Study On The Effect Of Continuous Intubation On Blind Nasoenteric Tube Placement In Critically Ill Patients And Evaluation Of Bedside Localization Methods

ObjectiveThese studies were designed to explore the effect of continuous intubation on improving intubation success in critically ill patients with blind nasointestinal tube placement and to compare the accuracy of several bedside localization methods for blind nasointestinal tube placement,so as to continuously improve the success rate of blind placement of nasointestinal tubes and bedside localization methods accuracy.These factors make it possible for patients with severe diseases to be fed via the intestine,which improves the prognosis of patients with severe diseases,promotes the recovery of patients and contributes to the realization of the goal of Healthy China.Methods1.A randomized controlled trial was used to compare the success rate,frequencies,time,and complications of intubation in 30 cases each of continuous intubation and intermittent intubation in blind placement nasointestinal tubes.2.The prospective study method was used to observe 60 patients with abdominal X-ray as the gold standard,comparing the bedside localization methods of palpation for bubbling,gastric antrum ultrasonography,and duodenal horizontal ultrasonography,testing the difference between the p H of the fluid withdrawn from the stomach and the fluid withdrawn from the duodenum,auscultation for bubbling and testing the p H of fluid withdrawn from the duodenum,which in blind placement nasointestinal tubes,in sensitivity,specificity,and diagnostic coincidence rate.The Kappa test was used to compare the consistency of the bedside localization methods with the gold standard,and multifactor ROC curve analysis was used to compare the diagnostic efficacy of each localization method.Results1.Compared with intermittent intubation,continuous intubation had a higher intubation success rate(93.0%vs.63.3%,X~2=7.954,P<0.05),less frequent intubation(1.37±0.72 vs.2.33±0.922,t=4.529,P<0.05),and shorter intubation time[7.53(5.67-11.80)minutes vs.11.91(14.94-37.23)minutes],Z=-4.798,P<0.05).A statistically significant difference was not statistically significant when comparing complication rates(6.7%vs.10.0%,P>0.05).2.Taking abdominal X-ray as the gold standard,the sensitivities of the bedside localization methods of palpation for bubbling,gastric antrum ultrasonography,duodenal horizontal ultrasonography,testing the difference between the p H of the fluid withdrawn from the stomach and the fluid withdrawn from the duodenum,auscultation for bubbling and testing the p H of fluid withdrawn from the duodenum were 95.7%,95.7%,87.2%,100%,93.6%and 78.7%,respectively;the specificities were 84.6%,76.9%,92.3%,61.5%,30.8%and 38.5%,respectively;the diagnostic agreement rates were 93.3%,91.7%,88.3%,91.7%,80.0%and 70.0%,respectively;the kappa values were 0.804,0.750,0.698,0.715,0.293 and 0.163,respectively;and the p values were 0.000,0.000,0.000,0.000,0.015 and 0.205,respectively.The bedside localization methods of palpation for bubbling,gastric antrum ultrasonography,duodenal horizontal ultrasonography and testing the difference between the p H of the fluid withdrawn from the stomach and the fluid withdrawn from the duodenum were in strong agreement with the gold standard.The kappa values were 0.61～0.80,and the p values were all<0.05.The differences were statistically significant.The AUC values of the bedside localization methods of palpation for bubbling,gastric antrum ultrasonography,duodenal horizontal ultrasonography,testing the difference between the p H of the fluid withdrawn from the stomach and the fluid withdrawn from the duodenum,auscultation for bubbling and testing the p H of fluid withdrawn from the duodenum were 0.902,0.863,0.898,0.759,0.622 and 0.586,respectively.The pairwise comparison revealed that the bedside localization methods of palpation for bubbling,gastric antrum ultrasonography and duodenal horizontal ultrasonography had higher diagnostic efficiency than the other three bedside localization methods,with p values all<0.05,and the differences were statistically significant.Conclusion1.Continuous intubation can improve the intubation success rate of blind placement of nasointestinal tubes.2.Among all bedside localization methods for blind placement of nasointestinal tubes,the bedside localization methods of palpation for bubbling,gastric antrum ultrasonography,duodenal horizontal ultrasonography and testing the difference between the p H of the fluid withdrawn from the stomach and the fluid withdrawn from the duodenum are consistent with the gold standard,while the bedside localization methods of auscultation for bubbling and testing the p H of fluid withdrawn from the duodenum are inconsistent with the gold standard.The three localization methods of palpation for bubbling,gastric antrum ultrasonography and duodenal horizontal ultrasonography have high diagnostic efficacy.