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Nasogastric tube in mechanical ventilated patients: ETCO2 and pH measuring to confirm correct placement. A pilot study

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Listed:
  • Samuele Ceruti
  • Simone Dell’Era
  • Francesco Ruggiero
  • Giovanni Bona
  • Andrea Glotta
  • Maira Biggiogero
  • Edoardo Tasciotti
  • Christoph Kronenberg
  • Gianluca Lollo
  • Andrea Saporito

Abstract

Introduction: Nasogastric tube (NGT) placement is a procedure commonly performed in mechanically ventilated (MV) patients. Chest X-Ray is the diagnostic gold-standard to confirm its correct placement, with the downsides of requiring MV patients’ mobilization and of intrinsic actinic risk. Other potential methods to confirm NGT placement have shown lower accuracy compared to chest X-ray; end-tidal CO2 (ETCO2) and pH analysis have already been singularly investigated as an alternative to the gold standard. Aim of this study was to determine threshold values in ETCO2 and pH measurement at which correct NGT positioning can be confirmed with the highest accuracy. Materials & methods: This was a prospective, multicenter, observational trial; a continuous cohort of eligible patients was allocated with site into two arms. Patients underwent general anesthesia, orotracheal intubation and MV; in the first and second group we respectively assessed the difference between tracheal and esophageal ETCO2 and between esophageal and gastric pH values. Results: From November 2020 to March 2021, 85 consecutive patients were enrolled: 40 in the ETCO2 group and 45 in the pH group. The ETCO2 ROC analysis for predicting NGT tracheal misplacement demonstrated an optimal ETCO2 cutoff value of 25.5 mmHg, with both sensitivity and specificity reaching 1.0 (AUC 1.0, p

Suggested Citation

  • Samuele Ceruti & Simone Dell’Era & Francesco Ruggiero & Giovanni Bona & Andrea Glotta & Maira Biggiogero & Edoardo Tasciotti & Christoph Kronenberg & Gianluca Lollo & Andrea Saporito, 2022. "Nasogastric tube in mechanical ventilated patients: ETCO2 and pH measuring to confirm correct placement. A pilot study," PLOS ONE, Public Library of Science, vol. 17(6), pages 1-12, June.
    • Handle: RePEc:plo:pone00:0269024
    DOI: 10.1371/journal.pone.0269024
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