Post-pyloric versus gastric tube feeding for preventing pneumonia and improving nutritional outcomes in critically ill adults

Alkhawaja, Sana; Martin, Claudio M.; Butler, Ronald; Gwadry-Sridhar, Femida

doi:10.1002/14651858.cd008875.pub2

Cited by 98 publications

(102 citation statements)

References 69 publications

(13 reference statements)

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“…In both RCTs, rates of aspiration were similar between PP EN and gastric EN . In a systematic review of RCTs in critically ill adults, PP EN was associated with a greater amount of nutrition delivered when compared with gastric EN; however, the evidence was considered to be low‐quality by grading of recommendations, assessment, development and evaluations (GRADE) criteria . Also, in critically ill adults, significant delays in EN initiation have been reported in patients receiving PP EN compared with gastric EN because of delays in PP tube placements .…”

Section: Discussionmentioning

confidence: 99%

Bedside Postpyloric Tube Placement and Enteral Nutrition Delivery in the Pediatric Intensive Care Unit

Turner¹,

Hamilton²,

Callif

et al. 2020

Nut in Clin Prac

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Background Enteral nutrition (EN) delivery may be more effective via a postpyloric (PP) feeding tube in critically ill children, but tube placement can be challenging. We aimed to describe PP tube placement and EN practices in a multidisciplinary pediatric intensive care unit (PICU) after the implementation of a nurse‐led bedside PP tube‐placement program. Methods In a single‐center retrospective study, we identified 100 consecutive patients admitted to the PICU for >48 hours and for whom PP tube placement was attempted. Demographics, clinical characteristics, and details of PP tube placement and EN delivery were examined. Results The study cohort had a median age (25th, 75th percentiles) of 3.89 years (0.55, 14.86); 66% were male. Respiratory illness was the primary diagnosis of admission (55%); 92% were on respiratory support. Risk of aspiration was the primary indication for PP tube placement (48%). Bedside placement was the initial technique for PP tube placement in 93% of patients (successful for 84.9%) and was not associated with serious complications. Eighty‐seven patients with a PP tube started EN and received a median 73.9% (12.3%, 100%) of prescribed energy goal on day 3 after EN initiation. PP EN allowed 14 of 39 patients receiving parenteral nutrition (PN) to transition off PN 7 days after EN initiation. Thirty‐five percent of EN interruptions were due to feeding‐tube dysfunction. Conclusion Bedside PP tube placement is safe and feasible and allows for effective EN delivery and decreased PN use when applicable. Interruptions in PP EN due to tube malfunction are prevalent.

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Section: Discussionmentioning

confidence: 99%

Bedside Postpyloric Tube Placement and Enteral Nutrition Delivery in the Pediatric Intensive Care Unit

Turner¹,

Hamilton²,

Callif

et al. 2020

Nut in Clin Prac

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“…1 Conversely, malnutrition is associated with poor outcomes in patients in the intensive care unit (ICU) and in those recovering from surgery. 2,3 Delivering early nutrition via the enteral route is thereby seen as a proactive therapeutic strategy that may reduce disease severity, diminish complications, decrease length of ICU stay, and improve patient outcomes. [4][5][6] Current Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition guidelines recommend that EN be initiated within 24-48 hours in a critically ill patient who is unable to maintain volitional nutrition intake.…”

Section: Introductionmentioning

confidence: 99%

Successful Identification of Anatomical Markers and Placement of Feeding Tubes in Critically Ill Patients via Camera‐Assisted Technology with Real‐Time Video Guidance

Wischmeyer

McMoon

Waldron

et al. 2018

J Parenter Enteral Nutr

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“…With the increasing use of nasojejunal tubes, which have been associated with a lower risk of aspiration pneumonitis compared to nasogastric tubes, [22][23][24] imaging guidance is often required in order to place the tip of the feeding tubes beyond the pylorus or even into the proximal jejunum. Fluoroscopy is available in most institutions and is well-suited for such purpose because most commercially available feeding tubes appear radio-opaque on X-ray.…”

Section: Real-time Fluoroscopy For Feeding Tube Placementmentioning

confidence: 99%

Placement of feeding tubes using fluoroscopy guidance and over-the-wire technique: A technical review

Kim

Shin

2017

Int J Gastrointest Interv

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Nutritional support is essential for improving the outcome in critically ill patients. Enteral nutrition possesses advantages over total parenteral nutrition in that it maintains the physiologic barrier function of the gastrointestinal mucosa. Short-term enteral nutrition can be achieved through transnasal feeding tubes. Traditionally, feeding tubes have been placed at bedside in a blind fashion. However, blind tube placement is unreliable as it may result in improper positioning of the tubes. Numerous complications arising from misplacement have been reported in the literature. A number of modalities may be used in order to improve the accuracy and safety of transnasal feeding tube placement. Fluoroscopy is widely accepted for this purpose. Together with the use of water-soluble contrast media and over-the-wire technique, fluoroscopy-guided placement of nasogastric or nasojejunal feeding tubes offers a higher rate of technical success while decreasing procedure time as well as the incidence of procedure-related complications.

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Post-pyloric versus gastric tube feeding for preventing pneumonia and improving nutritional outcomes in critically ill adults

Abstract: Post-pyloric versus gastric tube feeding for preventing pneumonia and improving nutritional outcomes in critically ill adults.

Cited by 98 publications

References 69 publications

Bedside Postpyloric Tube Placement and Enteral Nutrition Delivery in the Pediatric Intensive Care Unit

Bedside Postpyloric Tube Placement and Enteral Nutrition Delivery in the Pediatric Intensive Care Unit

Successful Identification of Anatomical Markers and Placement of Feeding Tubes in Critically Ill Patients via Camera‐Assisted Technology with Real‐Time Video Guidance

Placement of feeding tubes using fluoroscopy guidance and over-the-wire technique: A technical review

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