Safety and effectiveness of dual guidance with video-laryngoscopy and ultrasound in jejunal tube placement in patients undergoing invasive mechanical ventilation

BACKGROUND Appropriate and effective post-pyloric enteral nutrition (EN) is valuable for patients undergoing invasive ventilation, but blind bedside insertion of jejunal tubes is often difficult during mechanical ventilation. Here, we first report on the safety and effectiveness of inserting the jejunal tubes under the dual guidance (DG) of video-laryngoscopy and ultrasound in patients in whom jejunal tube placement during invasive mechanical ventilation is difficult. METHODS Twenty patients in the emergency department-based intensive care unit (ICU) who were receiving invasive mechanical ventilation and had difficulty in jejunal tube placement were selected for video-laryngoscopy and ultrasound-guided jejunal tube placement (the DG group), and the outcomes were compared with patients experiencing difficult intubation before the introduction of the DG technique (the control group) in terms of the incidence of postintubation complications and the effectiveness and efficiency of nutritional support. RESULTS The DG group had a significantly higher success rate of intubation and better nutritional status than the control group. The incidences of nasopharyngeal bleeding, dental and gingival injuries, and tracheostomy tube dislodgement were not significantly increased in the DG group, and the blood pressure and heart rate also showed no significant fluctuations. CONCLUSIONS DG with both video-laryngoscopy and ultrasound is a safe and effective technique in patients with difficulty in jejunal tube placement.