Nasogastric tube in critical care setting: combining ETCO2 and pH measuring to confirm correct placement

Introduction: nasogastric tube (NGT) placement is a common procedure performed in critical care setting. Chest X-Ray is the diagnostic gold-standard to confirm correct placement, with the downsides of both the need for critical care patients' mobilization and intrinsic actinic risk. Other potential methods to confirm NGT placement have shown lower accuracy compared to chest X-ray; ETCO2 and pH analysis have singularly yet investigated as an alternative to the gold standard. Aim of this study was to determine thresholds in combine measurements of ETCO2 and pH values, at which correct NGT positioning can be confirmed with the highest accuracy. Material & Methods: a prospective, multicenter, observational trial; a continuous cohort of eligible patients was allocated to two arms, to identify clear cut-off threshold able to detect correct NGT tip positioning with the maximal accuracy. Patients underwent general anesthesia and orotracheal intubation; in the first group difference between tracheal and esophageal ETCO2 values were assessed. In the second group difference between esophageal and gastric pH values were determined. 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 demonstrate an optimal ETCO2 cutoff value of 25.5 mmHg, where both sensitivity than specificity reach 1.0 (AUC 1.0, p < 0.001). The pH ROC analysis for predicting NGT correct gastric placement demonstrated the optimal pH cutoff value at 4.25, with a mild diagnostic accuracy (AUC 0.79, p < 0.001). Discussion: A device capable of combining the presence of a negative marker with a positive marker could be accurate enough in identifying the correct NGTs positioning. Further studies are required to validate the reproducibility of these results by a specific device, whose accuracy also ought to be compared with standard chest X-ray.

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Use of an Electromagnetic Device Compared With Chest X-ray to Confirm Nasogastric Feeding Tube Position in Critical Care

Journal of Parenteral and Enteral Nutrition ◽

10.1177/0148607115575034 ◽

2015 ◽

Vol 40 (4) ◽

pp. 581-586 ◽

Cited By ~ 15

Author(s):

Danielle E. Bear ◽

Alice Champion ◽

Katie Lei ◽

John Smith ◽

Richard Beale ◽

...

Keyword(s):

Critical Care ◽

Feeding Tube ◽

Nasogastric Feeding ◽

X Ray ◽

Electromagnetic Device ◽

Nasogastric Feeding Tube ◽

Tube Position ◽

Chest X Ray

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Ultrasound-Guided Placement of Central Venous Port Systems via the Right Internal Jugular Vein: Are Chest X-Ray and/or Fluoroscopy Needed to Confirm the Correct Placement of the Device?

World Journal of Surgery ◽

10.1007/s00268-016-3574-2 ◽

2016 ◽

Vol 40 (10) ◽

pp. 2353-2358 ◽

Cited By ~ 10

Author(s):

Michelangelo Miccini ◽

Diletta Cassini ◽

Matteo Gregori ◽

Sergio Gazzanelli ◽

Simone Cassibba ◽

...

Keyword(s):

Internal Jugular Vein ◽

Jugular Vein ◽

Ultrasound Guided ◽

Central Venous ◽

X Ray ◽

Central Venous Port ◽

Correct Placement ◽

Chest X Ray ◽

Port Systems ◽

The Right

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Ultrasound-Guided Placement of Central Venous Port Systems via the Right Internal Jugular Vein: Are Chest X-ray and/or Fluoroscopy Needed to Confirm the Correct Placement of the Device

World Journal of Surgery ◽

10.1007/s00268-016-3811-8 ◽

2016 ◽

Vol 41 (5) ◽

pp. 1396-1397

Author(s):

Chandan Kumar Jha ◽

Raouef Ahmed Bichoo ◽

Anjali Mishra

Keyword(s):

Internal Jugular Vein ◽

Jugular Vein ◽

Ultrasound Guided ◽

Central Venous ◽

X Ray ◽

Central Venous Port ◽

Correct Placement ◽

Chest X Ray ◽

Port Systems ◽

The Right

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732. Sensitivity and Specificity of Point of Care Lung Ultrasound vs. Chest X-Ray for the Diagnosis of Pediatric Pneumonia in Limited resource settings: The Zambia Experience

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.929 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S464-S464

Author(s):

Ingrid Y Camelo ◽

Rachel Pieciak ◽

Ilse castro-aragon ◽

Bindu Setty ◽

Lauren Etter ◽

...

