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1.
Gharpure V Meert KL Sarnaik AP 《JPEN. Journal of parenteral and enteral nutrition》2001,25(3):160-165
BACKGROUND: Erythromycin enhances gastric emptying and has been suggested to facilitate nasoenteric feeding tube placement in adults. Our primary objective was to evaluate the effect of erythromycin on the transpyloric passage of feeding tubes in critically ill children, and second, to evaluate the effect of erythromycin on the distal migration of duodenal feeding tubes. METHODS: Seventy-four children were randomly assigned to receive erythromycin lactobionate (10 mg/kg) IV or equal volume of saline placebo 60 minutes before passage of a flexible weighted tip feeding tube. Abdominal radiographs were obtained 4 hours later to assess tube placement. If the tube was proximal to the third part of the duodenum, two additional doses of erythromycin/placebo were administered 6 hours apart. Those receiving additional doses had repeat radiographs 14 to 18 hours after tube placement. RESULTS: The number of postpyloric feeding tubes was similar in the erythromycin and placebo treated groups 4 hours after tube insertion (23/37 vs 27/37, p = .5). Of those with prepyloric tubes at 4 hours, none in the erythromycin group and 3 in the placebo group had the tube migrate to the postpyloric position by 14 to 18 hours (p < .05). Of those with postpyloric tubes proximal to the third part of the duodenum at 4 hours, additional doses of erythromycin did not cause more tubes to advance further into the intestine than did placebo (p = .6). CONCLUSIONS: Erythromycin does not facilitate transpyloric passage of feeding tubes in critically ill children. The distal migration of duodenal tubes further into the small bowel is also not enhanced by erythromycin. 相似文献
2.
Phipps LM Weber MD Ginder BR Hulse MA Thomas NJ 《JPEN. Journal of parenteral and enteral nutrition》2005,29(6):420-424
BACKGROUND: The goal of this study was to compare 3 different techniques used to place nasojejunal (NJ) feeding tubes in the critically ill or injured pediatric patients. This was a randomized, prospective trial in a university-affiliated 12-bed pediatric intensive care unit. Patients were critically ill children requiring placement of an NJ feeding tube. Patient age, weight, medications, use of mechanical ventilation, and patient tolerance were recorded. An abdominal radiograph obtained immediately after the placement determined correct placement. The final placement was recorded, as was the number of placement attempts. METHODS: Patients were randomized to 1 of 3 groups: standard technique, standard technique facilitated with gastric insufflation, and standard technique facilitated with the use of preinsertion erythromycin. To ensure equal distribution, all patients were stratified by weight (<10 kg vs > or =10 kg) before randomization. All NJ tubes were placed by one of the investigators. If unsuccessful, a second attempt by the same investigator was allowed. Successful placement of the NJ tube was defined by confirmation of the tip of the tube in the first part of the duodenum or beyond by a pediatric radiologist blinded to the treatment groups. RESULTS: Seventy-five pediatric patients were enrolled in the study; 94.6% (71/75) of tubes were passed successfully into the small bowel on the first or second attempt. Evaluation of the data revealed no significant association with a specific technique and successful placement (p = .1999). CONCLUSIONS: When placed by a core group of experienced operators, the majority of NJ feeding tubes can be placed in critically ill or injured children on the first or second attempt, regardless of the technique used. 相似文献
3.
内镜下放置鼻空肠管在危重病人的应用 总被引:4,自引:2,他引:4
目的:总结危重病人内镜辅助下床边放置鼻空肠管的经验,探讨内镜置管的具体方法及其在危重病人中的应用.方法:1997年1月至2005年1月间共107例重症病人接受内镜辅助下放置鼻空肠管,观察置管的时间、成功率、并发症及留置时间.结果:置管时间为(12.3±7.8)min,成功率为98.1%,未发生置管相关并发症,置管后并发症发生率为2.8%(3/107).导管留置时间为(20.7±8.4)d.结论:内镜辅助放置鼻空肠管具有简单、快捷、安全,易于护理、病人痛苦小和易于耐受等优点,尤其适于危重病人使用. 相似文献
4.
