GASTROINTESTINAL TUBE INSERTION TECHNIQUES IN CRITICAL PATIENTS: SCOPING REVIEW

Queiroz, Cintia Galvão; Duarte, Fernando Hiago da Silva; Sarmento, Sabrina Daiane Gurgel; Dantas, Joyce Karolayne dos Santos; Dantas, Daniele Vieira; Dantas, Rodrigo Assis Neves

doi:10.1590/1980-265X-TCE-2021-0017

Cintia Galvão Queiroz

Universidade Federal do Rio Grande do Norte, Programa de Pós-Graduação em Enfermagem. Natal, Rio Grande do Norte, Brasil.

http://orcid.org/0000-0003-4680-4373

Fernando Hiago da Silva Duarte

Universidade Federal do Rio Grande do Norte, Programa de Pós-Graduação em Enfermagem. Natal, Rio Grande do Norte, Brasil.

http://orcid.org/0000-0002-2743-0452

Sabrina Daiane Gurgel Sarmento

Universidade Federal do Rio Grande do Norte, Programa de Pós-Graduação em Enfermagem. Natal, Rio Grande do Norte, Brasil.

http://orcid.org/0000-0002-5999-0139

Joyce Karolayne dos Santos Dantas

Universidade Federal do Rio Grande do Norte. Natal, Rio Grande do Norte, Brasil.

http://orcid.org/0000-0002-5259-8556

Daniele Vieira Dantas

Universidade Federal do Rio Grande do Norte, Programa de Pós-Graduação em Enfermagem. Natal, Rio Grande do Norte, Brasil.

http://orcid.org/0000-0003-0307-2424

Rodrigo Assis Neves Dantas

Universidade Federal do Rio Grande do Norte, Programa de Pós-Graduação em Enfermagem. Natal, Rio Grande do Norte, Brasil.

http://orcid.org/0000-0002-9309-2092

CONTRIBUTION OF AUTHORITY

Study design: Queiroz CG, Duarte FHS, Sarmento SDG, Dantas JKS, Dantas DV, Dantas RAN. Data collection: Queiroz CG, Dantas JKS. Data analysis and interpretation: Queiroz CG, Duarte FHS, Sarmento SDG, Dantas JKS. Discussion of results: Queiroz CG, Duarte FHS, Sarmento SDG, Dantas JKS, Dantas DV, Dantas RAN. Writing and/or critical review of the content: Queiroz CG, Duarte FHS, Sarmento SDG, Dantas JKS, Dantas DV, Dantas RAN. Review and final approval of the final version: Dantas DV, Dantas RAN.

CONFLICT OF INTEREST

There is no conflict of interest.

EDITORS

Associated Editors: Mara Ambrosina de Oliveira Vargas, Gisele Cristina Manfrini, Ana Izabel Jatobá de Souza. Editor-in-chief: Roberta Costa.

CORRESPONDING AUTHOR

Cintia Galvão Queiroz cintia.queiroz@yahoo.com.br

PCC	MESH/DeCS			Keywords (Ing/En)
*Population*	Coma/Coma		OR	Critical patients/ Pacientes críticos OR Comatose
	*AND*
*Concept*		Intubation, Gastrointestinal/ OR Intubação gastrointestinal		Intubation, Nasogastric/ Intubação nasogástrica OR Gastrointestinal intubation/ Gastrointestinal intubation
	AND
*Context*	Critical Care		OR	Intensive Care / Intensive Care OR Care, Intensive Surgical / Intensive Care Cirúrgica *OR Care,* Intensive / Intensive CareOR Surgical Intensive Care

