使用电磁装置对比胸部X射线确认重症患者的鼻胃管位置

　　鼻饲管（NGT）置入常用于重症患者。然而，导管异位很常见并可引起显著发病。当前用于确认NGT位置的方法在该情况下并不可靠，英国伦敦盖伊与圣托马斯医院、伦敦国王学院回顾比较了电磁引导鼻胃管（e-NGT）和通过胸部X射线（CXR）确定的NGT位置、肺部置入避免率、建立肠内喂养时间。

　　该回顾观察研究于2006年2月～2013年11月在三级转诊成人重症监护病房进行。入组标准为放射学确认NGT的患者。所有CXR由重症医师独立复核以确定位置，并且e-NGT亚组患者影像被独立复核用于质量控制，对其敏感度、特异度、所描述位置进行统计学分析。

　　结果共入组113例患者的121次NGT供分析。e-NGT与CXR相比，敏感度为98%（95%置信区间：93.9%～99.7%），特异度为100%（95%置信区间：48.0%～100.0%）。在51例e-NGT亚组患者中，避免9例肺部置入。e-NGT置入至CXR时间为185±264.4分钟，至喂养为404±77.8分钟。

　　因此，专门团队置管时，e-NGT能够立即发现置管错位。如果用作确定NGT位置的唯一方法，e-NGT可缩短喂养延迟时间，并且节省后续多次CXR的费用。

JPEN J Parenter Enteral Nutr. 2016;40(4):581-6.

Use of an Electromagnetic Device Compared With Chest X-ray to Confirm Nasogastric Feeding Tube Position in Critical Care.

Bear DE, Champion A, Lei K, Smith J, Beale R, Camporota L, Barrett NA.

Guy's and St Thomas's NHS Foundation Trust, London, UK; King's College London, London, UK.

BACKGROUND: Insertion of nasogastric feeding tubes (NGTs) is common in critical care. However, misplacement is frequent and can carry a significant morbidity. Current methods to confirm position of NGTs are not reliable in this setting. We retrospectively compared the position of NGTs using an electromagnetically guided nasogastric tube (e-NGT) with that demonstrated by chest x-ray (CXR), the proportion of lung placements avoided, and the time taken to establish enteral feeding.

METHODS: This was a retrospective, observational study undertaken in a tertiary referral, adult intensive care unit between February 2006 and November 2013. Patients were included if they had a radiologically confirmed NGT. All CXRs were independently reviewed by an intensivist to determine position, and a subset of patients had their e-NGT image independently reviewed for quality control. Statistical analysis was in the form of sensitivity and specificity and descriptive where indicated.

RESULTS: In total, 121 NGT placements in 113 patients were analyzed. We found a sensitivity of 98% (95% confidence interval [CI], 93.9%-99.7%) and a specificity of 100% (95% CI, 48.0%-100.0%) when using the e-NGT compared with CXR. In the subset of 51 independently reviewed e-NGT images, 9 lung placements were avoided. The mean (SD) time from e-NGT placement to CXR was 185 (264.4) minutes and to feeding was 404 (77.8) minutes.

CONCLUSION: When placed by a dedicated team, e-NGT allowed immediate detection of tube misplacement. As such, if used as the sole method for determining NGT position, e-NGTs minimize feeding delay and the need for multiple CXRs with subsequent cost savings.

PMID: 25758256

DOI: 10.1177/0148607115575034