Real-time imaging-guided visualization facilitates post-pyloric feeding tube placement in critically ill patients: a prospective randomized controlled study.

BACKGROUND

Early post-pyloric feeding is critical for improving outcomes in critically ill patients. While guided feeding tube placement has demonstrated superior efficacy to blind insertion, its clinical application remains constrained by technical and operational challenges. The integrated real-time imaging system (IRIS) addresses these limitations by combining continuous lumen visualization with device portability, potentially democratizing precise feeding tube placement. This study evaluated whether IRIS-assisted placement achieved higher efficacy while maintaining equivalent safety compared to traditional blind bedside insertion.

METHODS

In this prospective randomized controlled trial, a total of 46 critically ill patients requiring enteral nutrition due to dysphagia or high aspiration risk were randomized to IRIS-guided visualization (VG group) or blind insertion (CG group). One patient was excluded from the analysis because of a major protocol violation. The primary and secondary outcomes were the procedural time and first-attempt success rate, respectively. Safety outcomes included adverse events and hemodynamic stability.

RESULTS

Among the 45 analyzed patients (VG: 22, CG: 23), the VG group presented a significantly shorter median procedural time (3.19 vs. 22.52 min; 95% CI, -32.23 to -14.22; P < 0.0001) and a higher first-attempt success rate (95.45% vs. 69.57%; odds ratio, 9.19; 95% CI, 1.02-82.41; P = 0.047) than the CG group. Adverse event incidence and hemodynamic stability were comparable between the groups.

CONCLUSION

IRIS-guided visualization technology significantly reduces the procedural duration and improves the first-attempt success rate for post-pyloric feeding-tube placement in critically ill patients, while enabling real-time anatomical visualization.