Data sources	Search syntax
Pubmed*	(Coma OR Comatose OR Critical patients) AND (Intubation, Gastrointestinal OR Intubation, Nasogastric OR Gastrointestinal intubation) AND (Critical Care OR Intensive Care OR Care, Intensive Surgical OR Care, Intensive OR Surgical Intensive Care).
CINAHL†	(Coma OR Comatose OR Critical patients) AND (Intubation, Gastrointestinal OR Intubation, Nasogastric OR Gastrointestinal intubation) AND (Critical Care OR Intensive Care OR Care, Intensive Surgical OR Care, Intensive OR Surgical Intensive Care).
Scopus‡	TITLE-ABS-KEY (“Coma” OR “Comatose” OR "Critical patients") AND TITLE-ABS-KEY ("Intubation, Gastrointestinal" OR "Intubation, Nasogastric" OR “Gastrointestinal intubation”) AND TITLE-ABS-KEY ("Critical Care” OR “Intensive Care” OR “Care, Intensive Surgical” OR “Care, Intensive” OR “Surgical Intensive Care”).
Web of Science§	TS= (Coma OR Comatose OR Critical patients) AND TS= (Intubation, Gastrointestinal OR Intubation, Nasogastric OR Gastrointestinal intubation) AND TS= (Critical Care OR Intensive Care OR Care, Intensive Surgical OR Care, Intensive OR Surgical Intensive Care).
Cochrane\|\|	(Coma OR Comatose OR Critical patients) AND (Intubation, Gastrointestinal OR Intubation, Nasogastric OR Gastrointestinal intubation) AND (Critical Care OR Intensive Care OR Care, Intensive Surgical OR Care, Intensive OR Surgical Intensive Care).
ScienceDirect¶	(Coma OR Comatose) AND (Intubation, Gastrointestinal OR Intubation, Nasogastric OR Gastrointestinal intubation) AND (Critical Care OR Intensive Care OR Surgical Intensive Care).
Gale**	(Coma OR Comatose OR Critical patients) AND (Intubation, Gastrointestinal OR Intubation, Nasogastric OR Gastrointestinal intubation) AND (Critical Care OR Intensive Care OR Care, Intensive Surgical OR Care, Intensive OR Surgical Intensive Care).
Catalogue of Theses and Dissertations††	(Coma OR Comatoso OR Critically Ill Patients) AND (Gastrointestinal intubation OR Nasogastric intubation OR Gastrointestinal intubation) AND (Critical Care OR Intensive Care OR Surgical Intensive Care OR Intensive Care OR Intensive Care OR Intensive Surgical Care).
Usp‡‡ Digital Library of Theses and Dissertations	(Coma or comatose) AND (Gastrointestinal intubation OR Nasogastric Intubation OR Gastrointestinal Intubation) AND (Critical Care OR Intensive Care OR Intensive Surgical Care).
Google Academic§	(Coma OR Comatose OR Critically Ill Patients) AND (Gastrointestinal intubation OR Nasogastric intubation OR Gastrointestinal intubation) AND (Critical Care OR Intensive Care OR Surgical Intensive Care OR Intensive Care OR Intensive Care OR Intensive Surgical Care).

