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

To systematically compare the effectiveness and safety of different nasointestinal tube (NET) placement techniques in Intensive Care Unit (ICU) patients through a Bayesian network meta-analysis (NMA). 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. Data were analyzed within a Bayesian framework utilizing the ‘BUGSnet’ package in R, deriving relative treatment effects from posterior distributions and estimating rank probabilities. Efficacy hierarchies were established according to the surface under the cumulative ranking curve (SUCRA) values, which serve strictly as summary measures of probabilistic ordering. The assessed outcomes were placement success rate, procedure time, complication incidence rate, and direct healthcare costs. This NMA evaluated 19 RCTs involving 1,554 ICU patients. All instrument-assisted methods demonstrated higher placement success rates than Blind placement. Of the five assessed techniques, Fluoroscopic guidance showed the highest probability of being ranked favorably for placement success and complication reduction. However, wide and overlapping credible intervals suggest comparable clinical efficacy among the instrumented modalities. Furthermore, Electromagnetic and Endoscopic placements exhibited the highest probabilities of being the most time-efficient solutions, markedly decreasing procedural duration relative to the Blind method. Importantly, sparse data yielded no statistically significant differences in direct healthcare costs, preventing definitive conclusions regarding economic differences. This NMA demonstrates that instrument-guided methods are significantly superior to Blind placement for NET placement in ICU patients. While Fluoroscopic guidance holds the highest probabilistic ranking for success and safety, other instrument-guided methods offer comparable clinical benefits and high probability in minimizing procedural duration. Clinical medical professionals should prioritize instrument-assisted methods to improve patient safety and procedural efficacy, selecting the specific modality based on resource availability, local expertise, and particular clinical requirements.