Diagnostic accuracy of end-tidal carbon dioxide detection in determining correct placement of nasogastric tube: An updated systematic review with meta-analysis.

Published on Aug 24, 2021in International Journal of Nursing Studies3.783
· DOI :10.1016/J.IJNURSTU.2021.104071
Janita Pak Chun Chau20
Estimated H-index: 20
(CUHK: The Chinese University of Hong Kong),
Xu Liu5
Estimated H-index: 5
(CUHK: The Chinese University of Hong Kong)
+ 5 AuthorsDavid R. Thompson100
Estimated H-index: 100
('QUB': Queen's University Belfast)
Sources
Abstract
Abstract null null Background null Misplacement of the nasogastric tube in the respiratory tract could cause serious complications and even death. Thus, nasogastric tube verification is necessary for optimal patient safety and comfort. Although end-tidal carbon dioxide detection is considered an effective approach to determine nasogastric tube location, there is a paucity of up-to-date evidence. null null null Objectives null To review the diagnostic accuracy of end-tidal carbon dioxide detection in determining inadvertent airway intubation and verifying correct placement of nasogastric tubes. null null null Design null A systematic review and meta-analysis. null null null Methods null We searched clinical trials that evaluated the diagnostic accuracy of colorimetric capnometry or capnography in detecting nasogastric tubes located in the airway and differentiating between inadvertent airway intubation and correct nasogastric tube placement in any adult care setting. Four English language databases - Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and CINAHL - and four Chinese language databases - China Biomedical Literature Database, WanFang Data, China National Knowledge Infrastructure, and Airiti Library - were searched from July 2009 to March 2021. Clinical trial registration databases and reference lists of included studies and relevant reviews were also searched. Two reviewers extracted the data of all included studies using a data extraction form. Two reviewers assessed the methodological quality independently with the Quality Assessment of Diagnostic Accuracy Studies-2 tool. We conducted meta-analysis using the hierarchical bivariate model and estimated the pool sensitivity and specificity of capnography and colorimetric capnometry. Forest plots were generated to display the results. Heterogeneity was investigated by meta-regression. The certainty of evidence was evaluated with the Grading of Recommendations Assessment, Development and Evaluations framework. null null null Results null Of 1,155 records identified, seven new studies were added to this update and a total of 16 studies were analysed in the systematic review. The total absolute number of true positive, false negative, true negative, and false positive observations were 142, 6, 1,500, and 65 respectively. Low to very low certainty of evidence indicated that the use of colorimetric capnometry or capnography is potentially an effective method in differentiating between respiratory and nasogastric tube placement for critically ill adult patients. Pooled results (13 studies, 1,541 intubations) for sensitivity and specificity were 0.96 (95% confidence interval [0.88, 0.99]) and 0.99 (95% confidence interval [0.96, 1.00]), respectively. null null null Conclusions null Colorimetric capnometry and capnography may have the potential to be of high sensitivity and specificity for the detection of inadvertent airway nasogastric tube placements in critically ill adults. More evidence is required to generalize the updated findings to different types of patients and settings.
📖 Papers frequently viewed together
8 Authors (Eitan Dickman, ..., John Marshall)
82 Citations
References44
Newest
#2David Moher (U of O: University of Ottawa)H-Index: 104
#3Patrick M.M. Bossuyt (UvA: University of Amsterdam)H-Index: 147
Last. Joanne E. McKenzie (Monash University)H-Index: 38
view all 26 authors...
The methods and results of systematic reviews should be reported in sufficient detail to allow users to assess the trustworthiness and applicability of the review findings. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement was developed to facilitate transparent and complete reporting of systematic reviews and has been updated (to PRISMA 2020) to reflect recent advances in systematic review methodology and terminology. Here, we present the explanation and ...
141 CitationsSource
In this case series we present 3 cases of nasogastric tube misplacement in tracheostomy patients. Although considered safe and it being a common procedure nasogastric tube misplacement can lead to serious and life-threatening complications. We present three cases of nasogastric tube misplacement in tracheostomized patients. One of the cases presented suffered from pneumothorax. Different time intervals between procedures in these different cases resulted in similar results. We would like to emph...
1 CitationsSource
#1Annette M. Bourgault (UCF: University of Central Florida)H-Index: 10
#2Jan PowersH-Index: 7
Last. Robert B. Hines (UCF: University of Central Florida)H-Index: 11
view all 4 authors...
