Eficácia de técnicas não instrumentais para inserção de sonda de alimentação em pacientes críticos: ensaio clínico randomizado

Abstract

The insertion of the nasoenteral tube, despite being a frequent procedure, is invasive and traditionally inserted with the patient's head in the neutral position and without instrumental assistance or external laryngeal manipulation. This procedure sometimes becomes difficult and traumatic, presenting greater complexity in comatose and intubated patients, becoming a challenge in the face of anatomical obstacles. Its insertion is not without risks, adverse events may occur and compromise patient safety. To this end, the objective was to compare the effectiveness of two non-instrumental methods of nasoenteral tube insertion in comatose and intubated patients. This is a prospective, randomized and controlled clinical trial, carried out in the Intensive Care Unit of Hospital Dr. José Pedro Bezerra, between March 2022 and August 2023, where adult patients in physiological or induced coma and intubated were randomly selected. distributed into two groups: insertion of the probe conventionally, with the head in the neutral position (Control Group) and the group with the head positioned laterally to the right (Intervention Group). The following were recorded and calculated: success rate of the selected technique in the first attempt, second attempt and total; time required for the first successful attempt and the sum of all attempts; complications during insertion, including probe kinking, twisting, knotting, mucosal bleeding, and insertion into the trachea; patient's vital signs. The project was assessed by the Research Ethics Committee of the Federal University of Rio Grande do Norte, where it received a favorable opinion and was registered on the Brazilian Clinical Trials Registry platform (RBR-8cktds4). 32 patients were distributed according to randomization and allocated as follows: 16 (50%) in the control group and 16 (50%) in the intervention group. The overall success rate was 75%. Success in the first insertion attempt was 87.50% in the intervention group and 62.50% in the control group. The time required, in seconds, for successful insertion was shorter in the intervention group (53.31 ± 17.50) compared to the control group (84.38 ± 29.81), with a statistical difference being evident (p<0.001). Complications were higher in the control group (31.25%) when compared to the intervention group (6.25%). There was no statistical difference between the groups in the first and second attempt (p=0.172 and p=0.301, respectively). The complications observed were: tube coiling (12.25%) and coiling associated with bleeding (25.00%). In the control group, the mean pressure before the procedure was 107.38 mmHg and 110.53 mmHg immediately after. Likewise, the average heart rate before the procedure was 84.69 bpm and 93.13 bpm immediately after. Both comparisons were statistically significant (p<0.035 and p<0.002, respectively). It is concluded that the simple neck lateralization maneuver, as a stand-alone maneuver, results in faster and more successful insertion times, with low complication rates