title: Progression rate of self-propelled feeding tubes in critically ill patients.
abstract: OBJECTIVE
  Gaining postpyloric access in ventilated, sedated ICU patients usually requires time-consuming procedures such as endoscopy. Recently, a feeding tube has been introduced that migrates spontaneously into the jejunum in surgical patients. The study aimed at assessing the rate of migration of this tube in critically ill patients.
  
  
  METHODS
  Prospective descriptive trial.
  
  
  METHODS
  Surgical ICU in a tertiary University Hospital.
  
  
  METHODS
  One hundred and five consecutive surgical ICU patients requiring enteral feeding were enrolled, resulting in 128 feeding-tube placement attempts.
  
  
  METHODS
  A self-propelled tube was used and followed up for 3 days: progression was assessed by daily contrast-injected X-ray. Severity of illness was assessed with SAPS II and organ failure assessed with SOFA score.
  
  
  RESULTS
  The patients were aged 55+/-19 years (mean+/-SD) with SAPS II score of 45+/-18. Of the 128 tube placement attempts, 12 could not be placed in the stomach; eight were accidentally pulled out while in gastric position due to the necessity to avoid fixation during the progression phase. Among organ failures, respiratory failure predominated, followed by cardiovascular. By day 3, the postpyloric progression rate was 63/128 tubes (49%). There was no association between migration and age, or SAPS II score, but the progression rate was significantly poorer in patients with hemodynamic failure. Use of norepinephrine and morphine were negatively associated with tube progression (P<0.001), while abdominal surgery was not. In ten patients, jejunal tubes were placed by endoscopy.
  
  
  CONCLUSIONS
  Self-propelled feeding tubes progressed from the stomach to the postpyloric position in 49% of patients, reducing the number of endoscopic placements: these tubes may facilitate enteral nutrient delivery in the ICU.
authors.affiliation: Soins Intensifs de Chirurgie et Centre des Brûlés, CHUV-BH08.660, 1011 Lausanne, Switzerland. Mette.Berger@chuv.hospvd.ch
authors.forename: Mette M
authors.initials: MM
authors.lastname: Berger
authors.forename: Marc D
authors.initials: MD
authors.lastname: Bollmann
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Revelly
authors.forename: M-Christine
authors.initials: MC
authors.lastname: Cayeux
authors.forename: Nathalie
authors.initials: N
authors.lastname: Pilon
authors.forename: David
authors.initials: D
authors.lastname: Bracco
authors.forename: René L
authors.initials: RL
authors.lastname: Chioléro
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D016638:Critical Illness; D004750:Enteral Nutrition / Q000295:instrumentation*; D005260:Female; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000379:methods*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011140:Polyurethanes; D011446:Prospective Studies; D012121:Respiration, Artificial; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D011140:Polyurethanes