Efficacy and safety of visual placement of a nasojejunal feeding tube in ARDS patients receiving mechanical ventilation

This study aimed to evaluate the clinical efficacy of different nasojejunal tube placement techniques in patients with acute respiratory distress syndrome (ARDS) receiving mechanical ventilation, with particular emphasis on a visualized placement system and its potential to improve clinical outcomes. This prospective, randomized controlled trial was conducted at a single center between September 2021 and September 2025. A total of 249 mechanically ventilated (MV) ARDS patients requiring enteral nutrition were randomly assigned to three groups ( n = 83 per group): a conventional nasogastric tube group, a magnetic navigation group, and a visualization-guided placement group. Primary outcomes included first-pass success rate, intubation time, and complication rate. Secondary outcomes included nutritional status improvement, extubation success, and 28-day clinical outcomes. The magnetic navigation group demonstrated significantly longer intubation time compared with the nasogastric and visualization groups (27.89 ± 5.84 vs. 16.10 ± 2.90 vs. 17.30 ± 3.15 min, respectively; P < 0.05). First-attempt success rates were highest in the visualization group (98.80%), followed by the nasogastric group (95.18%) and magnetic navigation group (84.34%) ( P < 0.05). The overall complication rate was lowest in the visualization group (18.07%), followed by the magnetic navigation group (34.94%) and nasogastric group (55.42%) ( P < 0.05). Magnetic navigation was associated with a higher incidence of catheter obstruction compared with the visualization technique ( P < 0.05). After 2 weeks of enteral nutrition, serum albumin levels were significantly higher in the magnetic navigation and visualization groups than in the nasogastric group ( P < 0.05), while hemoglobin levels were the highest in the visualization group, followed by magnetic navigation and nasogastric groups (all P < 0.05). Extubation success rates were 90.36% in the visualization group, 87.95% in the magnetic navigation group, and 73.49% in the nasogastric group ( P < 0.05). The 28-day deterioration or mortality rates were significantly lower in the visualization (13.25%) and magnetic navigation groups (15.66%) compared with the nasogastric group (30.12%) ( P < 0.05). Compared with conventional and magnetic navigation techniques, visualization-guided nasojejunal tube placement significantly improves first-pass success rate, reduces complications, and is associated with better nutritional and clinical outcomes in mechanically ventilated ARDS patients receiving enteral nutrition.