Keyword(s):

Sensitivity And Specificity ◽

Predictive Value ◽

Gold Standard ◽

Point Of Care ◽

Severe Pneumonia ◽

Limited Resource ◽

Ultrasound Images ◽

X Ray ◽

Pediatric Pneumonia ◽

Chest X Ray

Abstract Background Pediatric pneumonia is the leading cause of child mortality in low-income countries. Pneumonia diagnosis is a challenge. Chest x-ray (CXR) is considered the gold standard, but it exposes children to ionizing radiation, and access to CXR is limited to hospital settings. Lung Point of Care Ultrasound (POCUS) is a portable and non-radiating alternative to CXR. Methods We enrolled 200 children aged 1-59 months from the University Teaching Hospital (UTH) Emergency Department (ED) in Lusaka, Zambia who met the WHO (World Health Organization) case definition for severe pneumonia. From each child, we collected demographic and clinical data, a CXR, and a set of ultrasound images using a Butterfly ultrasound probe. Images were independently interpreted by two radiologists blinded to the results of the other imaging modality. Using CXR as the gold standard, we determined the sensitivity and specificity, positive and negative predictive values, and likelihood ratios for pneumonia using lung POCUS. Results This preliminary analysis included 50 children seen between May-October 2020. Median age (9 months) (Range 4-15). 58% were male, (29/50). Median temperature was 37.3⁰C (range 36.5-38.0); median respiratory and pulse rates were 41 breaths/min (range 31-50) and 139 beats/min (range 124-160) respectively; median SpO2 on RA was 91% (range 89-95). 50% of cases had difficulty breathing (82%, 41/50); chest retractions (70%, 35/50) and grunting (62%, 31/50). Ultrasound images for 49/50 (98%) cases and CXRs for 50/50 (100%) of cases we analyzed. Sensitivity of lung POCUS in the detection of CAP was 61% (95% Cl: 0.52-0.84). The specificity was 77% (95% Cl: 0.56-0.91). Positive predictive value (PPV) 70% (95% CI: 0.62-0.94) and negative predictive value (NPV) 69% (95% CI: 0.56-0.79). Conclusion Preliminary findings of this study demonstrated the lower diagnostic accuracy of lung POCUS versus CXR in the detection of pneumonia in children 1- 59 months. The high specificity of the test will aid in ruling out severe pneumonia in children. Due to its availability, ease of interpretation, and absence of radiation exposure, lung POCUS should still be considered as an important initial imaging tool for the diagnosis of CAP in children in limited-resource settings. Disclosures All Authors: No reported disclosures

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The Role of Imaging In The Diagnosis of Pulmonary Embolism

Biomolecular and Health Science Journal ◽

10.20473/bhsj.v2i1.13281 ◽

2019 ◽

Vol 2 (1) ◽

pp. 57

Author(s):

Alfian Nur Rosyid ◽

M. Yamin ◽

Arina Dery Puspitasari

Keyword(s):

Risk Factors ◽

Pulmonary Embolism ◽

Gold Standard ◽

Common Condition ◽

X Ray ◽

Life Threatening ◽

Chest X Ray ◽

Proper Diagnosis ◽

D Dimer

Pulmonary embolism is a common condition and sometimes can be life-threatening. A proper diagnosis can reduce mortality. Some examinations are needed to diagnose pulmonary embolism, including assessing the risk factors, clinical examination, D-dimer tests, and imaging. Imaging is necessary when the previous assessment requires further investigation. There are more imaging that can be used to diagnose and assess the severity of pulmonary embolism. However, it is still controversial regarding imaging modalities for optimizing pulmonary embolism diagnose. Chest X-Ray cannot exclude pulmonary embolism, but it is needed to guide the next examinations and to find alternative diagnoses. Pulmonary Multi-Detector CT Angiography is the gold standard to diagnose pulmonary embolism.

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Audit of feasibility of pH use to confirm nasogastric tube placement in an adult critical care setting

Clinical Nutrition ESPEN ◽

10.1016/j.clnesp.2019.12.030 ◽

2020 ◽

Vol 35 ◽

pp. 220

Author(s):

M. Dawson ◽

L. Stokes ◽

J. Bazely ◽

A. Case ◽

C. Goodman ◽

...

