1. Introduction
death, critically ill, comatose, traumatic, coma, tube obstruction
CRITICALLY ILL, COMATOSE, CAVITY, COMA, COMPLICATIONS
According to the World Health Organization, 1 in 10 patients experience unnecessary harm as a consequence of unsafe health care assistance, which in more extreme situations, can cause the patient death.In this context, despite being a common procedure, nasally placed small-bowel feeding tube insertion is not risk-free and can compromise patient safety. Due to the fact that nasally placed small-bowel feeding tube is commonly inserted ‘“blindly,” with the patient head in the neutral position, sometimes the process becomes difficult and traumatic, and may present higher level of complexity in physiological or induced coma and intubated patients, as the tongue displaced backwards blocks the passage through the pharynx. In addition, the piriform sinus and the arytenoid cartilage are considered anatomical obstacles for the nasally placed small-bowel feeding tube passage, which is sometimes bended in the oral cavity due to the inability to swallow and the presence of the endotracheal cannula cuff.Therefore, AEs such as accidental tube displacement, wrong positioning in the respiratory tract, tube obstruction, inadvertent exit, bronchoaspiration and connection route errors can occur during this procedure.There are different nasally placed small-bowel feeding tube insertion methods in critically ill and/or coma patients, which, although less common, have high procedural success rates, but none of them is perfect or universally accepted.Results favorable to the use of different nasally placed small-bowel feeding tube insertion methods have been described by anesthesiologists.In a study conducted in Taiwan, 130 insertion attempts were performed. The success rate was 82.7% (86 of 104 patients) on the first attempt and 100% in 5 attempts. In 23 patients the tube deviated to the oral cavity and 3 to the trachea.We seek to test the following hypothesis: null hypothesis: There are no significant differences between the methods of insertion of the nasally placed small-bowel feeding tube in patients in coma (physiological or induced) and intubated in relation to the rate of success in the first attempt, insertion time and the presence of complications; alternative hypothesis: There are significant differences between the methods of nasally placed small-bowel feeding tube insertion in comatose patients (physiological or induced) and intubated in relation to the rate of success in the first attempt, insertion time and the presence of complications.Therefore, the study aims to determine the effectiveness of different nasally placed small-bowel feeding tube insertion techniques in coma and intubated patients, in comparison with conventional method.