Comparison of the effects of different types of nasointestinal tube placement techniques for ICU patients: A Bayesian network meta-analysis

Objective To systematically evaluate the comparative effectiveness and safety of different nasoenteric tube (NET) placement techniques in Intensive Care Unit (ICU) patients through a Bayesian network meta-analysis (NMA). Methods In accordance with PRISMA-NMA guidelines, we conducted a systematic review of randomized controlled trials (RCTs) from major English and Chinese databases, including PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, CBM, CNKI, Wanfang, and VIP. The analysis of data was performed within a Bayesian framework utilizing the 'BUGSnet' package in R. Efficacy rankings were established according to the surface under the cumulative ranking curve (SUCRA) values. The assessed outcomes were placement success rate, procedure time, complication incidence rate, and direct healthcare costs. Results This NMA evaluated 19 RCTs involving 1,554 ICU patients. The investigation revealed that all instrument-assisted methods surpassed the Blind placement regarding placement success rates. Of the five assessed techniques, Fluoroscopic guiding had the highest ranking for optimizing placement success and reducing complication incidence rate. Furthermore, Electromagnetic and Endoscopic placement were the most time-efficient solutions, markedly decreasing procedural duration relative to the Blind method. Although there were no statistically significant differences in direct healthcare costs, SUCRA rankings suggested a potential cost-benefit advantage for Fluoroscopic guiding. Conclusions This NMA shows that instrument-guided methods are better than Blind placement for NET placement in ICU patients. Fluoroscopic guidance provides the best success rates and safety, although electromagnetic guidance exhibits greater efficiency in minimizing process duration. Clinical medical professionals should prioritize instrument-assisted methods to improve patient safety and procedural efficacy. Additionally, they have to select the placement method according to resource availability and particular clinical requirements.