The Use of Transpyloric Enteral Nutrition in the Critically Ill Child

Abstract

To assess the use and complications of transpyloric enteral nutrition (TEN) in the critically ill child we evaluated prospectively all children who received TEN in a pediatric intensive care unit (PICU) of a tertiary university hospital. The type of nutrition used, its duration, medication administered, tolerance, gastrointestinal complications (vomiting, abdominal distension or excessive gastric residue, diarrhea, and pulmonary aspiration), nongastrointestinal complications, and mortality were assessed. A comparative analysis was made between the first 2 years of the study and the remaining period. Over a period of 4.5 years, 152 patients between the ages of 3 days and 17 years received TEN for a duration of 19 ± 32.3 days (range 1–240 days). Forty-one patients received TEN during the first 2 years; 100 patients received TEN in the postoperative period after cardiac surgery (66%). One hundred seventeen patients (77%) received sedation and 65 (43%) received muscle relaxants, presenting no extra complications. Twenty-four patients (15.8%) presented with gastrointestinal complications: abdominal distension and/or excessive gastric residue in 17 and diarrhea in 11. Gastrointestinal intolerance was associated with pulmonary infection (p < 0.05), altered hepatic function (p < 0.001), and hypokalemia or hypocalcemia (p < 0.05). Diarrhea was more frequent in patients with shock (p < 0.05), altered hepatic function (p < 0.05), excessive gastric residue (p < 0.001), and hypokalemia or hypocalcemia (p < 0.05). In the second study period, the number of patients on TEN and the doses of sedatives, muscle relaxants, and vasoactives were higher (p < 0.05), with no increase in the incidence of complications. TEN is a useful method of nutrition with few complications in the critically ill child.

The effect of enteral nutrition on nutritional status in the critically ill child

“…There were few complications secondary to the nutrition, fewer than have been found in adults [46], and of a similar rate to that/ similar to those reported in previous studies carried out by our group [9,47,48]. The administration of vasoactive drugs (26% of patients received adrenaline) and/or sedatives and muscle relaxants, which reduce intestinal motility (28.5% of our patients received muscle relaxants in continuous infusion), did not affect tolerance to the nutrition.…”

“…The desired calorie delivery was reached rapidly with the transpyloric enteral nutrition, as reported previously [8,9,45]. There were few complications secondary to the nutrition, fewer than have been found in adults [46], and of a similar rate to that/ similar to those reported in previous studies carried out by our group [9,47,48].…”

Transpyloric enteral feeding in the postoperative of cardiac surgery in children

“…Most children in the postoperative period of cardiac surgery tolerate transpyloric nutrition adequately well despite the fact that a significant percentage of them were receiving high doses of epinephrine and/or dopamine, which can reduce intestinal perfusion, and high doses of sedatives and muscle relaxants, which can reduce gastrointestinal motility [28]. We found no relationship in our patients between the administration of vasoactive drugs or sedatives and the presence of gastrointestinal complications [29,30].…”

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

“…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). However, transpyloric enteral nutrition could also increase the incidence of complications in preterm infants (McGuire and McEwan, 2004).…”