METHODS: We assessed high-risk ICU patients from October 2014 to March 2019 to address three objectives. First, we prospectively monitored ICU patients with a nasal bridle for all types of adverse events. Second, we used propensity score methods to create a (1:1) matched historical comparison group (ie, tape group). We then compared the number of inadvertent tube dislodgements and the caloric intake between the tape and nasal bridle groups.
RESULTS: In the prospective group (n = 64), there were 20 adverse events, 12 of which were inadvertent tube dislodgements. Forty-eight participants in the nasal bridle group were matched with participants in the historical group. Thirty-five percent (17/48) of patients in the tape group had at least one inadvertent tube dislodgement; in the nasal bridle group, 48% (23/48) had at least one inadvertent tube dislodgement, although this only occurred in 7 of 48 (15%) patients after the nasal bridle had been inserted. The tape group achieved a lower median percentage of total caloric intake received (66.0%) compared with that of the nasal bridle group (86.1%; P = 0.017).
CONCLUSIONS: In the subpopulation of ICU patients with a small-bore feeding tube who demonstrate a higher risk of inadvertent tube dislodgement, use of the nasal bridle may be associated with a higher caloric intake, even though it does not completely prevent tube dislodgement.
方法:我们评估了2014年10月至2019年3月的ICU高危患者,以解决三个目标。首先,我们前瞻性地监测了ICU有鼻绳的患者的所有类型的不良事件.第二,我们使用倾向评分方法创建一个(1:1)匹配的历史比较组(即,磁带组)。然后,我们比较了胶带组和鼻绳组之间的意外导管移位次数和热量摄入。
结果:在前瞻性组中(n=64),有20个不良事件,其中12例是无意的导管移位。鼻绳组的48名参与者与历史组的参与者进行了匹配。胶带组中有35%(17/48)的患者至少有一次意外的导管移位;在鼻绳组中,48%(23/48)至少有一次意外的导管移位,尽管这只发生在插入鼻绳后的48例患者中的7例(15%)。与鼻绳组(86.1%;P=0.017)相比,胶带组获得的总热量摄入的中位数百分比(66.0%)较低。
结论:在使用小口径饲管的ICU患者亚群中,有较高的意外脱管风险,使用鼻绳可能与更高的热量摄入有关,即使它不能完全防止管移位。