Study Year/Location	Type of study/Level of evidence/Degree of recommendation	Study population
E1 2020 - USA1717. Cha PI, Jou RM, Spain DA, Forrest JD. Placement of surgical feeding tubes among patients with severe traumatic brain injury requiring exploratory abdominal surgery: better early than late. Am Surg [Internet]. 2020 [cited 2020 Dec 22];86(6):635-42. Available from: Available from: https://doi.org/10.1177/0003134820923302 https://doi.org/10.1177/0003134820923302...	Cohort study /2B/B	601 patients undergoing induced coma.
E2 2020 - Belgium1818. Torsy T, Saman R, Boeykens K, Duysburgh I, Eriksson M, Verhaeghe S, et al. Accuracy of the corrected nose-earlobe-xiphoid distance formula for determining nasogastric feeding tube insertion length in intensive care unit patients: a prospective observational study. Int J Nurs Stud [Internet]. 2020 [cited 2020 Dec 24];110:1-7. Available from: Available from: https://doi.org/10.1016/j.ijnurstu.2020.103614 https://doi.org/10.1016/j.ijnurstu.2020....	Cohort study /2B/B	218 critically ill ICU patients.
E3 2020 - Iran1919. Sanie S, Mirzalou N, Shadvar K, Golzari SEJ, Soleimanpour H, Shamekh DB, et al. A comparison of nasogastric tube insertion by SORT maneuver (snifng position, NGT orientation, contralateral rotation, and twisting movement) versus neck fexion lateral pressure in critically ill patients admitted to ICU: a prospective randomized clinical trial. Ann Intensive Care [Internet]. 2020 [cited 2020 Dec 26];10:79. Available from: Available from: https://doi.org/10.1186/s13613-020-00696-2 https://doi.org/10.1186/s13613-020-00696...	Randomized clinical trial /1B/A	396 critically ill patients.
E4 2018 - India2020. Mandal M, Karmakar A, Basu SR. Nasogastric tube insertion in anaesthetised, intubated adult patients: a comparison between three techniques. Indian J Anaesth [Internet]. 2018 [cited 2021 Jan 06];63(8):609-15. Available from: Available from: https://doi.org/10.4103/ija.IJA_342_18 https://doi.org/10.4103/ija.IJA_342_18...	Randomized clinical trial /1B/A	195 anesthetized and intubated adult patients undergoing abdominal surgeries.
E5 2017 - Turkey2121. Kavakli AS, Ozturk NK, Karaveli A, Onuk AA, Ozyurek L, Inanoglu K. Comparação de diferentes métodos de inserção de sonda nasogástrica em pacientes anestesiados e intubados. Rev Bras Anestesiol [Internet]. 2017 [cited 2021 Jan 07];67(6):578-83. Available from: Available from: https://doi.org/10.1016/j.bjan.2017.04.020 https://doi.org/10.1016/j.bjan.2017.04.0...	Randomized clinical tria l/1B/A	200 adult patients who received general anesthesia for elective abdominal surgeries.
E6 2017 - Italy2222. Zatelli M, Vezzali N. 4-Point ultrasonography to confirm the correct position of the nasogastric tube in 114 critically ill patients. J ultrasound [Internet]. 2017 [cited 2020 Dec 22];20(1):53-8. Available from: Available from: https://doi.org/10.1007/s40477-016-0219-0 https://doi.org/10.1007/s40477-016-0219-...	Cohort study /2B/B	114 patients in critical condition, 100 mechanically intubated and two tracheostomized.
E7 2016 - Malaysia2323. Ibadullah WHW, Yahya N, Ghazali SS, Kamaruzaman E, Yong LC, Dan A et al. Comparação das características de inserção de sonda nasogástrica, usando visibilização pelo laringoscópio GlideScope® vs. guiada pelo laringoscópio MacIntosh em pacientes anestesiados e intubados. Rev Bras Anestesiol [Internet]. 2016 [cited 2021 Jan 06];66(4):363-8. Available from: Available from: https://doi.org/10.1016/j.bjan.2016.04.007 https://doi.org/10.1016/j.bjan.2016.04.0...	Randomized clinical trial /1B/A	96 anesthetized and intubated adult patients scheduled for surgery.
E8 2016 - Japan2424. Yoon EWT, Nishihara K, Murata H. Maintaining enteral nutrition in the severely ill using a newly developed nasojejunal feeding tube with gastric decompression function. Intern Med [Internet]. 2016 [cited 2020 Dec 22];55:2945-50. Available from: https://doi.org/10.2169/internalmedicine.55.6915 https://doi.org/10.2169/internalmedicine...	Case report /5/D	84-year-old patient in physiological coma.