Transnasal endoscopic placement of nasoenteric feeding tubes: outcomes and limitations in non-critically ill patients. 总被引:1,自引:0,他引:1
Sanjiv Mahadeva Abdul Malik Ida Hilmi Choon-Seng Qua Choon-Heng Wong Khean-Lee Goh 《Nutrition in clinical practice》2008,23(2):176-181
Transnasal endoscopic placement of nasoenteric tubes (NETs) has been demonstrated to be useful in the critical care setting, with limited data on its role in non-critically ill patients. The authors collected data on consecutive patients from a non-critical care setting undergoing transnasal endoscopic NET placement. All NETs were endoscopically placed using a standard over-the-guidewire technique, and positions were confirmed with fluoroscopy. Patients were monitored until the removal of NETs or death. Twenty-two patients (median age = 62.5 years, 36.4% female) were referred for postpyloric feeding, with main indications of persistent gastrocutaneous fistula (n = 6), gastroparesis or gastric outlet obstruction (n = 5), duodenal stenosis (n = 6), acute pancreatitis (n = 4), and gastroesophageal reflux after surgery (n = 1). Postpyloric placement of NET was achieved in 19 of 22 (86.3%) patients, with 36.8% tube positions in the jejunum, 47.4% in the distal duodenum, and 15.8% in the second part of the duodenum. NET placement was least successful in cases with duodenal stenosis. NETs remained in situ for a median of 24 days (range, 2-94), with tube dislodgement (n = 3) and clogging (n = 5) as the main complications. NET feeding resulted in complete healing of gastrocutaneous fistulae in 5 of 6 patients and provision of total enteral nutrition in 3 of 4 cases of acute pancreatitis and 9 of 11 cases of gastroparesis or proximal duodenal obstruction. Transnasal endoscopy has a role in the placement of NET in non-critically ill patients requiring postpyloric feeding. However, there are some limitations, particularly in cases with altered duodenal anatomy. 相似文献
5.
Numerous complications have been encountered with small-bore nasoenteric feeding tubes, some potentially life threatening. Patients particularly at risk are those with anatomic abnormalities, debilitation, or neurologic impairment. Fluoroscopy has been reported to be a safe, efficacious modality for the placement of these tubes. Thirty critically ill patients were studied to assess caloric delivery, costs, and complications associated with both fluoroscopically and blindly placed feeding tubes. All patients had either a tracheostomy or an endotracheal tube. They were randomized to group A (fluoroscopy) or group B (blind). Caloric delivery was greater in group A patients on days 1 through 5, with statistically significant differences on days 1 through 4. The mean daily calories per patient over the study period was 1135 +/- 96 and 662 +/- 110 (mean +/- SEM) in groups A and B, respectively (P < 0.01). Costs were similar in both groups. The most frequent problems encountered were difficult insertion, tubes requiring replacement, and failure to intubate the duodenum. We conclude that critically ill patients intubated either endotracheally or with tracheostomy should have nasoenteric feeding tubes placed with the guidance of fluoroscopy. 相似文献
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BACKGROUND: There is an increasing demand for enteral feeding in intensive care unit (ICU) patients. However, gastroparesis is common, and jejunal placement with gastric decompression leads to delays in feeding. In an attempt to minimize delays, we describe our technique and results with transnasal endoscopic placement of double-lumen gastric aspiration, jejunal feeding tubes (DLFT). METHODS: Fifty-one consecutive ICU patients referred for nutrition support were studied; 29% had respiratory failure, 28% acute head injury, and 33% acute pancreatitis. A 5.8-mm ultraslim video endoscope was used to place a guidewire through the nose terminating beyond the Ligament of Treitz. After withdrawal of the endoscope, a DLFT was passed over the wire. Final position of the tube was checked and adjusted under direct vision by reendoscopy though the opposite nasal passage. RESULTS: Initial placement of the guidewire and DLFT was successful in 46 of 51 patients. Massive gastric dilatation and acute pancreatitis complicated by duodenal compression impeded full duodenoscopy in 5 patients, necessitating fluoroscopy for correct guidewire deployment. In confirming correct tube placement, there was near perfect concordance between reendoscopy and x-ray (45/46). Previously unrecognized upper gastrointestinal tract pathology was detected in most patients, with acute gastritis in 47, superficial gastric ulceration in 24, and erosive esophagitis in 5. CONCLUSIONS: Transnasal endoscopic placement of feeding tubes in the ICU is quick, effective, and minimally disruptive of intensive therapy. In addition, it can reveal unrecognized pathology, which potentially could lead to improvements in overall medical care. 相似文献
8.
