Gastric vs Small-Bowel Feeding in Critically Ill Children Receiving Mechanical Ventilation

Risk factors for gastrointestinal complications in critically ill children with transpyloric enteral nutrition

“…The frequency of gastrointestinal complications in critically ill adults fed with enteral nutrition can reach 62%, and withdrawal of the nutrition is required in 15% of the patients (Montejo et al, 2002;Ho et al, 2006). In our study, the incidence of gastrointestinal complications was lower similar to the figures reported in other studies in critically ill children (Sánchez Sánchez et al, 2003;Meert et al, 2004;Briassoulis et al, 2005;Pérez-Navero et al, 2005), and the TEN was definitively suspended owing to gastrointestinal complications in only 2.1% of the patients.…”

“…The most frequent problems during enteral nutrition are gastro- intestinal complications and, in the case of gastric nutrition, the interruptions of feeding for procedures (Rogers et al, 2003;Meert et al, 2004;O'Leary-Kelley et al, 2005). Transpyloric enteral nutrition reduces the number of interruptions and permits the administration of the prescribed feeding without increasing the incidence of complications (Ho et al, 2006).…”

“…The diarrhea in our patients was generally mild and improved after modification of the diet. It could be assumed that the incidence of diarrhea would be higher in patients fed by transpyloric nutrition as the processes of gastric digestion are bypassed and the nutrition is administered directly into the duodenum or jejunum; however, comparative studies have found no differences (Montejo et al, 2002;Meert et al, 2004;Ho et al, 2006).…”

“…However, oral or nasogastric feeding is sometimes poorly tolerated, particularly in the patients on mechanical ventilation, owing to the reduced gastric motility secondary to the administration of drugs or to the disease itself, with the onset of distension, the accumulation of gastric residues and an increased risk of pulmonary aspiration (Montejo, 1999;Mentec et al, 2001;(Montejo et al, 2002). Furthermore, a high percentage of critically ill patients on mechanical ventilation who are fed enterally via a nasogastric tube do not receive their full energy requirements, principally because of the frequent interruptions in the enteral feeding (Rogers et al, 2003;Meert et al, 2004;O'Leary-Kelley et al, 2005). Duodeno-jejunal enteral nutrition has been shown to be a good alternative route in critically ill adults (Davies et al, 2002;Montejo et al, 2002) and children (Chellis et al, 1996;Sánchez et al, 2000).…”

Use of a Noninvasive Electromagnetic Device to Place Transpyloric Feeding Tubes in Critically Ill Children

“…[3][4][5][6] Critically ill children often have slowed gastric motility as a result of immobility, sedation, and neuromuscular blockade. 6 Transpyloric feeding tubes are often used to feed critically ill patients with slow gastric emptying and may reduce gastroesophageal regurgitation and reduce the risk of ventilator-associated pneumonia.…”