E9 2015 - Netherlands2525. Gerritsen A, Rooij T, Dijkraaf MG, Busch OR, Bergman JJ, Ubbink DT, et al. Electromagnetic guided bedside or endoscopic placement of nasoenteral feeding tubes in surgical patients (CORE trial): study protocol for a randomized controlled trial. Trials [Internet]. 2015 [cited 2020 Dec 22];16:119. Available from: Available from: https://doi.org/10.1186/s13063-015-0633-1 https://doi.org/10.1186/s13063-015-0633-...	Randomized clinical trial /1B/A	154 patients in surgical patients (sedated).
E10 2015 - Turkey2626. Gok F, Kilicaslan A, Yosunkaya A. Ultrasound-guided nasogastric feeding tube placement in critical care patients. Nutr Clin Pract [Internet]. 2015 [cited 2020 Dec 22];30(2):257-60. Available from: Available from: https://doi.org/10.1177/0884533614567714 https://doi.org/10.1177/0884533614567714...	Cohort study /2B/B	56 patients using mechanical ventilation hospitalized in ICU.
E11 2015 - China2727. Liu X‐F, Zhu H‐Q, Xu Q‐L, Xie Y‐M. Comparison of two nasal-jejunal tube placement methods in critically ill patients with different acute gastrointestinal injury grades. Acad J Second Mil Med Univ [Internet]. 2015 [cited 2020 Dec 24];36(9):961-5. Available from: Available from: https://doi.org/10.3724/SP.J.1008.2015.00961 https://doi.org/10.3724/SP.J.1008.2015.0...	Randomized clinical trial /1B/A	156 critically ill patients with acute gastrointestinal injury admitted to the ICU.
E12 2013 - India2828. Ghatak T, Samanta S, Baronia AK. A new technique to insert nasogastric tube in an unconscious intubated patient. N Am J Med Sci [Internet]. 2013 [cited 2020 Dec 22];5(1):68-70. Available from: Available from: https://doi.org/10.4103/1947-2714.106215 https://doi.org/10.4103/1947-2714.106215...	Case report /5/D	one patient in physiological coma.
E13 2013 - Taiwan2929. Illias AM, Hui Y, Lin C, Chang C, Yu H. A comparison of nasogastric tube insertion techniques without using other instruments in anesthetized and intubated patients. Ann Saudi Med [Internet]. 2013 [cited 2021 Jan 06];33(5):476-81. Available from: Available from: https://doi.org/10.5144/0256-4947.2013.476 https://doi.org/10.5144/0256-4947.2013.4...	Randomized clinical trial /1B/A	150 anesthetized and intubated adult patients undergoing gastrointestinal surgeries.
E14 2012 - Taiwan3030. Tsai Y, Luo C, Illias A, Lin C, Yu H. Nasogastric tube insertion in anesthetized and intubated patients: a new and reliable method. BMC Gastroenterol [Internet]. 2012 [ cited 2021 Jan 07];12:99. Available from: Available from: https://doi.org/10.1186/1471-230X-12-99 https://doi.org/10.1186/1471-230X-12-99...	Randomized clinical trial /1B/A	103 anesthetized and intubated adult patients undergoing gastrointestinal or hepatic surgeries.
E15 2011 - USA3131. Holzinger U, Brunner R, Miehsler W, Herkner H, Kitzberger R, Fuhrmann V et al. Jejunal tube placement in critically ill patients: a prospective, randomized trial comparing the endoscopic technique with the electromagnetically visualized method. Crit Care Med [Internet]. 2011 [cited Dec 25];39(1):73-7. Available from: https://doi.org/10.1097/CCM.0b013e3181fb7b5f https://doi.org/10.1097/CCM.0b013e3181fb...	Randomized clinical trial /1B/A	Critically ill patients who do not tolerate intragastric nutrition.
E16 2011 - USA3232. Kline AM, Sorce L, Sullivan C, Weishaar J, Steinhorn DM. Use of noninvasive electromagnetic device to place transpyloric feeding tubes in critically ill children. AJCC [Internet]. 2011 [cited 2020 Dec 22];20(6):453-61. Available from: Available from: https://doi.org/10.4037/ajcc2011221 https://doi.org/10.4037/ajcc2011221...	Randomized clinical trial /1B/A	49 critically ill children admitted to ICU.
