title: Transpyloric feeding tube placement in critically ill patients using electromyogram and erythromycin infusion.
abstract: OBJECTIVE
  Transpyloric feeding is desirable in critically ill patients who often have gastroparesis; however, correct placement is difficult, requiring fluoroscopy, endoscopy, or time-consuming blind attempts. This study evaluated the success rate and time required to place transpyloric tubes using erythromycin infusion and GI electromyogram (EMG) signal.
  
  
  METHODS
  Observational trial.
  
  
  METHODS
  University hospital medical ICU.
  
  
  METHODS
  Thirty-nine patients receiving mechanical ventilation for respiratory failure (n = 13), pancreatitis (n = 9), ARDS (n = 8), neurologic disease (n = 4), major surgery (n = 3), and GI disease (n = 2) were enrolled (25 men and 14 women; mean age, 48.4 years; range, 21 to 82 years).
  
  
  METHODS
  Unweighted Flexiflo 10F feeding tubes were modified by the placement of an electrode 4 to 8 cm from the tip to record electromyogram (EMG) signals (Ross Products Division; Columbus, OH). Gastric signals are high amplitude with a frequency of 3 cycles per minute, while the duodenum and jejunum are low amplitude and 11 to 13 cycles per minute. Erythromycin was infused at a dose of 3 mg/kg to enhance gastric motor activity and emptying. The transpyloric tube was placed in the stomach, and its position was confirmed by EMG, then slowly advanced until duodenal EMG was detected. Tube position was determined by abdominal radiography.
  
  
  RESULTS
  Thirty-one of 39 placements were immediately successful (initial success rate, 80%), 23 jejunal and 8 duodenal, requiring an average 7.8 min (range, 3 to 31 min). Six attempts in five patients were initial failures but were repeated, reaching the duodenum in one patient and the jejunum in four patients.
  
  
  CONCLUSIONS
  Erythromycin infusion and EMG guidance can facilitate rapid transpyloric feeding tube placement in critically ill patients at the bedside.
authors.affiliation: Division of Pulmonary and Critical Care, Department of Medicine, University of New Mexico Health Sciences Center, 2211 Lomas Boulevard NE, Albuquerque, NM 87131-5271, USA.
authors.forename: Howard
authors.initials: H
authors.lastname: Levy
authors.forename: James
authors.initials: J
authors.lastname: Hayes
authors.forename: Michel
authors.initials: M
authors.lastname: Boivin
authors.forename: Todd
authors.initials: T
authors.lastname: Tomba
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003131:Combined Modality Therapy; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness / Q000628:therapy*; D004576:Electromyography; D004750:Enteral Nutrition / Q000295:instrumentation* / Q000379:methods; D004917:Erythromycin / Q000627:therapeutic use*; D005260:Female; D018589:Gastroparesis / Q000628:therapy; D006801:Humans; D007362:Intensive Care Units; D007441:Intubation, Gastrointestinal / Q000295:instrumentation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011708:Pylorus; D012121:Respiration, Artificial; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
chemical_list: D004917:Erythromycin