Keyword(s):

Critical Care ◽

Nasogastric Tube ◽

Care Setting ◽

Critical Care Setting ◽

Tube Placement ◽

Nasogastric Tube Placement

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Is chest X-ray in supine position for central lines confirmation a gold standard or a fallacy?

Journal of Emergency and Critical Care Medicine ◽

10.21037/jeccm.2018.03.05 ◽

2018 ◽

Vol 2 ◽

pp. 33-33

Author(s):

Achyut Sharma ◽

Apurb Sharma ◽

Diptesh Aryal

Keyword(s):

Supine Position ◽

Gold Standard ◽

Central Lines ◽

X Ray ◽

Chest X Ray

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DIAGNOSTIC ACCURACY OF CHEST X-RAY IN THE DETECTION OF PNEUMOTHORAX IN BLUNT CHEST TRAUMA PATIENTS WITH CT AS THE GOLD STANDARD

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v5i7.2020 ◽

2021 ◽

Vol 5 (7) ◽

Author(s):

Danquale Vance Kynshikhar ◽

Chaman Lal Kaushal ◽

Ashwani Tomar ◽

Neeti Aggarwal

Keyword(s):

Diagnostic Accuracy ◽

Predictive Value ◽

Gold Standard ◽

Blunt Chest Trauma ◽

Chest Trauma ◽

Trauma Patients ◽

Care Level ◽

X Ray ◽

Primary Health ◽

Chest X Ray

Background: To study the diagnostic accuracy of chest X-ray in the detection of pneumothorax in blunt chest trauma patients with CT as the Gold Standard Methods: The present study was conducted from 31th July 2018 to 30th July 2019. A total of 36 patients were enrolled in the study. Results: On Chest X-Ray Supine AP view, pneumothorax was detected in 11 of 24 patients. The sensitivity of Chest X-Ray Supine AP view was 45.83%, specificity was 100%, positive predictive value (PPV) was 100%, negative predictive value (NPV) was 48% and accuracy was 63.89% for the diagnosis of pneumothorax. Conclusion: A Chest radiograph is the most preferred and relevant primary investigation in the diagnosis of pneumothorax even with the various advanced techniques that are available. X-ray being relatively cheaper and is easily available even at the peripheral centers at the primary health care level. Keywords: X-ray, CT, Pneumothorax

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Lung Ultrasound for Initial Diagnosis and Subsequent Monitoring of Aspiration Pneumonia in Elderly in Home Medical Care Setting

Gerontology and Geriatric Medicine ◽

10.1177/2333721419858441 ◽

2019 ◽

Vol 5 ◽

pp. 233372141985844

Author(s):

Hirofumi Namiki ◽

Tadashi Kobayashi

Keyword(s):

Aspiration Pneumonia ◽

Care Setting ◽

Lung Ultrasound ◽

Initial Diagnosis ◽

Resource Limited Settings ◽

X Ray ◽

Resource Limited ◽

X Ray Imaging ◽

Chest X Ray ◽

B Lines

The number of aspiration pneumonia cases has increased in recent times. A definitive diagnosis of aspiration pneumonia is difficult in resource-limited settings where radiological equipment is unavailable. We report the initial diagnosis and subsequent monitoring of aspiration pneumonia in a home medical care setting. An 88-year-old Japanese male presented an acute onset of dyspnea, fever, and productive cough. At home, lung ultrasound displayed pleural effusion along with B-lines and subpleural consolidations. Upon admission, tests revealed increased total leucocyte counts with left-shifted neutrophils, elevated C-reactive protein levels, and positive sputum Gram stain. Chest X-ray imaging and computed tomography (CT) showed bibasilar infiltrates and wall thickening in the left S10 bronchi. The patient was diagnosed with aspiration pneumonia and treated with an antibiotic. After a 10-day hospitalization, lung ultrasound showed some remaining B-lines and disappearance of pleural effusion and subpleural consolidation. Chest X-ray image was normal, and CT revealed pleural abnormality and disappearance of bibasilar infiltrates, consistent with the ultrasound findings. Aspiration pneumonia develops with various clinical signs. However, diagnosis using chest X-ray imaging or CT in resource-limited settings is difficult. Ultrasound might allow physicians to make more accurate judgments, particularly while monitoring aspiration pneumonia following initial diagnosis in resource-limited settings.

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