E17 2011 - Germany3333. Zick G, Frerichs A, Ahrens M, Schniewind B, Elke G, Schädler D, et al. A new technique for bedside placement of enteral feeding tubes: a prospective cohort study. Crit Care [Internet]. 2011 [cited 2020 Dec 22];15:R8. Available from: Available from: https://doi.org/10.1186/cc9407 https://doi.org/10.1186/cc9407...	Cohort study /2B/B	27 critically ill patients undergoing trans nasal endoscopy and pylorus intubation.
E18 2010 - China3434. Gao X, Zhang L, Zhao J, Tian F, Sun H, Wang P, et al. Bedside electromagnetic-guided placement of nasoenteral feeding tubes among critically Ill patients: a single-centre randomized controlled trial. J Crit Care [Internet]. 2010 [cited 2020 Dec 23]; 8:216-21. Available from: Available from: https://doi.org/10.1016/j.jcrc.2018.09.001 https://doi.org/10.1016/j.jcrc.2018.09.0...	Randomized clinical trial /1B/A	50 children admitted to pediatric ICU.
E19 2010 - Netherlands3535. Mathus-Vliegen EMH, Duflou A, Spanier MBW, Fockens P. Nasoenteral feeding tube placement by nurses using an electromagnetic guidance system (with video). Gastrointest Endosc [Internet]. 2010 [cited 2020 Dec 24];71(4):728-36. Available from: Available from: https://doi.org/10.1016/j.gie.2009.10.046 https://doi.org/10.1016/j.gie.2009.10.04...	Randomized clinical trial /1B/A	210 critically ill patients.
E20 2005 - USA3636. Marino LV, Ramchandra P, Nathoo N. Blind transpyloric nasojejunal versus nasogastric tube intubation in severe head injuries: a preliminary report. J Clin Neurosci [Internet]. 2005 [cited 2020 Dec 22];12(4):435-7. Available from: Available from: https://doi.org/10.1016/j.jocn.2004.04.009 https://doi.org/10.1016/j.jocn.2004.04.0...	Randomized clinical trial /1B/A	14 patients admitted to neurosurgical ICU, with Glasgow score less than 8 (mean of 6.8 ± 0.36).
E21 2005 - USA3737. Fang JC, Hilden K, Holubkov R, DiSario JA. Transnasal endoscopy vs. fluoroscopy for the placement of nasoenteric feeding tubes in critically ill patients. Gastrointest Endosc [Internet]. 2005 [cited 2020 Dec 25];62(5):661-6. Available from: Available from: https://doi.org/10.1016/j.gie.2005.04.027 https://doi.org/10.1016/j.gie.2005.04.02...	Randomized clinical tria l/1B/A	100 untestable ICU patients.
E22 2005 - USA3838. Phipps LM, Weber MD, Ginder BR, Hulse MA, Thomas NJ. A randomized controlled trial comparing three different techniques of nasojejunal feeding tube placement in critically Ill children. JPEN J Parenter Enteral Nutr [Internet]. 2005 [cited 2020 Dec 25];29(6):420-4. Available from: Available from: https://doi.org/10.1177/0148607105029006420 https://doi.org/10.1177/0148607105029006...	Randomized clinical trial /1B/A	75 critical pediatric patients admitted to the ICU.
E23 2004 - USA3939. Foote JA, Kemmeter PR, Prichard PA, Baker RS, Paauw JD, Gawel JC, et al. A randomized trial of endoscopic and fluoroscopic placement of postpyloric feeding tubes in critically III patients. J Parenter Enter Nutr [Internet]. 2004 [cited 2020 Dec 23];28(3):154-7. Available from: Available from: https://doi.org/10.1177/0148607104028003154 https://doi.org/10.1177/0148607104028003...	Randomized clinical trial /1B/A	43 critically ill ICU patients.
E24 2000 - USA4040. Huerta G, Puri VK. Nasoenteric feeding tubes in critically ill patients (fluoroscopy versus blind). Nutrition [Internet]. 2000 [cited 2020 Dec 24];16(4):264-7. Available from: Available from: https://doi.org/10.1016/s0899-9007(99)00307-x https://doi.org/10.1016/s0899-9007(99)00...	Randomized clinical trial /1B/A	30 severely ill patients tracheostomized or with endotracheal tube.
E25 2000 - USA4141. Spalding HK, Sullivan KJ, Soremi O, Gonzalez F, Goodwin SR. Bedside placement of transpyloric feeding tubes in the pediatric intensive care unit using gastric insufflation. Crit Care Med [Internet]. 2000 [cited 2020 Dec 24];28(6):2041-4. Available from: Available from: https://doi.org/10.1097/00003246-200006000-00060 https://doi.org/10.1097/00003246-2000060...	Randomized clinical trial /1B/A	50 children admitted to pediatric ICU.

