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Nasogastric tube in mechanical ventilated patients: ETCO2 and pH measuring to confirm correct placement. A pilot study.
Ceruti, Samuele; Dell'Era, Simone; Ruggiero, Francesco; Bona, Giovanni; Glotta, Andrea; Biggiogero, Maira; Tasciotti, Edoardo; Kronenberg, Christoph; Lollo, Gianluca; Saporito, Andrea.
  • Ceruti S; Department of Critical Care, Clinica Luganese Moncucco, Lugano, Ticino, Switzerland.
  • Dell'Era S; Service of Anesthesiology, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Ticino, Switzerland.
  • Ruggiero F; Department of Internal Medicine, Clinica Luganese Moncucco, Lugano, Ticino, Switzerland.
  • Bona G; Clinical Research Unit, Clinica Luganese Moncucco, Lugano, Ticino, Switzerland.
  • Glotta A; Department of Critical Care, Clinica Luganese Moncucco, Lugano, Ticino, Switzerland.
  • Biggiogero M; Clinical Research Unit, Clinica Luganese Moncucco, Lugano, Ticino, Switzerland.
  • Tasciotti E; Service of Anesthesiology, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Ticino, Switzerland.
  • Kronenberg C; Service of Anesthesiology, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Ticino, Switzerland.
  • Lollo G; Department of Gastroenterology and Hepatology, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Ticino, Switzerland.
  • Saporito A; Service of Anesthesiology, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Ticino, Switzerland.
PLoS One ; 17(6): e0269024, 2022.
Article in English | MEDLINE | ID: covidwho-1933303
ABSTRACT

INTRODUCTION:

Nasogastric tube (NGT) placement is a procedure commonly performed in mechanically ventilated (MV) patients. Chest X-Ray is the diagnostic gold-standard to confirm its correct placement, with the downsides of requiring MV patients' mobilization and of intrinsic actinic risk. Other potential methods to confirm NGT placement have shown lower accuracy compared to chest X-ray; end-tidal CO2 (ETCO2) and pH analysis have already been singularly investigated as an alternative to the gold standard. Aim of this study was to determine threshold values in ETCO2 and pH measurement at which correct NGT positioning can be confirmed with the highest accuracy. MATERIALS &

METHODS:

This was a prospective, multicenter, observational trial; a continuous cohort of eligible patients was allocated with site into two arms. Patients underwent general anesthesia, orotracheal intubation and MV; in the first and second group we respectively assessed the difference between tracheal and esophageal ETCO2 and between esophageal and gastric pH values.

RESULTS:

From November 2020 to March 2021, 85 consecutive patients were enrolled 40 in the ETCO2 group and 45 in the pH group. The ETCO2 ROC analysis for predicting NGT tracheal misplacement demonstrated an optimal ETCO2 cutoff value of 25.5 mmHg, with both sensitivity and specificity reaching 1.0 (AUC 1.0, p < 0.001). The pH ROC analysis for predicting NGT correct gastric placement resulted in an optimal pH cutoff value of 4.25, with mild diagnostic accuracy (AUC 0.79, p < 0.001).

DISCUSSION:

In patients receiving MV, ETCO2 and pH measurements respectively identified incorrect and correct NGT placement, allowing the identification of threshold values potentially able to improve correct NGT positioning. TRIAL REGISTRATION NCT03934515 (www.clinicaltrials.gov).
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiration, Artificial / Intubation, Gastrointestinal Type of study: Cohort study / Diagnostic study / Observational study / Prognostic study / Randomized controlled trials Limits: Humans Language: English Journal: PLoS One Journal subject: Science / Medicine Year: 2022 Document Type: Article Affiliation country: Journal.pone.0269024

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiration, Artificial / Intubation, Gastrointestinal Type of study: Cohort study / Diagnostic study / Observational study / Prognostic study / Randomized controlled trials Limits: Humans Language: English Journal: PLoS One Journal subject: Science / Medicine Year: 2022 Document Type: Article Affiliation country: Journal.pone.0269024