title: How to Promote Bedside Placement of the Postpyloric Feeding Tube: A Network Meta-Analysis of Randomized Controlled Trials.
abstract: BACKGROUND
  The optimal method of achieving fast, safe, and accurate postpyloric tube placement at the bedside remains controversial. This study investigated whether facilitating techniques of bedside placement would improve the rate of successful placement of postpyloric tubes when compared with the standard technique and whether strategies should be confined to adult or pediatric patients.
  
  
  METHODS
  We searched electronic databases for eligible literatures that compared different methods of postpyloric tube placement, evaluating the successful rate of postpyloric tube placement. Two reviewers reviewed the quality of the studies and performed data extraction independently. Pairwise and network meta-analyses were performed to integrate the efficacy.
  
  
  RESULTS
  Fourteen clinical trials involving 753 patients were included. Pairwise meta-analyses demonstrated that prokinetic agents (odds ratio [OR], 2.263; 95% confidence interval [CI]: 1.140-4.490; P = .02) were associated with a higher success rate as compared with the standard technique, and gastric air insufflation was associated with a higher success rate as compared with prokinetic agents (OR, 3.462; 95% CI, 1.63-7.346; P = .001) in adult patients. In network analyses, prokinetic agents and gastric air insufflation were also consistently associated with a higher success rate in adult patients. Trend analyses of rank probabilities revealed gastric air insufflation had the cumulative probability of being the most efficacious strategy (78%), especially in adult patients (88%).
  
  
  CONCLUSIONS
  Gastric air insufflation seems to be clinically better for promoting bedside placement of postpyloric feeding tubes in adults. Clinicians should no longer use prokinetic agents in pediatric patients or patients without impaired motility.
authors.affiliation: Intensive Care Unit, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China.
authors.forename: Huang
authors.initials: H
authors.lastname: Tiancha
authors.affiliation: Department of Respiratory Care, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Jiyong
authors.affiliation: Department of Anesthesiology, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China yanmin_zju@126.com.
authors.forename: Yan
authors.initials: Y
authors.lastname: Min
mesh_terms: D000328:Adult; D000388:Air; D057785:Catheters; D002648:Child; D004750:Enteral Nutrition / Q000295:instrumentation / Q000379:methods*; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D006801:Humans; D007327:Insufflation / Q000379:methods*; D007441:Intubation, Gastrointestinal / Q000379:methods*; D059039:Standard of Care; D013270:Stomach
chemical_list: D005765:Gastrointestinal Agents
keywords: gastrointestinal intubation; network meta-analysis; postpyloric tube