title: Use of methylene blue spectrophotometry to detect subclinical aspiration in enterally fed intubated pediatric patients.
abstract: OBJECTIVE
  Enteral feeding is widely used in ventilated patients admitted to pediatric intensive care units. Although studies in adult patients have shown that the site of feeding (stomach vs. small intestine) may be associated with aspiration pneumonia, there are no such reports in critically ill pediatric patients. We hypothesized that in intubated pediatric patients, there was no difference in the frequency of aspiration between nasogastric and postpyloric enteral feeding.
  
  
  METHODS
  Randomized, prospective clinical study.
  
  
  METHODS
  Single pediatric intensive care unit of a tertiary care children's hospital.
  
  
  METHODS
  Forty-four intubated patients (< or = 18 yrs old).
  
  
  METHODS
  Intubated patients were randomized to receive either nasogastric (n = 27) or postpyloric (n = 17) enteral feeding. Feeding tube placement by the bedside nurse was confirmed by abdominal radiograph. Methylene blue was added at a standard dilution to an age-appropriate formula. Tracheal secretions were suctioned every 8 hrs, tested for blue color by observation, and analyzed via spectrophotometry. Patients were followed until feeds were stopped for anticipated extubation. Aspiration pneumonia was defined using criteria of the Centers of Disease Control and Prevention (CDC).
  
  
  RESULTS
  Methylene blue was detected in two patients in the postpyloric group by spectrophotometry. None of the patients met the CDC criteria for aspiration. There was no difference in the frequency of aspiration between the two groups (p < .07). The time until beginning feedings in the postpyloric group was greater than that for the nasogastric group (18-24 hrs vs. 6 hrs, p < .05). The postpyloric group required more abdominal radiographs compared with the nasogastric group (three radiographs vs. one, p < .05).
  
  
  CONCLUSIONS
  Use of nasogastric feeding shortens the time needed to reach nutritional goals and reduces the number of radiographic studies. Nasogastric feeding demonstrates no increase in aspiration compared with postpyloric feeding in intubated pediatric patients.
authors.affiliation: Pediatric Critical Care Medicine, Children's Healthcare of Atlanta at Egleston, Atlanta, GA, USA. pradip.kamat@choa.org
authors.forename: Pradip
authors.initials: P
authors.lastname: Kamat
authors.forename: Jennifer
authors.initials: J
authors.lastname: Favaloro-Sabatier
authors.forename: Kristine
authors.initials: K
authors.lastname: Rogers
authors.forename: Jana A
authors.initials: JA
authors.lastname: Stockwell
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004750:Enteral Nutrition / Q000379:methods; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D007441:Intubation, Gastrointestinal; D007442:Intubation, Intratracheal; D008297:Male; D008751:Methylene Blue; D011446:Prospective Studies; D053120:Respiratory Aspiration / Q000175:diagnosis*; D013053:Spectrophotometry / Q000379:methods*
chemical_list: D008751:Methylene Blue