Microendoscopic nasointestinal feeding tube placement in mechanically ventilated patients with gastroparesis.
Gastroparesis often precludes gastric enteral nutrition (EN) in critically ill patients. Our aim was to determine the feasibility of bedside microendoscopic placement of nasointestinal feeding tubes to facilitate enteral nutrition in critically ill patients with poor gastric emptying. Nine mechanically ventilated patients with proven gastroparesis underwent 10 nasointestinal intubations using a microendoscope. These were compared with 35 patients who underwent pH sensor-guided intubation. Blind pH-guided intubation was faster than microendoscopic placement (21.4 +/- 10.7 v 32 +/- 11.6 min, P = 0.016) and cheaper in terms of disposables [87 pounds sterling (132 dollars) vs 222 pounds sterling (337 dollars) per intubation, P < 0.0001]. Depth of placement (postpyloric: 64% vs 50% including 32% vs 50% reaching duodenum part 3, 4, or jejunum, both NS) was similar. We conclude that microendoscopy failed to improve transpyloric intubation due to poor visualization of gastrointestinal anatomy and difficulty maneuvering the tube-endoscope ensemble. However, when successful, transpyloric placement was always deep, permitting immediate and full EN. To date, the technique and equipment is not superior to pH-guided placement and is not suitable for use by personnel with minimal training.
Frenchay Hospital, North Bristol NHS Trust, Bristol, United Kingdom.
Stephen J
SJ
Taylor
Robert
R
Przemioslo
Alex R
AR
Manara
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D003362:Cost-Benefit Analysis; D003422:Critical Care; D004750:Enteral Nutrition / Q000191:economics / Q000295:instrumentation*; D004867:Equipment Design; D005746:Gastric Emptying / Q000502:physiology*; D018589:Gastroparesis / Q000503:physiopathology*; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000191:economics / Q000295:instrumentation*; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011706:Pyloric Antrum / Q000503:physiopathology; D006113:United Kingdom