Study Year/Local	Tubing technique	Denouement
E17 2011 - Germany3333. Zick G, Frerichs A, Ahrens M, Schniewind B, Elke G, Schädler D, et al. A new technique for bedside placement of enteral feeding tubes: a prospective cohort study. Crit Care [Internet]. 2011 [cited 2020 Dec 22];15:R8. Available from: Available from: https://doi.org/10.1186/cc9407 https://doi.org/10.1186/cc9407...	Insertion of the tube under radiological or endoscopic guidance.	Early placement of a feeding tube during abdominal surgery was beneficial in trauma patients with severe intracranial injury.
E18 2010 - China3434. Gao X, Zhang L, Zhao J, Tian F, Sun H, Wang P, et al. Bedside electromagnetic-guided placement of nasoenteral feeding tubes among critically Ill patients: a single-centre randomized controlled trial. J Crit Care [Internet]. 2010 [cited 2020 Dec 23]; 8:216-21. Available from: Available from: https://doi.org/10.1016/j.jcrc.2018.09.001 https://doi.org/10.1016/j.jcrc.2018.09.0...	"Blind" insertion and patient in semi-fowler position; application of corrected formula to measure how far the tube will be inserted.	The corrected formula of the nose-lobe distance of the ear-xiphoid process as a precise method to determine the insertion length of the nasogastric tube.
E19 2010 - Netherlands3535. Mathus-Vliegen EMH, Duflou A, Spanier MBW, Fockens P. Nasoenteral feeding tube placement by nurses using an electromagnetic guidance system (with video). Gastrointest Endosc [Internet]. 2010 [cited 2020 Dec 24];71(4):728-36. Available from: Available from: https://doi.org/10.1016/j.gie.2009.10.046 https://doi.org/10.1016/j.gie.2009.10.04...	The SORT maneuver (patient positioning, NGT orientation, contralateral rotation and torsional movement) versus neck flexion lateral pressure method (NFLP).	The SORT maneuver has a high success rate. Therefore, this method can be executed, but there is still no consensus on a standard approach.
E20 2005 - USA3636. Marino LV, Ramchandra P, Nathoo N. Blind transpyloric nasojejunal versus nasogastric tube intubation in severe head injuries: a preliminary report. J Clin Neurosci [Internet]. 2005 [cited 2020 Dec 22];12(4):435-7. Available from: Available from: https://doi.org/10.1016/j.jocn.2004.04.009 https://doi.org/10.1016/j.jocn.2004.04.0...	Conventional technique, tube freezing and reverse Sellick´s maneuver.	Nasogastric tube insertion using reverse Sellick´s maneuver shows the highest success rate and fewer adverse events among the three methods compared in anesthetized and intubated adult patients.
E5 2017 - Turkey2121. Kavakli AS, Ozturk NK, Karaveli A, Onuk AA, Ozyurek L, Inanoglu K. Comparação de diferentes métodos de inserção de sonda nasogástrica em pacientes anestesiados e intubados. Rev Bras Anestesiol [Internet]. 2017 [cited 2021 Jan 07];67(6):578-83. Available from: Available from: https://doi.org/10.1016/j.bjan.2017.04.020 https://doi.org/10.1016/j.bjan.2017.04.0...	"Blind" insertion, laterally positioned head, tracheal tube assistance as an introducer "guide" and video laryngoscope aid in anesthetized and intubated adult patients.	The use of video laryngoscope and tracheal tube during tube insertion compared to conventional ones increased the success rate and reduced tube folding, in addition to reducing mucosal bleeding.
E6 2017 - Italy2222. Zatelli M, Vezzali N. 4-Point ultrasonography to confirm the correct position of the nasogastric tube in 114 critically ill patients. J ultrasound [Internet]. 2017 [cited 2020 Dec 22];20(1):53-8. Available from: Available from: https://doi.org/10.1007/s40477-016-0219-0 https://doi.org/10.1007/s40477-016-0219-...	Tip measurement of the ear-lobe tip-xiphoid process/Ultrasound examination.	Ultrasound is effective in verifying the correct positioning of the tube.
E7 2016 - Malaysia2323. Ibadullah WHW, Yahya N, Ghazali SS, Kamaruzaman E, Yong LC, Dan A et al. Comparação das características de inserção de sonda nasogástrica, usando visibilização pelo laringoscópio GlideScope® vs. guiada pelo laringoscópio MacIntosh em pacientes anestesiados e intubados. Rev Bras Anestesiol [Internet]. 2016 [cited 2021 Jan 06];66(4):363-8. Available from: Available from: https://doi.org/10.1016/j.bjan.2016.04.007 https://doi.org/10.1016/j.bjan.2016.04.0...	GlideScope-guided laryngoscope ® MacIntosh laryngoscope.	The use of GlideScope® to facilitate nasogastric tube insertion was comparable to Macintosh laryngoscope use for insertion success rate and complications.
E8 2016 - Japan2424. Yoon EWT, Nishihara K, Murata H. Maintaining enteral nutrition in the severely ill using a newly developed nasojejunal feeding tube with gastric decompression function. Intern Med [Internet]. 2016 [cited 2020 Dec 22];55:2945-50. Available from: https://doi.org/10.2169/internalmedicine.55.6915 https://doi.org/10.2169/internalmedicine...	Fluoroscopy.	The insertion of the fluoroscopy tube was successful in gastric decompression, assisting in nutrition until the preparation of a percutaneous endoscopic gastrostomy.