目的:探讨床旁空肠营养管徒手置入技术在危重症病人肠内营养(EN)治疗中的安全性、有效性和实用性. 方法:鼻空肠管组病人采用美国CORPAK公司CORFLO导管置入行鼻空肠营养29例.鼻胃管组采用普通胃管置入行EN支持30例.观察鼻空肠管组置管成功率,置管时间和不良反应.对比观察两组病人血清清蛋白(ALB)、前清蛋白(PA)、血红蛋白(Hb)、APACHEⅡ评分、入住ICU时间、置管费用和ICU总费用等指标的变化,以及反流、腹胀、腹泻、应激性溃疡和吸入性肺炎等并发症的发生率. 结果:床旁经鼻空肠营养管徒手置入成功率为93.1%,置管时间为(19.3-6.8) min,无不良反应.鼻空肠管组病人营养指标和APACHEⅡ评分改善明显,且入住ICU时间、ICU总费用和并发症的发生率均低于对照组. 结论:床旁空肠营养管徒手置入技术在危重症病人EN支持治疗中,具有操作简单、安全、置管成功率高、并发症低、病人营养状况改善明显的优点. 相似文献
9.
Comparison of gastrointestinal tolerance to two enteral feeding protocols in critically ill patients: a prospective, randomized controlled trial 总被引:4,自引:0,他引:4
Pinilla JC Samphire J Arnold C Liu L Thiessen B 《JPEN. Journal of parenteral and enteral nutrition》2001,25(2):81-86
BACKGROUND: The purpose of this study was to compare gastrointestinal tolerance to two enteral feeding protocols in critically ill patients. METHODS: A prospective, randomized controlled trial, that involved 96 consecutive patients expected to stay in the intensive care unit for > or =3 days and who had no contraindications to enteral feeding. The patients were randomized to either the current protocol (group I; gastric residual volume threshold, 150 mL, optional prokinetic) or proposed feeding protocol (group II; gastric residual volume threshold 250 mL, mandatory prokinetic). Gastrointestinal intolerance was recorded as episodes of high gastric residual volume, emesis, or diarrhea. The time to reach the goal rate of feeding and the percentage of nutritional requirements received during the study period were also recorded. RESULTS: Nineteen of 36 patients (19/36 = 0.53) in group I had one or more episodes of high gastric residual volume, compared with 10 of 44 patients (10/44 = 0.23) in group II (p < .005). There was no statistical difference between the two protocols with regards to emesis, diarrhea, or the total episodes of intolerance. The patients in group II reached their goal rates on average in 15 hours and received 76% of their nutritional requirements, compared with 22 hours and 70% in group I; however, these differences were not statistically significant. CONCLUSIONS: The incidence of enteral feeding intolerance was reduced by using a gastric residual volume of 250 mL along with the mandatory use of prokinetics. The study showed a trend of improved enteral nutrition provision and reduced the time to reach the goal rate in group II. These improvements support the adoption of the proposed feeding protocol for critically ill patients. 相似文献
10.
