Meta-Analysis
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 16, 2021; 9(26): 7772-7785
Published online Sep 16, 2021. doi: 10.12998/wjcc.v9.i26.7772
Comparison of different methods of nasogastric tube insertion in anesthetized and intubated patients: A meta-analysis
Gao-Wen Ou, Heng Li, Bing Shao, Li-Ming Huang, Guo-Min Chen, Wei-Chao Li
Gao-Wen Ou, Heng Li, Bing Shao, Li-Ming Huang, Guo-Min Chen, Wei-Chao Li, Department of Anesthesiology, Qingyuan People’s Hospital, The Six Affiliated Hospital of Guangzhou Medical University, Qingyuan 511518, Guangdong Province, China
Author contributions: Ou GW contributed to the conception and design of the study, and drafting the article; Li H, Shao B, Huang LM, Chen GM, and Li WC contributed to the acquisition of data, analysis and interpretation of data; Ou GW contributed to revision of the article and final approval.
Conflict-of-interest statement: The authors deny any conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Gao-Wen Ou, MD, Nurse, Department of Anesthesiology, Qingyuan People’s Hospital, The Six Affiliated Hospital of Guangzhou Medical University, No. B24 Yinquan North Road, Qingyuan 511518, Guangdong Province, China. wenzhemami@163.com
Received: February 28, 2021
Peer-review started: February 28, 2021
First decision: April 24, 2021
Revised: May 11, 2021
Accepted: July 2, 2021
Article in press: July 2, 2021
Published online: September 16, 2021
Processing time: 194 Days and 5.2 Hours
Abstract
BACKGROUND

Several techniques of nasogastric tube (NGT) insertion have been described in the literature with different success rates.

AIM

To systematically search the literature and conduct a meta-analysis comparing the success rates, insertion time and complications associated with different techniques of NGT insertion in anesthetized and intubated patients.

METHODS

An electronic search of the PubMed, Scopus, CENTRAL (Cochrane Central Register of Controlled Trials), and Google Scholar databases were performed up to October 31, 2019. We included 17 randomized controlled trials with 2500 participants in the meta-analysis.

RESULTS

As compared to the conventional method, successful insertion of the NGT on first attempt was higher with modified techniques such as the reverse Sellick’s maneuver [relative risk (RR) 1.94; 95% confidence interval (CI): 1.62-2.31], use of a frozen NGT (RR 1.55; 95%CI: 1.13-2.13), inserting the NGT with neck flexion and lateral neck pressure (RR 1.64; 95%CI: 1.10-2.45), endotracheal tube-assisted (RR 1.88; 95%CI: 1.52-2.32) and video-assisted placements (RR 1.60; 95%CI: 1.31-1.95). All the modified techniques also led to comparatively higher insertion success rates than the conventional technique.

CONCLUSION

The use of modified techniques of NGT insertion such as the reverse Sellick’s maneuver, neck flexion with lateral neck pressure, frozen NGT, endotracheal tube-guided or video-assisted methods result in a significantly better chance of successful tube insertion at first attempt as compared to the conventional technique. All modified techniques also significantly improve the overall chance of successful NGT placement as compared to the conventional method.

Keywords: Nasogastric tube; Anesthetized patient; Intubated patients; Mucosal bleeding

Core Tip: Our study indicates that the use of modified techniques of nasogastric tube (NGT) insertion such as the reverse Sellick’s maneuver, neck flexion with lateral neck pressure, frozen NGT, endotracheal tube-guided or video-assisted methods result in a significantly better chance of successful tube insertion at first attempt as compared to the conventional technique.