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Published on: September 20, 2019
How to Promote Bedside Placement of the Postpyloric Feeding Tube: A Network Meta-Analysis of Randomized Controlled
Huang Tiancha1, Jing Jiyong2, Yan Min3
1Intensive Care Unit, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China.
Insights
Gastric air insufflation is the most effective method for bedside postpyloric tube placement in adults. Prokinetic agents are not recommended for pediatric patients or those without motility issues.
Area of Science:
- Gastroenterology
- Medical Devices
- Clinical Trials
Background:
- Bedside postpyloric tube placement methods lack consensus for speed, safety, and accuracy.
- Investigating techniques to improve postpyloric tube insertion success rates is crucial.
Purpose of the Study:
- To compare the efficacy of different bedside postpyloric tube placement techniques.
- To determine if specific techniques are more suitable for adult or pediatric patients.
Main Methods:
- Systematic literature search of electronic databases for comparative studies on postpyloric tube placement.
- Independent quality review and data extraction by two reviewers.
- Pairwise and network meta-analyses to synthesize efficacy data.
Main Results:
- Fourteen trials with 753 patients were analyzed.
- Prokinetic agents showed higher success rates than the standard technique (OR, 2.263).
- Gastric air insufflation was superior to prokinetic agents in adults (OR, 3.462), with an 88% probability of being most efficacious.
Conclusions:
- Gastric air insufflation is clinically superior for adult bedside postpyloric feeding tube placement.
- Prokinetic agents should be avoided in pediatric patients or those with normal motility.
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.
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