Withholding or continuing enteral feedings during repositioning and the incidence of aspiration.
BACKGROUND
Withholding enteral feedings during repositioning is based on tradition, but available evidence does not support this practice. Although research indicates that withholding of enteral feedings during repositioning contributes to undernourishment, the relationship between continuing enteral feedings during repositioning and the incidence of aspiration has not been determined.


OBJECTIVE
To determine the feasibility of a study designed to explore differences in the incidence of aspiration when enteral feedings are withheld or continued during repositioning.


METHODS
A crossover design with a convenience sample from 3 medical and 3 surgical intensive care units was used. Two sample sets of subglottal secretions were collected from each patient, once when enteral feedings were withheld during repositioning and once when enteral feedings were continued during the change in position. The incidence of aspiration was assessed by testing specimens for the presence of pepsin.


RESULTS
Sublgottal secretions were collected from 23 patients (n = 46 with crossover design). Aspiration during repositioning occurred in 2 patients when enteral feedings were withheld and in 2 patients when feedings were continued during repositioning. According to the McNemar test, the incidence of aspiration when enteral feedings were withheld did not differ significantly from the incidence when the feedings were continued during repositioning (P = .88).


CONCLUSIONS
A research protocol to directly explore the relationship between the incidence of aspiration and withholding or continuing enteral feedings during repositioning is feasible.
Justin DiLibero, Sharon O'Donoghue, and Mary Lavieri are clinical nurse specialists at Beth Israel Deaconess Medical Center, Boston, Massachusetts. Susan DeSanto-Madeya is an associate professor at Boston College, Boston, Massachusetts, and is the Beth Israel Hospital Nurses' Alumnae Association Endowed Nurse Scientist at Beth Israel Deaconess Medical Center. jdiliber@bidmc.harvard.edu.
Justin
J
DiLibero
Justin DiLibero, Sharon O'Donoghue, and Mary Lavieri are clinical nurse specialists at Beth Israel Deaconess Medical Center, Boston, Massachusetts. Susan DeSanto-Madeya is an associate professor at Boston College, Boston, Massachusetts, and is the Beth Israel Hospital Nurses' Alumnae Association Endowed Nurse Scientist at Beth Israel Deaconess Medical Center.
Mary
M
Lavieri
Justin DiLibero, Sharon O'Donoghue, and Mary Lavieri are clinical nurse specialists at Beth Israel Deaconess Medical Center, Boston, Massachusetts. Susan DeSanto-Madeya is an associate professor at Boston College, Boston, Massachusetts, and is the Beth Israel Hospital Nurses' Alumnae Association Endowed Nurse Scientist at Beth Israel Deaconess Medical Center.
Sharon
S
O'Donoghue
Justin DiLibero, Sharon O'Donoghue, and Mary Lavieri are clinical nurse specialists at Beth Israel Deaconess Medical Center, Boston, Massachusetts. Susan DeSanto-Madeya is an associate professor at Boston College, Boston, Massachusetts, and is the Beth Israel Hospital Nurses' Alumnae Association Endowed Nurse Scientist at Beth Israel Deaconess Medical Center.
Susan
S
DeSanto-Madeya
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018592:Cross-Over Studies; D004750:Enteral Nutrition / Q000379:methods* / Q000706:statistics & numerical data; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D056888:Patient Positioning / Q000379:methods*; D053120:Respiratory Aspiration / Q000453:epidemiology*; D028761:Withholding Treatment / Q000706:statistics & numerical data*