Diagnostic accuracy of end-tidal carbon dioxide detection in determining correct placement of nasogastric tube: An updated systematic review with meta-analysis
Section snippets
What is already known
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It is vital to verify the placement of the nasogastric tubes immediately after insertion and prior to each feed and medication administration because inadvertent pulmonary placement of nasogastric tube results in serious pulmonary complications or even death.
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A systematic review we conducted in 2011 concluded that there was evidence to support the use of colorimetric capnometry or capnography for the identification of nasogastric tube placement in mechanically ventilated patients.
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Limitations
What this paper adds
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Colorimetric capnometry and capnography may be of comparable diagnostic accuracy to radiography in their ability to differentiate between respiratory and gastrointestinal tube placement in critically ill adult patients, though the certainty of evidence was low or very low.
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The limited number of studies conducted in general wards renders determination of diagnostic accuracy in this patient population uncertain.
Methods
This review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement (Page et al., 2021) and the PRISMA of Diagnostic Test Accuracy (PRISMA-DTA) reporting guideline (Salameh et al., 2020).
Study selection
From 2009 to 2021, we identified 1154 records from the initial database search. A total of 939 records were screened after the removal of duplicates, of which 923 records were irrelevant and excluded (Cohen's kappa = 0.66). We identified one more record (an article in press) from an acute hospital in Hong Kong. Seventeen full-text articles were assessed for inclusion. One ongoing study (Samuele, November 2020—) and nine studies were further excluded (Cohen's kappa=0.77) due to ineligible
Summary of main results
Seven new trials were added to this update and a total of 16 trials were analysed in this systematic review. All of these trials investigated the diagnostic accuracy of colorimetric capnometry or capnography in detecting the positions of nasogastric tubes against reference standards (i.e., X-ray, aspiration of stomach contents, air auscultation, and capnography) in adults. The results of this updated review indicate that the use of colorimetric capnometry or capnography may be an effective
Conclusions
The use of colorimetric capnometry or capnography may have the potential to effectively differentiate inadvertent airway intubation from gastrointestinal nasogastric tube placement in critically ill adults. More evidence is required to generalize the updated findings to different types of patients and settings.
Declaration of Competing Interest
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Funding
No external funding.
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