Background 

The complications of a blind procedure for gastric tube placement are well documented. POCUS has been widely used to confirm the position of blindly inserted gastric tubes, and it does not prevent complications caused by the blind method. We performed a randomized controlled trial to compare gastric tube insertion with real-time oesophagus visualization using POCUS to the standard technique.

Objective 

The primary goal of this study was to compare the accuracy of real-time POCUS-guided nasogastric tube (NGT) insertion and confirmation to that of the standard technique.

Methods 

It was a prospective, parallel-group, open-label randomized controlled trial with a superiority design. All patients requiring NGT were screened for inclusion and exclusion criteria, and 120 patients were randomly assigned to one of two groups: POCUS (n = 60) or control (n = 60). Following the procedures, confirmatory chest radiographs were obtained in both groups.

Results 

As per protocol, 118 patients were analyzed. In POCUS group, the oesophagus was visualized on POCUS in 56 of 58 patients (96.5%). In 55 of 58 cases (94.8%), an NGT was inserted in real time. Despite visualizing the oesophagus, we fail to insert the tube in one (1.8%). The oesophagus could not be seen on the scan in two cases (3.4%). Chest radiographs confirmed the tube in the stomach in 55 (98.2%). The chest radiograph revealed the tip of the NGT in the stomach in 52 of 60 (86.6%) patients. In seven cases (11.7%), we were unable to insert NGT. On a chest radiograph, one (1.6%) tip of the tube was seen in the right lung and was safely removed. The ultrasound-guided gastric tube insertion had a sensitivity of 96.5% (95% CI, 88–99.6%) and a positive predictive value (PPV) of 98.2% (95% CI, 98.1–98.3%). The conventional technique had 88% (95% CI, 77–95%) sensitivity and a PPV of 98% (95% CI, 97.9–98.2%).

Conclusion 

POCUS enables real-time insertion of a gastric tube with high sensitivity, in a short time with high first-attempt success rate and limited passage-related complications. POCUS should be utilized for NGT insertion whenever expertise is available on the bedside.

中文翻译：

---

急诊科床旁超声辅助鼻胃管置入术：一项随机对照试验

背景 

盲法胃管置入手术的并发症已有充分记录。POCUS已被广泛用于确认盲插胃管的位置，但它并不能防止盲法引起的并发症。我们进行了一项随机对照试验，将胃管插入与使用 POCUS 的实时食管可视化与标准技术进行比较。

客观的 

本研究的主要目标是比较实时 POCUS 引导鼻胃管 (NGT) 插入和确认与标准技术的准确性。

方法 

这是一项具有优越性设计的前瞻性、平行组、开放标签随机对照试验。所有需要 NGT 的患者都根据纳入和排除标准进行筛选，120 名患者被随机分配到两组中的一组：POCUS ( n = 60) 或对照组 ( n = 60)。手术结束后，两组均获得了确认性胸部X光片。

结果 

根据方案，对 118 名患者进行了分析。在 POCUS 组中，58 名患者中有 56 名 (96.5%) 在 POCUS 上看到了食管。58 例中有 55 例 (94.8%) 实时插入了 NGT。尽管可以看到食道，但我们未能将管插入其中（1.8%）。有 2 例（3.4%）在扫描中看不到食管。胸片证实 55 例（98.2%）胃内有管子。60 名患者中有 52 名 (86.6%) 的胸片显示 NGT 尖端位于胃中。在 7 例 (11.7%) 中，我们无法插入 NGT。在胸片上，右肺中看到一个（1.6%）管尖，并被安全移除。超声引导下胃管插入的敏感性为 96.5%（95% CI，88-99.6%），阳性预测值（PPV）为 98.2%（95% CI，98.1-98.3%）。传统技术的敏感性为 88% (95% CI, 77–95%)，PPV 为 98% (95% CI, 97.9–98.2%)。

结论 

POCUS 能够在短时间内以高灵敏度实时插入胃管，且首次尝试成功率高且与通过相关的并发症较少。只要床边有专业知识，就应使用 POCUS 进行 NGT 插入。