title: Effect of postpyloric feeding on gastroesophageal regurgitation and pulmonary microaspiration: results of a randomized controlled trial.
abstract: OBJECTIVE
  To determine the extent to which postpyloric feeding reduces gastroesophageal regurgitation and pulmonary microaspiration in critically ill patients.
  
  
  METHODS
  Randomized trial.
  
  
  METHODS
  A medical/surgical intensive care unit at a tertiary care hospital.
  
  
  METHODS
  Intensive care unit patients were expected to remain ventilated >72 hrs. We excluded patients with esophageal, gastric, or small bowel surgery in the last week and patients with overt or clinically significant gastrointestinal bleeding. We studied 33 patients; 42.4% were female, mean age (sd) was 59.2 (+/- 16.8) yrs, and mean Acute Physiology and Chronic Health Evaluation II score was 22.5 (7.8).
  
  
  METHODS
  Patients were randomized to gastric or postpyloric enteral feeds. Technetium 99-sulphur colloid was added to the feeds for 6 hrs of each of the first 3 days on study.
  
  
  RESULTS
  We sampled the oropharynx and trachea hourly for the 6 hrs per day that patients received radioisotope-labeled enteral feeds, and the level of radioactivity in these specimens was measured. We defined an episode of gastroesophageal regurgitation and microaspiration as an increase in radioactivity >100 counts per minute/g. Patients fed into the stomach had more episodes of gastroesophageal regurgitation (39.8% vs. 24.9%, p =.04) and trended toward more microaspiration (7.5% vs. 3.9%, p =.22) compared with patients fed beyond the pylorus. When the logarithmic mean of the radioactivity count was compared across groups, there was a trend toward an increase in gastroesophageal regurgitation (3.7 vs. 2.9 counts/g, p =.22) and a trend toward increased microaspiration (1.9 vs. 1.4 counts/g, p =.09) in patients fed into the stomach. Patients who had gastroesophageal regurgitation were much more likely to aspirate than patients who did not have gastroesophageal regurgitation (odds ratio: 3.2; 95% confidence interval: 1.36, 7.77).
  
  
  CONCLUSIONS
  Feeding beyond the pylorus is associated with a significant reduction in gastroesophageal regurgitation and a trend toward less microaspiration.
authors.affiliation: Department of Medicine, Kingston General Hospital, Queen's University, 76 Stuart Street, Kingston, Ontario, KVL 2V7, Canada. dkh2@post.queensu.ca
authors.forename: D K
authors.initials: DK
authors.lastname: Heyland
authors.forename: J W
authors.initials: JW
authors.lastname: Drover
authors.forename: S
authors.initials: S
authors.lastname: MacDonald
authors.forename: F
authors.initials: F
authors.lastname: Novak
authors.forename: M
authors.initials: M
authors.lastname: Lam
mesh_terms: D018806:APACHE; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D005764:Gastroesophageal Reflux / Q000000981:diagnostic imaging / Q000517:prevention & control*; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011015:Pneumonia, Aspiration / Q000517:prevention & control*; D011877:Radionuclide Imaging