title: Comparison of a new unguided self-advancing jejunal tube with the endoscopic guided technique: a prospective, randomized study.
abstract: OBJECTIVE
  To compare the success rate of correct jejunal placement of a new self-advancing jejunal tube with the gold standard, the endoscopic guided technique, in a comparative intensive care unit (ICU) patient population.
  
  
  METHODS
  Prospective, randomized study.
  
  
  METHODS
  Two medical ICUs at a university hospital.
  
  
  METHODS
  Forty-two mechanically ventilated patients with persisting intolerance of intragastric enteral nutrition despite prokinetic therapy.
  
  
  METHODS
  Patients were randomly assigned to receive an unguided self-advancing jejunal feeding tube (Tiger Tube) or an endoscopic guided jejunal tube (Freka Trelumina). Primary outcome measure was the success rate of correct jejunal placement after 24 h.
  
  
  RESULTS
  Correct jejunal tube placement was reached in all 21 patients using the endoscopic guided technique whereas the unguided self-advancing jejunal tube could be placed successfully in 14 out of 21 patients (100% versus 67%; P = 0.0086). In the remaining seven patients, successful endoscopic jejunal tube placement was performed subsequently. Duration of tube placement was longer in the unguided self-advancing tube group (20 +/- 12 min versus 597 +/- 260 min; P < 0.0001). Secondary outcome parameters (complication rate, number of attempts, days in correct position with accurate functional capability, days with high gastric residual volume, length of ICU stay, ICU mortality) were not statistically different between the two groups. No potentially relevant parameter predicting the failure of correct jejunal placement of the self-advancing tube could be identified.
  
  
  CONCLUSIONS
  Success rate of correct jejunal placement of the new unguided self-advancing tube was significantly lower than the success rate of the endoscopic guided technique.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Intensive Care Unit 13H1, Medical University of Vienna, 1090 Vienna, Austria. ulrike.holzinger@meduniwien.ac.at
authors.forename: Ulrike
authors.initials: U
authors.lastname: Holzinger
authors.forename: Reinhard
authors.initials: R
authors.lastname: Kitzberger
authors.forename: Andja
authors.initials: A
authors.lastname: Bojic
authors.forename: Marlene
authors.initials: M
authors.lastname: Wewalka
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Miehsler
authors.forename: Thomas
authors.initials: T
authors.lastname: Staudinger
authors.forename: Christian
authors.initials: C
authors.lastname: Madl
mesh_terms: D000368:Aged; D004724:Endoscopy / Q000379:methods / Q000592:standards*; D004750:Enteral Nutrition / Q000295:instrumentation*; D004867:Equipment Design; D005260:Female; D006801:Humans; D007583:Jejunum; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012121:Respiration, Artificial