A prospective randomised trial of probiotics in critically ill patients 总被引:10,自引:0,他引:10
McNaught CE Woodcock NP Anderson AD MacFie J 《Clinical nutrition (Edinburgh, Scotland)》2005,24(2):211-219
BACKGROUND AND AIMS: Probiotics exert a beneficial effect on the host through modulation of gastrointestinal microflora. The aim of this study was to investigate the effect of the probiotic Lactobacillus plantarum 299v on gut barrier function and the systemic inflammatory response in critically ill patients. SUBJECTS AND METHODS: One hundred and three critically ill patients were randomised to receive an oral preparation containing L. plantarum 299v (ProViva) in addition to conventional therapy (treatment group, n = 52) or conventional therapy alone (control group, n = 51). Serial outcome measures included gastric colonisation, intestinal permeability (lactulose/rhamnose dual-sugar probe technique), endotoxin exposure (IgM EndoCAb), C-reactive protein and Interleukin 6 levels. RESULTS: L. plantarum had no identifiable effect on gastric colonisation, intestinal permeability, endotoxin exposure or serum CRP levels. There were no differences between the groups in terms of septic morbidity or mortality. On day 15 serum IL-6 levels were significantly lower in the treatment group compared to controls. CONCLUSIONS: The enteral administration of L. plantarum 299v to critically ill patients was associated with a late attenuation of the systemic inflammatory response. This was not accompanied by any significant changes in the intestinal microflora, intestinal permeability, endotoxin exposure, septic morbidity or mortality. 相似文献
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Dickerson RN Boschert KJ Kudsk KA Brown RO 《Nutrition (Burbank, Los Angeles County, Calif.)》2002,18(3):241-246
OBJECTIVE: We respectively compared the nutritional and clinical efficacies of eucaloric and hypocaloric enteral feedings in 40 critically ill, obese patients admitted to the trauma or surgical intensive care unit. METHODS: Adult patients, 18 to 69 years old, with weights greater than 125% of ideal body weight, normal renal and hepatic functions, and who received at least 7 d of enteral tube feeding were studied. Patients were stratified according to feeding group: eucaloric feeding (>or=20 kcal/kg of adjusted weight per day; n = 12) or hypocaloric feeding (<20 kcal/kg of adjusted weight per day; n = 28). The goal protein intake for both groups was approximately 2 g/kg of ideal body weight per day. Clinical events and nutrition data were recorded for 4 wk. RESULTS: Patients were similar according to sex, age, weight, body mass index, Second Acute Physiology and Chronic Health Evaluation score, Trauma score, and Injury Severity Score. The hypocaloric feeding group received significantly fewer calories than the eucaloric group (P相似文献
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经皮内镜下空肠造口术在危重症病人的应用 总被引:2,自引:1,他引:2
目的:研究床边经皮内镜下空肠造口术(PEGJ)置管对危重症病人的可行性、疗效和并发症.方法:21例重症病人接受PEGJ,观察置管的时间、成功率、并发症及留置时间.结果:平均置管时间为(14.3±8.6)min,成功率达100%,未发生置管相关并发症.置管后并发症的发生率为9.5%(2/21),空肠管尖端移位1例及造口渗液1次.平均导管留置时间为(235.7±209.3)d.结论:PEGJ具有操作简便、快捷、安全,易于护理,病人痛苦少、易于耐受、可长期带管等优点,尤其适合在危重症病人中使用. 相似文献
15.
Lee JM Fernandez F Staff I Mah JW 《JPEN. Journal of parenteral and enteral nutrition》2012,36(3):323-329
Background: Bedside protocols improve success rates of postpyloric nasoenteric tube (NET) placement by nutrition teams and experienced individuals. However, many hospitals require novice practitioners to perform these procedures and often choose fluoroscopy, endoscopy, or newer alternative devices to achieve success. Little is known about the ability to train inexperienced practitioners or the effectiveness of the methods used to implement these protocols. Web‐based learning is a potential tool to improve knowledge and procedural skills. The authors created a self‐directed Web‐based teaching module (WBTM) to educate and standardize placement of postpyloric NETs. Methods: Forty‐three first‐, second‐, or third‐year residents or medical or physician assistant students took pretests for knowledge and confidence surveys, viewed the WBTM, placed NET at the bedside, then took a posttest and confidence survey while awaiting confirmation of tube position by abdominal radiograph. Success was acknowledged if the tip of the NET was beyond the pylorus. A retrospective chart review was used to determine a historical success rate, which was used as a control. Results: Knowledge and confidence significantly improved. Overall success rate of postpyloric NET placement for all participants on first attempt was 74.4% vs 46.7% in the control (P = .005). Improvement occurred in all subgroups, including those with no prior experience, who were successful 70.4% of the time (P = .009). Conclusions: This WBTM is simple to implement, inexpensive, and resource efficient. The improvement in postpyloric NET placement, especially among novice practitioners, demonstrates the benefit and applicability of this method of standardized education. 相似文献
16.
