Application of pressure at the gastric tube tip manometry for nasogastric tube positioning in neurocritical care: A prospective diagnostic study.

Objectives: To evaluate the accuracy of pressure at the gastric tube tip manometry for confirming nasogastric (NG) tube placement in neurocritical care patients.

Methods: A total of 150 patients who underwent NG tube placement in the Neurocritical Care Unit (NICU) of a tertiary hospital in Henan Province from August to December 2024 were consecutively enrolled. After tube insertion, pressure at the gastric tube tip manometry was used to assess tube position, with accuracy confirmed by chest X-ray, the gold standard. The method's consistency, specificity, sensitivity, and area under the receiver operating characteristic (ROC) curve were then analyzed.

Results: Pressure at the gastric tube tip manometry demonstrated exceptional diagnostic performance, with an AUC of 0.992 (95 % CI: 0.979-1.000), 100 % sensitivity, and 98.39 % specificity. In patients with artificial airways, an AUC of 0.989 (95 % CI: 0.975-1.000) was achieved, with 100 % sensitivity and 97.87 % specificity. For patients without artificial airways, specificity was 100 %, but sensitivity and AUC could not be calculated. In mechanically ventilated patients, an AUC of 0.987 (95 % CI: 0.965-1.000) was achieved, with 100 % sensitivity and 97.37 % specificity. In contrast, in non-mechanically ventilated patients, an AUC of 1.000 (95 % CI: 1.000-1.000) was observed, with both sensitivity and specificity at 100 %. When stratified by Glasgow Coma Scale (GCS) scores, patients with a GCS ≤ 8 had an AUC of 0.990(95 % CI: 0.973-1.000), with 100 % sensitivity and 97.96 % specificity, while those with a GCS of 9-15 showed a perfect AUC of 1.000(95 % CI: 1.000-1.000), with both sensitivity and specificity at 100 %.

Conclusions: Pressure at the gastric tube tip manometry, unaffected by the presence of fluid in the tube, is a highly reliable method for verifying NG tube placement in neurocritical care patients and exhibits excellent concordance with chest X-ray results.

Implications For Clinical Practice: The pressure at the gastric tube tip manometry method provides an accurate, rapid, and non-invasive means of confirming NG tube placement in neurocritical care patients, particularly those without artificial airways. The method shows great practical potential in enhancing the accuracy and efficiency of NG tube placement verification.