E9 2015 - Netherlands2525. Gerritsen A, Rooij T, Dijkraaf MG, Busch OR, Bergman JJ, Ubbink DT, et al. Electromagnetic guided bedside or endoscopic placement of nasoenteral feeding tubes in surgical patients (CORE trial): study protocol for a randomized controlled trial. Trials [Internet]. 2015 [cited 2020 Dec 22];16:119. Available from: Available from: https://doi.org/10.1186/s13063-015-0633-1 https://doi.org/10.1186/s13063-015-0633-...	Patient in supine position. Insertion of post-pyloric feeding tube via electromagnetic transmitter and endoscopy in surgical patients.	Effective techniques for insertion of nasoenteral feeding tube. More scientific studies are needed to strengthen the evidence.
E10 2015 - Turkey2626. Gok F, Kilicaslan A, Yosunkaya A. Ultrasound-guided nasogastric feeding tube placement in critical care patients. Nutr Clin Pract [Internet]. 2015 [cited 2020 Dec 22];30(2):257-60. Available from: Available from: https://doi.org/10.1177/0884533614567714 https://doi.org/10.1177/0884533614567714...	Ultrasound examination/head in supine position.	The passage of the tube with the aid of this method can be used as an adjuvant.
E11 2015 - China2727. Liu X‐F, Zhu H‐Q, Xu Q‐L, Xie Y‐M. Comparison of two nasal-jejunal tube placement methods in critically ill patients with different acute gastrointestinal injury grades. Acad J Second Mil Med Univ [Internet]. 2015 [cited 2020 Dec 24];36(9):961-5. Available from: Available from: https://doi.org/10.3724/SP.J.1008.2015.00961 https://doi.org/10.3724/SP.J.1008.2015.0...	Placement of nasojejunal tube guided by ultrasound at the bedside versus "blind" insertion at the bedside.	Placement of the ultrasound-guided jejunal nasal tube is better than the blind method.
E12 2013 - India2828. Ghatak T, Samanta S, Baronia AK. A new technique to insert nasogastric tube in an unconscious intubated patient. N Am J Med Sci [Internet]. 2013 [cited 2020 Dec 22];5(1):68-70. Available from: Available from: https://doi.org/10.4103/1947-2714.106215 https://doi.org/10.4103/1947-2714.106215...	"Blind" insertion with neck flexion, identification of cricoid cartilage (all 20 cm inserted), and insertion of approximately 50 cm of nasogastric tube.	Easy and useful technique for insertion in unconscious intubated patients. It does not alter vital responses or increase intracranial pressure as in laryngoscopy.
E13 2013 - Taiwan2929. Illias AM, Hui Y, Lin C, Chang C, Yu H. A comparison of nasogastric tube insertion techniques without using other instruments in anesthetized and intubated patients. Ann Saudi Med [Internet]. 2013 [cited 2021 Jan 06];33(5):476-81. Available from: Available from: https://doi.org/10.5144/0256-4947.2013.476 https://doi.org/10.5144/0256-4947.2013.4...	Conventional insertion, neck flexion with lateral pressure and cricoid cartilage lifting.	Neck flexion with lateral pressure and cricoid cartilage lifting are reliable for inserting the tube without the use of other instruments.
E14 2012 - Taiwan3030. Tsai Y, Luo C, Illias A, Lin C, Yu H. Nasogastric tube insertion in anesthetized and intubated patients: a new and reliable method. BMC Gastroenterol [Internet]. 2012 [ cited 2021 Jan 07];12:99. Available from: Available from: https://doi.org/10.1186/1471-230X-12-99 https://doi.org/10.1186/1471-230X-12-99...	Insertion of the tube with the head in the supine position versus insertion with the aid of a "Rusch" intubation stylus tied at the ends by a knot.	The "Rusch" stiletto-guided method of intubation is reliable, with a high success rate in anesthetized and intubated patients.
E15 2011 - USA3131. Holzinger U, Brunner R, Miehsler W, Herkner H, Kitzberger R, Fuhrmann V et al. Jejunal tube placement in critically ill patients: a prospective, randomized trial comparing the endoscopic technique with the electromagnetically visualized method. Crit Care Med [Internet]. 2011 [cited Dec 25];39(1):73-7. Available from: https://doi.org/10.1097/CCM.0b013e3181fb7b5f https://doi.org/10.1097/CCM.0b013e3181fb...	Insertion of a jejunal feeding tube electromagnetically or endoscopically.	The placement of the tube electromagnetically was as fast, safe and successful as the endoscopic tube.
E16 2011 - USA3232. Kline AM, Sorce L, Sullivan C, Weishaar J, Steinhorn DM. Use of noninvasive electromagnetic device to place transpyloric feeding tubes in critically ill children. AJCC [Internet]. 2011 [cited 2020 Dec 22];20(6):453-61. Available from: Available from: https://doi.org/10.4037/ajcc2011221 https://doi.org/10.4037/ajcc2011221...	Insertion of transpypiloric feeding tube using conventional blind technique with the help of a noninvasive electromagnetic device.	Insertion by non-invasive electromagnetic device significantly increases the time required for placement.
E17 2011 - Germany3333. Zick G, Frerichs A, Ahrens M, Schniewind B, Elke G, Schädler D, et al. A new technique for bedside placement of enteral feeding tubes: a prospective cohort study. Crit Care [Internet]. 2011 [cited 2020 Dec 22];15:R8. Available from: Available from: https://doi.org/10.1186/cc9407 https://doi.org/10.1186/cc9407...	Insertion of feeding tube by transnasal endoscopy.	The procedure is safe and reliable, having a good success rate. Complications such as bleeding are rare.
E18 2010 - China3434. Gao X, Zhang L, Zhao J, Tian F, Sun H, Wang P, et al. Bedside electromagnetic-guided placement of nasoenteral feeding tubes among critically Ill patients: a single-centre randomized controlled trial. J Crit Care [Internet]. 2010 [cited 2020 Dec 23]; 8:216-21. Available from: Available from: https://doi.org/10.1016/j.jcrc.2018.09.001 https://doi.org/10.1016/j.jcrc.2018.09.0...	Patients in supine position. Insertion by optical endoscope fiber. Concomitantly, an electromagnetic technology is used. The image is displayed as the tube is inserted.	Bedside electromagnetic-guided placement is as fast, safe, and successful as endoscopic placement. It may be considered the preferred technique in critically ill patients.
