确率为79.3% （95% CI, 72.3% ~ 85.2%）。考虑到不确定的阳性和阴性结果，我们获得了类似的诊断测试性能。我们的研究结果表明，在ICU环境下，动态雾化试验是一种可靠的方法来确认胃内NGT的放置。它可以减少相当数量的患者对x线摄影的需求。临床试验注册网站clinicaltrials .gov；否。: NCT06693219;URL: www.clinicaltrials.gov

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Accuracy of Ultrasonography in Confirming Correct Positioning of Nasogastric Tube in the Intensive Care Setting

Background

Nasogastric tubes (NGTs) are used frequently in ICUs. Radiographic confirmation of correct placement represents the best available standard. According to a recently published Cochrane systematic review, ultrasonography has insufficient accuracy as a single test to confirm the correct placement.

Research Question

In a 2-step approach, is ultrasonography with a dynamic fogging test at the epigastric level reliable to confirm correct NGT placement?

Study Design and Methods

The study was conducted at 4 ICUs in Switzerland. The ultrasonography consisted of 2 parts: neck scan and epigastric scan with injection test. For safety concerns, only patients with a visible NGT in the esophagus underwent epigastric imaging with an injection test. We considered 3 results for the injection test: correct placement, incorrect placement, or uncertain placement in the stomach. Comparisons between the diagnostic test and the reference standard permitted to assess sensitivity, specificity, positive predictive value, negative predictive value, and accuracy.

Results

One hundred eighty-two patients were eligible for the study. The mean age was 68 years, 122 patients were male, 42 patients had obesity, and 120 patients were mechanically ventilated. Ten patients had to be excluded from the final analysis because of protocol violation or failed visualization of NGT in the esophagus. Dynamic fogging detection results were positive, negative, and inconclusive in 125 patients (73%), 39 patients (22%), and 8 patients (5%), respectively. Excluding inconclusive results, the test showed sensitivity of 79% (95% CI, 71.4%-84.7%), specificity of 100% (95% CI, 47.8%-100%), positive predictive value of 100% (95% CI, 97.1%-100%), negative predictive value of 13% (95% CI, 4.3%-27.4%), and an accuracy of 79.3% (95% CI, 72.3%-85.2%). Considering inconclusive results as both positive and negative, we obtained similar diagnostic test performances.

Interpretation

Our results indicate that in the ICU setting, the dynamic fogging test is a reliable method to confirm NGT placement in the stomach. It could reduce the need for radiography in a considerable number of patients.

Clinical Trial Registration

ClinicalTrials.gov; No.: NCT06693219; URL: www.clinicaltrials.gov

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CHEST critical care Critical Care and Intensive Care Medicine, Pulmonary and Respiratory Medicine

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