title: Clinical usefulness of capnographic monitoring when inserting a feeding tube in critically ill patients: retrospective cohort study.
abstract: It is not rare for a small-bore feeding tube to be inserted incorrectly into the respiratory system in critically ill patients. Thus, monitoring is necessary to prevent respiratory malplacement of the tube. We investigated the utility of capnographic monitoring to prevent respiratory complications due to feeding tube mispositioning in critically ill patients.
  
  
  
  This study was a pre and post-interventional study, including 445 feeding tube placements events studied retrospectively in the medical and surgical intensive care units of the Samsung Medical Center. We compared outcomes between time periods before and after capnographic monitoring and documented any respiratory complications.
  
  
  
  Feeding tubes were inserted in 275 cases without capnographic monitoring. Capnographic monitoring was performed in 170 cases. Sixteen patients (4%) had respiratory complications of all tube placements. Feeding tube was inserted into the trachea in 11 (2%) patients and for a pneumothorax in five (1%) patients. Fourteen cases of respiratory complications were detected in the control group (14/275, 5%, 10 tracheal insertions and four pneumothoraxes). Two respiratory complications were detected in the capnographic monitoring group (2/170, 1%, one tracheal insertion and one pneumothorax). Respiratory complications were detected less frequently in the capnographic monitoring group than that in the control group (P = 0.035).
  
  
  
  Capnographic monitoring is simple, easy to learn, and may be useful to prevent respiratory complications when placing a feeding tube in a critically ill patient.
authors.affiliation: Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Jeong-Am
authors.initials: JA
authors.lastname: Ryu
authors.affiliation: Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Kyoungjin
authors.initials: K
authors.lastname: Choi
authors.affiliation: Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.|Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Jeong Hoon
authors.initials: JH
authors.lastname: Yang
authors.affiliation: Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Dae-Sang
authors.initials: DS
authors.lastname: Lee
authors.affiliation: Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.|Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Gee Young
authors.initials: GY
authors.lastname: Suh
authors.affiliation: Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.|Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Kyeongman
authors.initials: K
authors.lastname: Jeon
authors.affiliation: Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Joongbum
authors.initials: J
authors.lastname: Cho
authors.affiliation: Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Chi Ryang
authors.initials: CR
authors.lastname: Chung
authors.affiliation: Research Institute for Future Medicine, Biostatistics and Clinical Epidemiology Center, Samsung Medical Center, Seoul, Korea.
authors.forename: Insuk
authors.initials: I
authors.lastname: Sohn
authors.affiliation: Research Institute for Future Medicine, Biostatistics and Clinical Epidemiology Center, Samsung Medical Center, Seoul, Korea.
authors.forename: Kiyoun
authors.initials: K
authors.lastname: Kim
authors.affiliation: Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. dr99.park@samsung.com.|Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. dr99.park@samsung.com.
authors.forename: Chi-Min
authors.initials: CM
authors.lastname: Park
mesh_terms: D000368:Aged; D019296:Capnography; D016638:Critical Illness; D004750:Enteral Nutrition / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D055370:Lung Injury / Q000453:epidemiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies
keywords: Capnographic monitoring; Critically ill patient; Feeding tube; Pneumothorax