title: To characterize the incidence of airway misplacement of nasogastric tubes in anesthetized intubated patients by using a manometer technique.
abstract: This study characterized the incidence of airway misplacement of nasogastric (NG) tubes in surgical patients, and the benefit of using a manometer to discriminate gastric placement from airway placement of NG tubes. Subjects included adult patients scheduled for abdominal surgery. After tracheal intubation, a 16 Fr. NG tube was inserted blindly through the nostril, and its position was assessed using the auscultation (10-ml air insufflation) or manometer (attached to NG tubes) techniques. Briefly, a biphasic pressure change synchronous with airway pressure during mechanical ventilation indicated airway misplacement. The presence of a notable pressure change while compressing the epigastric area indicated a gastric placement. A surgeon made the final confirmation of NG tube placement within the stomach using manual palpation of the tube immediately after laparotomy. The first-attempt success rate was 82.7 % in 104 patients. There were 29 misplacements of 130 attempted insertions (oral cavity, n = 23; trachea, n = 3; distal esophagus, n = 3). The incidence of airway misplacement was 2.9 % (3 of 104 cases). For confirmation of gastric placement, the auscultation technique had a sensitivity of 100.0 % and a specificity of 79.3 %. In contrast, the manometer technique had a sensitivity of 100.0 % and a specificity of 100.0 % in the discrimination of gastric placement from airway placement of NG tubes. Airway misplacement of NG tubes is not uncommon in surgical patients, and the manometer technique may be a reliable and safe method to discriminate gastric placement from airway placement of NG tubes.
authors.affiliation: Department of Anesthesiology, E-DA Hospital, 1, E-Da Road, Jiau-shu Tsuen, Yan-Chau Shiang, Kaohsiung, 824, Taiwan, ROC.
authors.forename: Shao-Wei
authors.initials: SW
authors.lastname: Hsieh
authors.affiliation: Department of Anesthesiology, E-DA Hospital, 1, E-Da Road, Jiau-shu Tsuen, Yan-Chau Shiang, Kaohsiung, 824, Taiwan, ROC.
authors.forename: Hung-Shu
authors.initials: HS
authors.lastname: Chen
authors.affiliation: Department of Anesthesiology, E-DA Hospital, 1, E-Da Road, Jiau-shu Tsuen, Yan-Chau Shiang, Kaohsiung, 824, Taiwan, ROC.
authors.forename: Yi-Ting
authors.initials: YT
authors.lastname: Chen
authors.affiliation: Department of Anesthesiology, E-DA Hospital, 1, E-Da Road, Jiau-shu Tsuen, Yan-Chau Shiang, Kaohsiung, 824, Taiwan, ROC. ed102605@gmail.com.
authors.forename: Kuo-Chuan
authors.initials: KC
authors.lastname: Hung
mesh_terms: D000328:Adult; D000368:Aged; D001314:Auscultation / Q000379:methods*; D004947:Esophagus; D005260:Female; D006801:Humans; D015994:Incidence; D007327:Insufflation / Q000379:methods*; D007441:Intubation, Gastrointestinal / Q000009:adverse effects*; D007442:Intubation, Intratracheal / Q000009:adverse effects; D007813:Laparotomy; D008297:Male; D008365:Manometry / Q000379:methods*; D019300:Medical Errors / Q000517:prevention & control / Q000706:statistics & numerical data*; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results; D012121:Respiration, Artificial; D014132:Trachea
keywords: Manometer; Nasogastric tube; Pneumothorax; Tracheal tube