Effect of postpyloric feeding on gastroesophageal regurgitation and pulmonary microaspiration: Results of a randomized controlled trial

Heyland, Daren K.; Drover, John W.; MacDonald, Shaun; Novák, František; Lam, Miu

doi:10.1097/00003246-200108000-00001

Cited by 288 publications

(139 citation statements)

References 31 publications

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“…10 Notwithstanding our disappointing clinical experiences with the technique of nasoduodenal enteral feeding, including in critically ill ICU patients, 10 there has subsequently been considerable interest in the technique of postpyloric enteral feeding in the ICU patient, particularly in respect of reducing the incidence of aspiration pneumonia. [13][14][15][16][17][18][19][20][21][22] In attempting to assess and compare the results of the 10 controlled studies, [13][14][15][16][17][18][19][20][21][22] one is forced to conclude that the term postpyloric almost certainly refers to nasoduodenal tube placement and that some authors may have been somewhat optimistic in thinking that they had achieved intrajejunal tube placement. Overall, the results of the studies have been conflicting, and no clear consensus on the efficacy of postpyloric feeding in reducing the incidence of aspiration pneumonia has been documented.…”

Section: 9mentioning

confidence: 99%

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The Evolving Role of Post–Ligament of Trietz Nasojejunal Feeding in Enteral Nutrition and the Need for Improved Feeding Tube Design and Placement Methods

Silk

2011

J Parenter Enteral Nutr

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Nutrition support is an important link in the chain of therapy for intensive care unit patients. The early institution of nutrition support significantly reduces the incidence of septic complications, reduces mortality, and shortens hospital stay. Unfortunately, impaired gastrointestinal function, particularly gastric atony, restricts the use of nasogastric enteral tube feeding, and the use of this route of administration in these patients can lead to regurgitation, aspiration, and the development of pneumonia. Postpyloric enteral feeding was heralded as a means of overcoming many of these problems. Overall, the results of controlled studies do not support a role of postpyloric duodenal feeding in reducing the incidence of aspiration pneumonia. As a consequence, post–ligament of Treitz nasojejunal enteral feeding is proposed as the technique of choice in these patients. Feeding tube design must incorporate a gastric aspiration port to overcome problems of gastroesophageal acid reflux, duodenogastric bile reflux, and increased gastric acid secretion, problems that occur during “downstream” jejunal feeding. Tube placement technique will need to be refined and patients will need to receive a predigested enteral diet. In postoperative surgical patients in the intensive care unit, there is also a need for a newly designed dual‐purpose nasogastric tube capable initially of providing a means of undertaking gastric aspiration and decompression and subsequently a means of initiating nasogastric enteral feeding.

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Section: 9mentioning

confidence: 99%

“…8,9,23,24 One possible reason for this is that there is a need to aspirate gastric contents during postpyloric feeding. It is unlikely that this was performed in the above studies, [13][14][15][16][17][18][19][20][21][22] as the available feeding tubes did not incorporate a gastric aspiration port.…”

Section: 9mentioning

confidence: 99%

The Evolving Role of Post–Ligament of Trietz Nasojejunal Feeding in Enteral Nutrition and the Need for Improved Feeding Tube Design and Placement Methods

Silk

2011

J Parenter Enteral Nutr

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“…Para lograrlo, es importante la monitorización intermitente de los residuos de contenido, los que impactarían en la incidencia de NAVM 19,20 . Por tanto, independientemente a usar la ubicación gástrica o post-pilórica de alimentación, este consenso considera importante el uso de cantidades moderadas de alimentación controlando la existencia de residuos para evitar la sobre-distensión abdominal (IIB).…”

Section: La Alimentación Enteral Fraccionada ¿Conlleva Un Menor Riesgunclassified

Actualización Consenso Neumonía asociada a ventilación mecánica: Segunda parte. Prevención

Chacón

et al. 2011

Rev. chil. infectol.