Optimal energy goals for adult, obese critically ill surgical patients are unclear. To date, there has been little data comparing feeding regimens for obese and non-obese critically ill surgical patients and the effect on outcomes. The objective was to compare the effect of hypoenergetic and euenergetic feeding goals in critically ill obese patients on outcomes, including infection, intensive care unit length of stay, and mortality. We hypothesized that hypoenergetic feeding of patients with premorbid obesity (body mass index ≥ 30 kg•m−2) during critical illness does not affect clinical outcomes. Post hoc analyses were performed on critically ill surgical patients enrolled in a randomized controlled trial. Patients were randomized to receive 25-30 kcal•kg−1•d−1 (105-126 kJ.kg−1•d−1, euenergetic) or 12.5-15 kcal•kg−1•d−1 (52-63 kJ.kg−1 •d−1, hypoenergetic), with equal protein allocation (1.5 g•kg−1•d−1). The effect of feeding regimen on outcomes in obese and nonobese patients were assessed. Of the 83 patients, 30 (36.1%) were obese (body mass index ≥ 30 kg•m−2). Average energy intake differed based on feeding regimen (hypoenergetic: 982±61 vs euenergetic: 1338±92 kcal•d−1, P = .02). Comparing obese and nonobese patients, there was no difference in the percentage acquiring an infection (66.7% [20/30] vs 77.4% [41/53], P = .29), intensive care unit length of stay (16.4±3.7 vs 14.3±0.9 days, P = .39), or mortality (10% [3/30] vs 7.6% [4/53], P = .7). Within the subset of obese patients, the percentage acquiring an infection (hypoenergetic: 78.9% [15/19] vs euenergetic: 45.5% [5/11], P = .11) was not affected by the feeding regimen. Within the subset of nonobese patients, there was a trend toward more infections in the euenergetic group (hypoenergetic: 63.6% [14/22] vs euenergetic: 87.1% [27/31], P = .05). Hypoenergetic feeding does not appear to affect clinical outcomes positively or negatively in critically ill patients with premorbid obesity. 相似文献
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18.
Endoscopic placement of enteral feeding tubes 总被引:1,自引:0,他引:1
S Gallo A Ramirez J Elizondo G Molina J Ramirez-Acosta 《JPEN. Journal of parenteral and enteral nutrition》1985,9(6):747-749
The techniques for placement of feeding tubes using fiberscopes are described and an evaluation of the results obtained in the last 12 months is made. The techniques are discussed and compared with other methods of enteral feeding known at present. It is concluded that placement of feeding tubes by endoscopy can be achieved easily, that it is possible to choose the site of enteric liberation of nutrients under conditions which previously represented contraindications, and that this procedure is free of complications even during long periods of time. 相似文献
19.
Background: Altered concentrations of ghrelin, motilin, and cholecystokinin (CCK) may contribute to gastric hypomotility. The aims of this study were to evaluate the concentrations of these hormones in patients tolerant and intolerant to gastric nutrition, assess the influence of prokinetic therapy on these hormone concentrations, determine the associations between these mediators and gastric emptying, and evaluate whether inflammation influences their concentrations. Methods: Post hoc analyses of 2 prospective studies that enrolled 20 critically ill patients with an aspirated gastric residual (GR) >150 mL while receiving gastric enteral nutrition (intolerant group) and 10 critically ill patients with minimal GR (tolerant group). Patients with intolerance were also assessed 1 day after prokinetic therapy. Fasting serum concentrations of total ghrelin, acyl ghrelin (active), des‐acyl ghrelin (inactive), motilin, CCK, and tumor necrosis factor (TNF)?α were determined. Gastric emptying was assessed concurrently using the acetaminophen absorption method. Results: Compared to the tolerant group, the intolerant group had higher total ghrelin (1324.8 ± 1204.6 vs 285.1 ± 132.5 pg/mL; P < .001), lower acyl ghrelin (70.5 ± 65.4 vs 208.5 ± 186.9 pg/mL; P < .05), and lower acyl ghrelin to des‐acyl ghrelin ratio (1.11 ± 1.35 vs 3.47 ± 3.21 pg/mL; P < .05). Concentrations of other hormones and TNF‐α were similar. Despite accelerated gastric emptying after prokinetic therapy, concentrations of all hormones and TNF‐α were similar to baseline values. Hormone concentrations were not associated with gastric emptying or TNF‐α. Conclusion: Patients intolerant to gastric nutrition generate less acyl ghrelin, which may contribute to gastric hypomotility. Intolerance is not associated with altered concentrations of other hormones. Hormone concentrations are not influenced by prokinetic therapy. 相似文献
20.
Post‐pyloric feeding tube placement in critically ill patients: Extending the scope of practice for Australian dietitians
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Rosalie Yandell Marianne Chapman Stephanie O'Connor Alison Shanks Kylie Lange Adam Deane 《Nutrition & Dietetics》2018,75(1):30-34