Transpyloric enteral feeding in the postoperative of cardiac surgery in children

Sánchez, César Sánchez; López‐Herce, Jesús; Carrillo, Ángel; Bustinza, Amaya; Sancho, Luís; Vigil, Dolores

doi:10.1016/j.jpedsurg.2006.02.010

Cited by 27 publications

(25 citation statements)

References 34 publications

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“…Reported complications from PP tube placement include necrotizing enterocolitis, bowel perforation, inadvertent tube placement into the lung, and hemodynamic instability during tube placement. The published rates of such complications are low: necrotizing enterocolitis (0%–0.6%), bowel perforation (0%–0.2%), inadvertent tube placement into the lung (0%–1.5%), and hemodynamic instability during tube placement (0%–4.4%) . In our study, we did not have any events of bowel perforation or inadvertent tube placement into the lung.…”

Section: Discussionmentioning

confidence: 46%

“…The PP route may potentially reduce the risk of aspiration and, by bypassing any abnormal gastric emptying, lead to greater EN tolerance . However, the indications for PP feeding are not clear, and practice is not uniform . In addition to careful selection of patients who might benefit from PP feeding, challenges surrounding PP tube placement must be considered.…”

Section: Introductionmentioning

confidence: 99%

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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: 46%

Section: Introductionmentioning

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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“…Compared with gastric feeding, postpyloric feeding did not improve outcomes in a randomized controlled trial in the PICU environment (27). Postpyloric feeding has been associated with EN tolerance and an earlier achievement of nutrient delivery goals in children with sepsis and cardiac disease (28,29). Our results suggest that postpyloric feeding deserves additional examination in welldesigned trials conducted in centers with local expertise and resources for the placement of specialized enteral access.…”

Section: Discussionmentioning

confidence: 67%

Adequate enteral protein intake is inversely associated with 60-d mortality in critically ill children: a multicenter, prospective, cohort study

Mehta

Bechard

Zurakowski

et al. 2015

The American Journal of Clinical Nutrition

185

153

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Background: The impact of protein intake on outcomes in pediatric critical illness is unclear. Objective: We examined the association between protein intake and 60-d mortality in mechanically ventilated children. Design: In a prospective, multicenter, cohort study that included 59 pediatric intensive care units (PICUs) from 15 countries, we enrolled consecutive children (age: 1 mo to 18 y) who were mechanically ventilated for $48 h. We recorded the daily and cumulative mean adequacies of energy and protein delivery as a percentage of the prescribed daily goal during the PICU stay #10 d. We examined the association of the adequacy of protein delivery with 60-d mortality and determined variables that predicted protein intake adequacy. Results: We enrolled 1245 subjects (44% female) with a median age of 1.7 y (IQR: 0.4, 7.0 y). A total of 985 subjects received enteral nutrition, 354 (36%) of whom received enteral nutrition via the postpyloric route. Mean 6 SD prescribed energy and protein goals were 69 6 28 kcal/kg per day and 1.9 6 0.7 g/kg per day, respectively. The mean delivery of enteral energy and protein was 36 6 35% and 37 6 38%, respectively, of the prescribed goal. The adequacy of enteral protein intake was significantly associated with 60-d mortality (P , 0.001) after adjustment for disease severity, site, PICU days, and energy intake. In relation to mean enteral protein intake ,20%, intake $60% of the prescribed goal was associated with an OR of 0.14 (95% CI: 0.04, 0.52; P = 0.003) for 60-d mortality. Early initiation, postpyloric route, shorter interruptions, larger PICU size, and a dedicated dietitian in the PICU were associated with higher enteral protein delivery. Conclusions: Delivery of .60% of the prescribed protein intake is associated with lower odds of mortality in mechanically ventilated children. Optimal prescription and modifiable practices at the bedside might enhance enteral protein delivery in the PICU with a potential for improved outcomes. This trial was registered at clinicaltrials.gov as NCT02354521.

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“…However, studies indicate that transpyloric feeding allows a larger volume of feeds to be delivered in critically ill children and may be safer in the periextubation period. But, contrary to popular belief, transpyloric feeding does not prevent tracheal aspiration of gastric fluids [31]. Given this limited data, initiation of gastric feeding first with transition to transpyloric feeding, if the gastric route is not tolerated, is advised.…”

Section: Which Feeding Route Is Better?mentioning

confidence: 91%

Nutritional challenges and outcomes after surgery for congenital heart disease

Cabrera

Parthak

Bhutta

2010

Current Opinion in Cardiology

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Transpyloric enteral feeding in the postoperative of cardiac surgery in children

Cited by 27 publications

References 34 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

Adequate enteral protein intake is inversely associated with 60-d mortality in critically ill children: a multicenter, prospective, cohort study

Nutritional challenges and outcomes after surgery for congenital heart disease

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