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Update. Consensus on Ventilator Associated Pneumonia.Second Part: ProphylaxisVentilator associated pneumonia is a life threatening disease, in spite of advances in its treatment, consequently the development of prevention strategies is a key factor in improving the morbidity and mortality in intensive care units (ICU). The new developments in this fi eld in the last years led to the need to update the recommendations done in 2001. Then, a new search and analysis of scientifi c literature was performed. The obtained data support different strategies highlighting: semi-recumbent position at 45° of patients; incorporation of routinely oral hygiene procedures with chlorhexidine; preference of orotracheal intubation; performing subglotic aspiration; use of standard hand hygiene techniques; not routine change of ventilator circuits; and defi ning bundles to organize the work at ICU. Some strategies were recommended for being of similar effi cacy to others but cost-effective as: use of heat and moisture humidifi cators; and changing humidifi cators every 5 to 7 days. The use of open or closed endotracheal suctioning system does not affect the incidence of pneumonia. Some recommendations were not incorporated because of lack of evidence supporting effectiveness, controversial data or doubtful application to our country as selective digestive decontamination.Key words: Prevention, ventilator-associated pneumonia, guidelines, mechanical ventilation, consensus. Palabras clave: Prevención, neumonía asociada a ventilación mecánica, guías clínicas, ventilación mecánica, consenso. Universidad Austral de Chile, Valdivia (MCA).Hospital San Borja Arriarán, Santiago (LDM).Hospital Padre Hurtado, Santiago. Enfermera Control de IAAS (ECV).Hospital Clínico Universidad IntroducciónL a neumonía asociada a ventilación mecánica (NAVM) se mantiene como una entidad de alta mortalidad que afecta a las poblaciones sometidas a este procedimiento. A pesar de que se han diseñado estrategias para iniciar un tratamiento oportuno y apropiado, mejorando el pronóstico de mortalidad de los enfermos, no es menos cierto que la mortalidad atribuible es aún elevada con una terapia adecuada. Por esto, el desarrollo y ejecución de medidas de prevención adecuadas parece ser uno de los esfuerzos más acertados para la disminución de la morbi-mortalidad asociada a este cuadro.En los últimos nueve años, el desarrollo de la literatura científi ca enfocada a este aspecto ha sido enorme y muy variado, incluyendo nuevos tipos de intervenciones, a la vez que ha intentado esclarecer la utilidad de las más antiguas; por otro lado, en otras se ha logrado tener un mejor dato respecto a su evidencia, así como en algunas, por el poco tiempo de desarrollo que llevan, no ha sido posible dar una recomendación con la misma calidad de fundamento.Como se ha mencionado previamente, este artículo es parte de la actualización del consenso realizado, con anterioridad, por la Sociedad Chilena de Infectología en el año 2001. La metodología nuevamente ha buscado realizar recomendacio...

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“…56 Diverting the level of EN infusion lower in the GI tract reduces gastroesophageal reflux and risk for aspiration, and may reduce the incidence of pneumonia. Using a radioisotope placed in the EN formula, Heyland 57 showed that reducing the level of infusion from the stomach down to the third portion of the duodenum significantly reduced reflux and aspiration. Whether or not this reduction in reflux and aspiration reduces pneumonia is not as clear.…”

Section: -52mentioning

confidence: 99%

Critical Care Nutrition: Getting Involved as a Gastrointestinal Endoscopist

McClave

2006

Journal of Clinical Gastroenterology

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The route, timing, and volume of enteral feeding delivered to a patient in the intensive care unit have a profound effect on clinical outcome. At the height of critical illness, problems with ileus, aspiration, and the systemic inflammatory response syndrome make the provision of enteral nutrients a difficult and somewhat risky endeavor. The gastrointestinal endoscopist has the technical skills to place feeding tubes deep within the jejunum and an underlying expertise in gut physiology to monitor patients effectively once feeds are initiated. Attention to detail in the techniques for attaining enteral access, early identification of potential problems, and quick institution of simple endoscopic strategies help improve delivery of nutrition support, minimize the likelihood for inhospital complications, and optimize patient outcome.

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Effect of postpyloric feeding on gastroesophageal regurgitation and pulmonary microaspiration: Results of a randomized controlled trial

Abstract: Feeding beyond the pylorus is associated with a significant reduction in gastroesophageal regurgitation and a trend toward less microaspiration.

Cited by 288 publications

References 31 publications

The Evolving Role of Post–Ligament of Trietz Nasojejunal Feeding in Enteral Nutrition and the Need for Improved Feeding Tube Design and Placement Methods

The Evolving Role of Post–Ligament of Trietz Nasojejunal Feeding in Enteral Nutrition and the Need for Improved Feeding Tube Design and Placement Methods

Actualización Consenso Neumonía asociada a ventilación mecánica: Segunda parte. Prevención

Critical Care Nutrition: Getting Involved as a Gastrointestinal Endoscopist

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