Clinical Usefulness of Capnographic Monitoring for Feeding Tube Insertion in Critically Ill Patients: Retrospective Cohort Study

Background: It is not rare for a small-bore feeding tube to be inserted incorrectly into the respiratory system in critically ill patients. Thus, monitoring is necessary to prevent respiratory malplacement of the tube. We investigated the utility of capnographic monitoring for the prevention of respiratory complications due to feeding tube mispositioning in critically ill patients.

Methods: This study is a pre- and post-intervention study, including a total of 445 feeding tube placements events that were retrospectively studied in the medical and surgical intensive care units of the Samsung Medical Center. We compared the outcomes between the time periods before and after the capnographic monitoring and respiratory complications.

Results: Feeding tubes were inserted in 275 cases without capnographic monitoring. Capnographic monitoring was performed in 170 cases. Sixteen patients (4%) had respiratory complications in total tube placements. Tracheal insertion was in 11 (2%) patients and pneumothorax in 5 (1%) patients. Fourteen cases of respiratory complications were detected in control group (14/275, 5%, ten tracheal insertions and four pneumothoraxes). Two cases of respiratory complications were detected in the capnographic monitoring group (2/170, 1%, one tracheal insertions and one pneumothorax). Respiratory complications were less detected in capnographic monitoring group than control group.

Conclusions: Capnographic monitoring is simple, easy to learn, and may be useful to prevent respiratory complication during feeding tube insertion in critically ill patients.