Relationship Between Feeding Tube Site and Respiratory Outcomes

Abstract

Background It is unclear if placing feeding tubes postpylorically to prevent respiratory complications is worth the extra effort. This study sought to determine the extent to which aspiration and pneumonia are associated with feeding site (controlling for the effects of severity of illness, degree of head-of-bed elevation, level of sedation, and use of gastric suction). Methods A retrospective analysis was performed on a large data set gathered prospectively to evaluate aspiration in critically ill, mechanically ventilated patients. Feeding site was designated by attending physicians and confirmed by radiography. Each patient participated in the study for 3 consecutive days, with pneumonia assessed by the simplified Clinical Pulmonary Infection Score on the fourth day. Tracheal secretions were assayed for pepsin in a research laboratory; the presence of pepsin served as a proxy for aspiration. A total of 428 patients were included in the regression analyses performed to address the research objectives. Results As compared with the stomach, the percentage of aspiration was 11.6% lower when feeding tubes were in the first portion of the duodenum, 13.2% lower when in the second/third portions of the duodenum, and 18.0% lower when in the fourth portion of the duodenum and beyond (all significant at P < .001). Pneumonia occurred less often when feedings were introduced at or beyond the second portion of the duodenum (P = .020). Conclusions The findings support feeding critically ill patients with numerous risk factors for aspiration in the mid-duodenum and beyond to reduce the risk of aspiration and associated pneumonia.

The Relationship Between Nutritional Status and Physical Function, Admission Frequency, Length of Hospital Stay, and Mortality in Old People Living in Long-Term Care Facilities

“…Previous studies have indicated that tube feeding leads to aspiration pneumonia (Metheny, 2006;Metheny, Stewart, & McClave, 2011). Most of our subjects were tube fed.…”

Monitoring for Intolerance to Gastric Tube Feedings: A National Survey

“…1 Gastric feedings are often tried first because they are easier to administer; however, they may be associated with increased risk for aspiration in some patients. 2 Therefore, monitoring for intolerance to feedings is a major nursing function. In this article, we report findings from a national survey of methods used by critical care nurses to assess tolerance to gastric tube feedings and discuss the findings in light of current enteral nutrition guidelines.…”

Nursing intervention bundle for enteral nutrition in intensive care: a collective construction

“…It showed that the rates of pneumonia were significantly lower in patients receiving diet from the second portion of the duodenum on (19) .…”