title: Equal aspiration rates in gastrically and transpylorically fed critically ill patients.
abstract: 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.
authors.affiliation: 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.
authors.forename: J
authors.initials: J
authors.lastname: Esparza
authors.forename: M A
authors.initials: MA
authors.lastname: Boivin
authors.forename: M F
authors.initials: MF
authors.lastname: Hartshorne
authors.forename: H
authors.initials: H
authors.lastname: Levy
mesh_terms: 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