Gastro-oesophageal reflux in mechanically ventilated patients: effects of an oesophageal balloon.
Gastro-oesophageal reflux (GOR) and bronchoaspiration of gastric content are risk factors linked with ventilator-associated pneumonia. This study was aimed at evaluating the effect of a nasogastric tube (NGT) incorporating a low-pressure oesophageal balloon on GOR and bronchoaspiration in patients receiving mechanical ventilation. Fourteen patients were studied in a semi-recumbent position for 2 consecutive days. Inflation or deflation of the oesophageal balloon was randomised. Samples of blood, gastric content, and oropharyngeal and bronchial secretions were taken every 2 h over a period of 8 h. A radioactively labelled nutritional solution was continuously administered through the NGT. The magnitude of both the GOR and bronchoaspiration was measured by radioactivity counting of oropharyngeal and bronchial secretion samples, respectively. Inflation of the oesophageal balloon resulted in a significant decrease of both GOR and bronchoaspiration of gastric content. This protective effect was statistically significant from 4 h following inflation throughout the duration of the study. This study demonstrates that an inflated oesophageal balloon delays and decreases gastro-oesophageal and bronchial aspiration of gastric content in patients carrying a nasogastric tube and receiving enteral nutrition during mechanical ventilation. Although the method was found to be safe when applied for 8 h, longer times should be considered with caution.
Orozco-Levi
M
M
Servei de Pneumologia, Hospital del Mar, and Unitat de Recerca Respiratòria i Ambiental, IMIM, Barcelona, Spain. morozco@imim.es
Félez
M
M
Martínez-Miralles
E
E
Solsona
J F
JF
Blanco
M L
ML
Broquetas
J M
JM
Torres
A
A
D000368:Aged; D000369:Aged, 80 and over; D004750:Enteral Nutrition / Q000009:adverse effects; D004947:Esophagus; D005260:Female; D005764:Gastroesophageal Reflux / Q000209:etiology* / Q000517:prevention & control*; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D011015:Pneumonia, Aspiration / Q000209:etiology* / Q000517:prevention & control*; D011187:Posture; D012121:Respiration, Artificial / Q000009:adverse effects*