Background Bedside methods to verify placement of a feeding tube are not accurate for detecting placement within the gastrointestinal tract, increasing risk of pulmonary aspiration. Current guidelines recommend verifying placement every 4 hours, yet the rationale for this recommendation is unknown. Objective To assess spontaneous migration of small-bore feeding tubes in critically ill adults. Methods A prospective, repeated-measures cohort study was performed in 2 intensive care units. An electr...
2 CitationsSource
BACKGROUND Harm events such as pneumothoraces and pneumonia continue to be associated with feeding tube insertion. Most bedside verification methods are not accurate to discriminate pulmonary from gastrointestinal system. Evidence-based clinical practice guidelines do not support auscultation of feeding tubes in adults, yet auscultation is the most common method used. OBJECTIVES Our survey assessed national feeding tube verification practices used by critical care nurses, including progress in a...
2 CitationsSource
#1Jean-Paul Salameh (Ottawa Hospital Research Institute)H-Index: 13
#2Patrick N M Bossuyt (UvA: University of Amsterdam)H-Index: 4
Last. Matthew D. F. McInnes (Ottawa Hospital Research Institute)H-Index: 31
view all 22 authors...
Systematic reviews of diagnostic test accuracy (DTA) studies are fundamental to the decision making process in evidence based medicine. Although such studies are regarded as high level evidence, these reviews are not always reported completely and transparently. Suboptimal reporting of DTA systematic reviews compromises their validity and generalisability, and subsequently their value to key stakeholders. An extension of the PRISMA (preferred reporting items for systematic review and meta-analys...
38 CitationsSource
#1Po-Ting Chen (NTU: National Taiwan University)H-Index: 3
#2Bo-Ching Lee (NTU: National Taiwan University)H-Index: 4
Last. Kao-Lang Liu (NTU: National Taiwan University)H-Index: 26
view all 6 authors...
Background/Purpose Enteral feeding, mainly by using a nasogastric tube (NGT), is generally favored over parenteral supplementation in head and neck cancer (HNC) patients with dysphagia. However, the placement of a NGT, either blindly or by endoscopy, is technically challenging in these patients due to the obstructive mass and the altered regional anatomy. The aim of this retrospective study was to estimate the clinical feasibility and safety of fluoroscopic-guided NGT placement in patients with ...
2 CitationsSource
#1Elahe Heidarzadi (Kermanshah University of Medical Sciences)H-Index: 1
#2Rostam Jalali (Kermanshah University of Medical Sciences)H-Index: 9
Last. Nader Salari (Kermanshah University of Medical Sciences)H-Index: 12
view all 4 authors...
BACKGROUND Placement of nasogastric (NG) tubes is a common procedure for patients especially in intensive care units (ICUs). Thus, it is important to determine the correct placement of the tube to prevent misplacement in the airways. Accordingly, the aim of this study was to compare the epigastric auscultation and capnography in assessing the accuracy of NG tube insertion in ICU patients. METHODS In this descriptive comparative study, 60 patients were selected trough convenience sampling. After ...
1 CitationsSource
#1Holger J. SchünemannH-Index: 155
#2Reem A. MustafaH-Index: 56
Last. Gordon H. Guyatt (KU: University of Kansas)H-Index: 260
view all 31 authors...
Abstract Objectives This article provides updated GRADE guidance about how authors of systematic reviews and health technology assessments (HTA) and guideline developers can assess the results and the certainty of evidence (also known as quality of the evidence or confidence in the estimates) of a body of evidence addressing test accuracy (TA). Study Design and Setting We present an overview of the GRADE approach and guidance for rating certainty in TA in clinical and public health and review th...
52 CitationsSource
OBJECTIVES This article provides updated GRADE guidance about how authors of systematic reviews and health technology assessments (HTA) and guideline developers can rate the certainty of evidence (also known as quality of the evidence or confidence in the estimates) of a body of evidence addressing test accuracy (TA) on the domains imprecision, inconsistency, publication bias and other domains. It also provides guidance for how to present synthesized information in evidence profiles and summary ...
49 CitationsSource
Abstract Objectives This article provides updated GRADE guidance about how authors of systematic reviews and health technology assessments (HTA) and guideline developers can rate the certainty of evidence (also known as quality of the evidence or confidence in the estimates) of a body of evidence addressing test accuracy (TA) on the domains imprecision, inconsistency, publication bias and other domains. It also provides guidance for how to present synthesized information in evidence profiles and...
51 CitationsSource
Cited By0
Newest