The Establishment And Validation Of Optimizing Strategies For Post-pyloric Placement Of A Spiral Nasoenteric Tube

Enteral Nutrition(EN)maintains the normal physiology of the gastrointestinal tract and protects the gastrointestinal mucosa,which should be the prior way of nutrition support choice for critically ill patients.In intensive care units,EN can be achieved by oral or tube feeding,which includes gastric and intestinal feeding.Intestinal feeding can significantly reduce the complications of reflux and aspiration compared with gastric feeding,and all the major guidelines recommend that intestinal feeding is preferred for EN.Postpyloric placement of the nasoenteral tube(NET)is a prerequisite for intestinal feeding.Clinically,the methods of postpyloric tube placement are mainly equipment-dependent or nonequipment-dependent.The former needs to be completed under the assistance of gastroscopy,ultrasound B and other devices,with a high success rate but a high cost,and the requirement to transport patients with transport risk.The latter includes bedside blind post-pyloric tube placement and self-propelling post-pyloric tube placement.The bedside blind post-pyloric tube placement was performed with a certain manipulation to place the feeding tube into the pylorus.The self-propelled spiral NET is a new type of enteral nutrition route.However,interfered with a number of factors including gastric motility,drugs and disease severity,the success rate of self-propelled post-pyloric placement of spiral NET in critically ill patients is low.Multiple randomized controlled trial(RCT)studies have shown that prokinetics can improve the success rate of postpyloric insertion,which has become a clinical consensus.This project aims to systematically optimize the strategy as a whole for postpyloric placement of a spiral nasointestinal tube in critically ill patients,improve the overall success rate of feeding tube placement,and initiate enteral nutrition as early as possible.Optimization strategy mainly includes three modules.The first module is to develop and verify a predictive model,which serves as a decision aid tool for self-propelled postpyloric placement of spiral nasointestinal tube assisted by prokinetic agents,to assist clinicians' pre-placement decisions and avoid unnecessary failures,promote overall success,achieve EN as early as possible.In this study,a predictive model for the successful placement of self-propelled spiral nasointestinal tubes was developed and validated using data mining techniques in a mixed cohort.The establishment and internal validation of prediction model were completed in a retrospective cohort,and external validation was completed in a prospective cohort.The decision curve analysis(DCA)was used to evaluate the decision benefit,and the calibration plot was used to evaluate the model of fitness.For predicted or proven failure of self-propelled placement,bedside blind postpyloric tube placement is used as a remedy scheme.The second module aims to study this remedy method for failed self-propelled post-pyloric placement.In order to demonstrate the feasibility and safety of this technique,this study prospectively observed and analyzed the relevant parameters of patients receiving bedside blind postpyloric placement after the failure of self-propelled insertion.The third module mainly demonstrates the extensibility of the bedside blind tube placement by analyzing the learning data of participating intensivists and exploring the learning curve.In this composite research,we found that the influencing factors against prokinetics-aided self-propelled postpyloric tube placement include the primary dignosis,APACHE ? score and AGI grade.The prediction model incorporating these factors can be visualized into a nomogram as a decision support tool for physicians to make more net benefits.Employing bedside blind placement as a rescue method for expected or happened failed self-propelled placement is feasible,safe,and is worth to be popularized into other medical settings.