E19 2010 - Netherlands3535. Mathus-Vliegen EMH, Duflou A, Spanier MBW, Fockens P. Nasoenteral feeding tube placement by nurses using an electromagnetic guidance system (with video). Gastrointest Endosc [Internet]. 2010 [cited 2020 Dec 24];71(4):728-36. Available from: Available from: https://doi.org/10.1016/j.gie.2009.10.046 https://doi.org/10.1016/j.gie.2009.10.04...	Patient in supine position. The stylus is inserted inside the tube and allows the visualization of its position and path traveled.	The procedure was considered feasible and safe and can be used in critically ill patients.
E20 2005 - USA3636. Marino LV, Ramchandra P, Nathoo N. Blind transpyloric nasojejunal versus nasogastric tube intubation in severe head injuries: a preliminary report. J Clin Neurosci [Internet]. 2005 [cited 2020 Dec 22];12(4):435-7. Available from: Available from: https://doi.org/10.1016/j.jocn.2004.04.009 https://doi.org/10.1016/j.jocn.2004.04.0...	Blind procedure. Position without reclining, with the head slightly tilted back.	The specifically designed nasojejunal tube showed greater efficacy in transpyloric placement after the Treitz ligament, when compared to the nasogastric tube in patients with severe head trauma.
E21 2005 - USA3737. Fang JC, Hilden K, Holubkov R, DiSario JA. Transnasal endoscopy vs. fluoroscopy for the placement of nasoenteric feeding tubes in critically ill patients. Gastrointest Endosc [Internet]. 2005 [cited 2020 Dec 25];62(5):661-6. Available from: Available from: https://doi.org/10.1016/j.gie.2005.04.027 https://doi.org/10.1016/j.gie.2005.04.02...	Endoscopic insertion of NES with a 5.1 mm ultra-thin tube endoscope and by fluoroscopic technique.	The success of placing NES with an ultrathin transnasal endoscope is equivalent to fluoroscopy.
E22 2005 - USA3838. Phipps LM, Weber MD, Ginder BR, Hulse MA, Thomas NJ. A randomized controlled trial comparing three different techniques of nasojejunal feeding tube placement in critically Ill children. JPEN J Parenter Enteral Nutr [Internet]. 2005 [cited 2020 Dec 25];29(6):420-4. Available from: Available from: https://doi.org/10.1177/0148607105029006420 https://doi.org/10.1177/0148607105029006...	Standard technique, standard technique with gastric insufflation and standard technique with the use of pre-insertion erythromycin.	Most feeding tubes can be placed in critically ill children on the first or second attempt, regardless of the technique used.
E23 2004 - USA3939. Foote JA, Kemmeter PR, Prichard PA, Baker RS, Paauw JD, Gawel JC, et al. A randomized trial of endoscopic and fluoroscopic placement of postpyloric feeding tubes in critically III patients. J Parenter Enter Nutr [Internet]. 2004 [cited 2020 Dec 23];28(3):154-7. Available from: Available from: https://doi.org/10.1177/0148607104028003154 https://doi.org/10.1177/0148607104028003...	Endoscopic vs. fluoroscopic placement of post-pyloric feeding tubes in critically ill patients.	There is no significant difference in relation to the success rate or time of placement via endoscope and fluoroscopic of post-pyloric feeding tubes.
E24 2000 - USA4040. Huerta G, Puri VK. Nasoenteric feeding tubes in critically ill patients (fluoroscopy versus blind). Nutrition [Internet]. 2000 [cited 2020 Dec 24];16(4):264-7. Available from: Available from: https://doi.org/10.1016/s0899-9007(99)00307-x https://doi.org/10.1016/s0899-9007(99)00...	Patients were randomized in group A (fluoroscopy) or group B (blind insertion).	Intubated or tracheostomized patients should place feeding nasoenteric tubes with fluoroscopy guidance.
E25 2000 - USA4141. Spalding HK, Sullivan KJ, Soremi O, Gonzalez F, Goodwin SR. Bedside placement of transpyloric feeding tubes in the pediatric intensive care unit using gastric insufflation. Crit Care Med [Internet]. 2000 [cited 2020 Dec 24];28(6):2041-4. Available from: Available from: https://doi.org/10.1097/00003246-200006000-00060 https://doi.org/10.1097/00003246-2000060...	Gastric insufflation as a complement to the placement of feeding tubes in the small intestine. And insertion through the nostrils without the aid of adjuvant method.	Gastric insufflation allows the rapid placement of feeding tubes in the small intestine with fewer attempts, compared to a standard insertion technique in children.

[1] CONTRIBUTION OF AUTHORITY

Study design: Queiroz CG, Duarte FHS, Sarmento SDG, Dantas JKS, Dantas DV, Dantas RAN. Data collection: Queiroz CG, Dantas JKS. Data analysis and interpretation: Queiroz CG, Duarte FHS, Sarmento SDG, Dantas JKS. Discussion of results: Queiroz CG, Duarte FHS, Sarmento SDG, Dantas JKS, Dantas DV, Dantas RAN. Writing and/or critical review of the content: Queiroz CG, Duarte FHS, Sarmento SDG, Dantas JKS, Dantas DV, Dantas RAN. Review and final approval of the final version: Dantas DV, Dantas RAN.

Brasil

Brasil

GASTROINTESTINAL TUBE INSERTION TECHNIQUES IN CRITICAL PATIENTS: SCOPING REVIEW

TÉCNICAS PARA LA INSERCIÓN DE SONDA GASTROINTESTINAL EN PACIENTES CRÍTICOS: REVISIÓN DEL ALCANCE

ABSTRACT

Objective

Method

Results

Conclusions