Uso do ultrassom á beira leito para confirmação de posicionamento de cateter enteral em pacientes criticamente enfermos

Abstract

Introduction: Enteral nutrition is the most used route in patients who need alternative nutritional therapy, being administered through an enteral catheter (EC) inserted through the nostrils or, less commonly, through the mouth. Incorrect placement of the FB in the lungs or esophagus can result in complications such as pneumonia, empyema, pneumothorax, pulmonary hemorrhage, and death. Plain radiography is considered the gold standard method for confirming EC placement, but it represents a source of radiation and risk of adverse events. Few published studies have tested the usefulness point-of-care (USPOC) to confirm the placement of the EC, and those that used only the epigastric window are even scarcer and have a small sample size. Objective: To assess whether the USPOC is a useful tool for confirming the placement of the enteral catheter in critically ill patients compared to thoracoabdominal radiography. Methods: This is a cross-sectional study, carried out in two Intensive Care Units (ICU) of the Hospital das Clínicas of the Federal University of Minas Gerais (HC-UFMG), between July 2020 and March 2021. Demographic and clinical data were collected Ultrasonography examinations were performed in the epigastric window, using a standardized protocol by the research team, in all adult patients (age > or = 18 years) of both genders who underwent EC insertion during the study period. The USBL was compared to the radiography to identify the EC. Also, variables related to the nutritional therapy were compared. Results: 83 patients were included, with a median age of 60 (50-70) years, the most frequent being female (51.8%). The median BMI was 26.4 (23.8-30.1) kg/m2, the median APACHE II score was 22 (15-26) points, and the SOFA score was 8 (5-10) spots. Mortality in the ICU was 50.6%. CE positioning was confirmed by radiography in all cases and by ultrasound in 81 (97.6%) patients. The reason for not identifying the EC at the US in two patients was abdominal distension with gas interposition. The median duration of the ultrasound examination was 2 (2-3) minutes. The time taken between requesting the radiograph and releasing the exam for consultation was 225 minutes. USBL and radiography were not associated with the occurrence of adverse events. Conclusion: Bedside ultrasonography proved to be an adequate method to confirm the position of the EC in critically ill patients, being safe and quick to perform. Clinical trials comparing outcomes related to the use of US compared to radiography are needed to confirm these findings.