J Esparza1, M A Boivin, M F Hartshorne, H Levy. 1. Division of Pulmonary/Allergy/Critical Care Medicine, Department of Internal Medicine, University Hospital, University of New Mexico, 2211 Lomas Blvd. NE, Albuquerque, NM 87131-5721, USA.
Abstract
OBJECTIVES: To determine the difference in aspiration rates between gastrically and transpylorically fed patients in the intensive care unit. DESIGN: A prospective controlled study of critically ill patients randomized to receive either a gastrically placed feeding tube or a transpylorically placed feeding tube. SETTING:University teaching hospital's medical intensive care unit. The study was conducted over 14 months. PATIENTS: Fifty-four critically ill subjects (with an overall 40% mortality) with similar baseline age, severity of illness, and nutritional needs requiring enteral nutrition, with 51 completing the study. INTERVENTIONS: All feeds were tagged with technetium-99m radiolabeled sulfur colloid, and the pulmonary secretions or lungs of each patient were scanned on a daily basis to determine whether aspiration had occurred. Patients were fed according to their assigned tube placement which was verified daily by continuous electromyography. MEASUREMENTS AND RESULTS: Of 27 gastrically fed patients 2 (7%) had evidence of scanned feed in pulmonary secretions or the lung, compared to 3 of 24 (13%) transpylorically fed patients (n.s.). Clinical suspicion of aspiration was insensitive and detected only 60% of isotopically documented aspirations with a positive predictive value of 27%. CONCLUSION: There was no difference in aspiration rates between gastrically and transpylorically fed critically ill patients.
RCT Entities:
OBJECTIVES: To determine the difference in aspiration rates between gastrically and transpylorically fed patients in the intensive care unit. DESIGN: A prospective controlled study of critically ill patients randomized to receive either a gastrically placed feeding tube or a transpylorically placed feeding tube. SETTING: University teaching hospital's medical intensive care unit. The study was conducted over 14 months. PATIENTS: Fifty-four critically ill subjects (with an overall 40% mortality) with similar baseline age, severity of illness, and nutritional needs requiring enteral nutrition, with 51 completing the study. INTERVENTIONS: All feeds were tagged with technetium-99m radiolabeled sulfur colloid, and the pulmonary secretions or lungs of each patient were scanned on a daily basis to determine whether aspiration had occurred. Patients were fed according to their assigned tube placement which was verified daily by continuous electromyography. MEASUREMENTS AND RESULTS: Of 27 gastrically fed patients 2 (7%) had evidence of scanned feed in pulmonary secretions or the lung, compared to 3 of 24 (13%) transpylorically fed patients (n.s.). Clinical suspicion of aspiration was insensitive and detected only 60% of isotopically documented aspirations with a positive predictive value of 27%. CONCLUSION: There was no difference in aspiration rates between gastrically and transpylorically fed critically ill patients.
Authors: J C Montejo; E Miñambres; L Bordejé; A Mesejo; J Acosta; A Heras; M Ferré; F Fernandez-Ortega; C I Vaquerizo; R Manzanedo Journal: Intensive Care Med Date: 2010-03-16 Impact factor: 17.440