Equal aspiration rates in gastrically and transpylorically fed critically ill patients.
OBJECTIVE
To determine the difference in aspiration rates between gastrically and transpylorically fed patients in the intensive care unit.


METHODS
A prospective controlled study of critically ill patients randomized to receive either a gastrically placed feeding tube or a transpylorically placed feeding tube.


METHODS
University teaching hospital's medical intensive care unit. The study was conducted over 14 months.


METHODS
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.


METHODS
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.


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%.


CONCLUSIONS
There was no difference in aspiration rates between gastrically and transpylorically fed critically ill patients.
Esparza
J
J
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.
Boivin
M A
MA
Hartshorne
M F
MF
Levy
H
H
D018806:APACHE; D000328:Adult; D000368:Aged; D016638:Critical Illness; D004576:Electromyography; D004750:Enteral Nutrition / Q000009:adverse effects*; D005260:Female; D006801:Humans; D001239:Inhalation / Q000502:physiology*; D007362:Intensive Care Units; D008168:Lung / Q000000981:diagnostic imaging / Q000378:metabolism / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011015:Pneumonia, Aspiration / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology*; D011446:Prospective Studies; D011708:Pylorus / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011860:Radiography, Abdominal; D011877:Radionuclide Imaging