Nursing in critical care · 2026
Application of Combined Gastric Tube Tip Manometry and Auscultation for Nasogastric Tube Positioning in Neurocritical Care Patients With Artificial Airways: A Prospective Diagnostic Pilot Study.
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Xu Mengmin, Chen Yunxia, Sheng Zhiyuan, Li Ying, Liang Qianqian, Meng Xiaobing
Аннотация
BACKGROUND: Nasogastric tube placement is central to enteral nutrition support in neurocritical care patients. However, tube malposition, particularly accidental placement into the airway, can lead to fatal complications.
AIM: To assess the accuracy of a combined gastric tube tip manometry and auscultation approach for confirming nasogastric tube placement in neurocritical care patients with artificial airways.
STUDY DESIGN: This prospective study enrolled patients who underwent nasogastric tube insertion in the neurocritical care unit of a tertiary hospital in China between January 2025 and May 2025. Using chest X-ray as the reference standard, we compared the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR) and negative likelihood ratio (NLR) for gastric tube tip manometry alone, auscultation alone and their combination.
RESULTS: In total, 120 patients participated. X-ray confirmed correct nasogastric tube positioning in 119 patients and malposition in 1 patient. For gastric tube tip manometry alone, the sensitivity was 97.48%, with a specificity of 0%, a positive predictive value (PPV) of 99.15% and a negative predictive value (NPV) of 0%. Auscultation alone yielded a sensitivity of 90.76%, a specificity of 100%, a PPV of 100% and an NPV of 8.33%. The combined manometry-plus-auscultation approach had a sensitivity of 88.24%, a specificity of 100%, a PPV of 100% and an NPV of 6.67%.
CONCLUSIONS: The combined gastric tube tip manometry and auscultation method might serve as an adjunctive bedside strategy for confirming nasogastric tube placement in neurocritical care patients with artificial airways. However, only one malpositioned tube was observed in this study; the specificity and NPV should be interpreted with caution.
RELEVANCE TO CLINICAL PRACTICE: When gastric aspirate cannot be obtained or immediate chest radiography is impractical, combined gastric tube tip manometry and auscultation provide a feasible, radiation-free bedside pathway for confirming nasogastric tube position; equivocal or negative bedside findings should still be verified radiographically before feeding.
TRIAL REGISTRATION: The study was registered with the Chinese Clinical Trial Registry (ChiCTR2300078001).
AIM: To assess the accuracy of a combined gastric tube tip manometry and auscultation approach for confirming nasogastric tube placement in neurocritical care patients with artificial airways.
STUDY DESIGN: This prospective study enrolled patients who underwent nasogastric tube insertion in the neurocritical care unit of a tertiary hospital in China between January 2025 and May 2025. Using chest X-ray as the reference standard, we compared the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR) and negative likelihood ratio (NLR) for gastric tube tip manometry alone, auscultation alone and their combination.
RESULTS: In total, 120 patients participated. X-ray confirmed correct nasogastric tube positioning in 119 patients and malposition in 1 patient. For gastric tube tip manometry alone, the sensitivity was 97.48%, with a specificity of 0%, a positive predictive value (PPV) of 99.15% and a negative predictive value (NPV) of 0%. Auscultation alone yielded a sensitivity of 90.76%, a specificity of 100%, a PPV of 100% and an NPV of 8.33%. The combined manometry-plus-auscultation approach had a sensitivity of 88.24%, a specificity of 100%, a PPV of 100% and an NPV of 6.67%.
CONCLUSIONS: The combined gastric tube tip manometry and auscultation method might serve as an adjunctive bedside strategy for confirming nasogastric tube placement in neurocritical care patients with artificial airways. However, only one malpositioned tube was observed in this study; the specificity and NPV should be interpreted with caution.
RELEVANCE TO CLINICAL PRACTICE: When gastric aspirate cannot be obtained or immediate chest radiography is impractical, combined gastric tube tip manometry and auscultation provide a feasible, radiation-free bedside pathway for confirming nasogastric tube position; equivocal or negative bedside findings should still be verified radiographically before feeding.
TRIAL REGISTRATION: The study was registered with the Chinese Clinical Trial Registry (ChiCTR2300078001).