Technology advances in the placement of naso-enteral tubes and in the management of enteral feeding in critically ill patients: A narrative study

Enteral feeding needs secure access to the upper gastrointestinal tract, an evaluation of the gastric function to detect gastrointestinal intolerance, and a nutritional target to reach the patient's needs. Only in the last decades has progress been accomplished in techniques allowing an appropriate placement of the nasogastric tube, mainly reducing pulmonary complications. These techniques include point-of-care ultrasound (POCUS), electromagnetic sensors, real-time video-assisted placement, impedance sensors, and virtual reality. Again, POCUS is the most accessible tool available to evaluate gastric emptying, with antrum echo density measurement. Automatic measurements of gastric antrum content supported by deep learning algorithms and electric impedance provide gastric volume. Intragastric balloons can evaluate motility. Finally, advanced technologies have been tested to improve nutritional intake: Stimulation of the esophagus mucosa inducing contraction mimicking a contraction wave that may improve enteral nutrition efficacy, impedance sensors to detect gastric reflux and modulate the rate of feeding accordingly have been clinically evaluated. Use of electronic health records integrating nutritional needs, target, and administration is recommended.