-
1.
Nasal Feeding Tubes Are Associated with Fewer Adverse Events than Feeding via Ostomy in Hospitalized Patients Receiving Enteral Nutrition.
Bowman, CA, Hutchins, E, Burgermaster, M, Sant, V, Seres, DS
The American journal of medicine. 2022;(1):97-102.e1
-
-
Free full text
-
Abstract
BACKGROUND Surgical feeding ostomies (eg, gastrostomy) have become required by many nursing facilities for all patients receiving enteral nutrition, whether for short- or long-term use. These policies lack supportive evidence. Comparisons of adverse event rates between surgical and natural orifice tubes are few and lacking in the inpatient setting. Additionally, we hypothesize that adverse events related to feeding tubes are underreported. We sought to quantify adverse events to test the relative safety of surgical feeding ostomies and natural orifice (eg. nasogastric or orogastric) feeding tubes in hospitalized patients. METHODS This was a prospective observational cohort study of enterally fed inpatients using semiweekly focused physical examination, scripted survey, and chart review. RESULTS All tube-fed patients admitted to a large, urban, academic hospital received semiweekly bedside evaluation and chart review over a 9-week period (n = 226 unique patients, mean 6.25 visits each, total 1118 observations). Demographics were comparable between 148 subjects with natural orifice and 113 subjects with surgical feeding tubes. A higher incidence of adverse events was observed with surgical tubes (3.34 vs 1.25 events per 100 subject days, P < .001). Only 50% of all adverse events were documented in the medical record. More patients with surgical tubes were discharged to skilled nursing facilities (58% vs 24%). CONCLUSIONS Surgical feeding tubes are associated with significantly higher in-hospital adverse event rates when compared with natural orifice (nasal or oral) feeding tubes. Policies requiring surgical feeding ostomies should be reevaluated.
-
2.
Small-bore feeding tube versus large-bore sump tube for early enteral nutrition in mechanically ventilated patients: A nationwide inpatient database study.
Ohbe, H, Matsui, H, Fushimi, K, Yasunaga, H
Clinical nutrition (Edinburgh, Scotland). 2021;(6):4113-4119
Abstract
BACKGROUND & AIMS When physicians start nasogastric tube feeding in mechanically ventilated patients, they have two choices of feeding tube device: a large-bore sump tube or a small-bore feeding tube. Some physicians may prefer to initiate enteral nutrition via the large-bore sump tube that is already in place, and others may prefer to use the small-bore feeding tube. However, it remains unknown whether small-bore feeding tubes or large-bore sump tubes are better for early enteral nutrition. The present study aimed to compare outcomes between these two types of feeding tubes in mechanically ventilated patients. METHODS Using the Japanese Diagnosis Procedure Combination inpatient database from July 2010 to March 2018, we identified adult patients who underwent invasive mechanical ventilation for ≥2 days in intensive care units and received nasogastric tube feeding within 2 days of starting mechanical ventilation. We categorized these patients as receiving early enteral nutrition via small-bore feeding tube (8- to 12-Fr single-lumen tubes) or via large-bore sump tube. Propensity score-matched analyses were performed to compare 28-day in-hospital mortality and hospital-acquired pneumonia between the two groups. RESULTS A total of 79,656 patients were included. Of these patients, 20,178 (25%) were in the small-bore feeding tube group. One-to-one propensity score matching created 20,061 matched pairs. Compared with those in the large-bore sump tube group, patients in the small-bore feeding tube group had significantly higher 28-day in-hospital mortality (17.0% versus 15.6%; hazard ratio, 1.08; 95% confidence interval, 1.03 to 1.14) and a significantly higher prevalence of hospital-acquired pneumonia (9.3% versus 8.5%; odds ratio, 1.11; 95% confidence interval, 1.02 to 1.21). CONCLUSIONS This nationwide observational study suggests that small-bore feeding tubes may not be associated with better clinical outcomes but rather with increased mortality and hospital-acquired pneumonia. Because of the uncertainty regarding the mechanism of our findings, further studies are warranted.
-
3.
Erythromycin versus metoclopramide for post-pyloric spiral nasoenteric tube placement: a randomized non-inferiority trial.
Hu, B, Ouyang, X, Lei, L, Sun, C, Chi, R, Guo, J, Guo, W, Zhang, Y, Li, Y, Huang, D, et al
Intensive care medicine. 2018;(12):2174-2182
-
-
Free full text
-
Abstract
PURPOSE To determine whether erythromycin is non-inferior to metoclopramide in facilitating post-pyloric placement of self-propelled spiral nasoenteric tubes (NETs) in critically ill patients. METHODS A prospective, multicenter, open-label, parallel, and non-inferiority randomized controlled trial was conducted comparing erythromycin with metoclopramide in facilitating post-pyloric placement of spiral NETs in critically ill patients admitted to intensive care units (ICUs) of eight tertiary hospitals in China. The primary outcome was procedure success defined as post-pyloric placement (spiral NETs reached the first portion of the duodenum or beyond confirmed by abdominal radiography 24 h after tube insertion). RESULTS A total of 5688 patients were admitted to the ICUs. Of these, in 355 patients there was a plan to insert a nasoenteric feeding tube, of whom 332 were randomized, with 167 patients assigned to the erythromycin group and 165 patients assigned to the metoclopramide group. The success rate of post-pyloric placement was 57.5% (96/167) in the erythromycin group, as compared with 50.3% (83/165) in the metoclopramide group (a difference of 7.2%, 95% CI - 3.5% to 17.9%), in the intention-to-treat analysis, not including the prespecified margin of - 10% for non-inferiority. The success rates of post-D1 (reaching the second portion of the duodenum or beyond), post-D2 (reaching the third portion of the duodenum or beyond), post-D3 (reaching the fourth portion of the duodenum or beyond), and proximal jejunum placement and the incidence of any adverse events were not significantly different between the groups. CONCLUSIONS Erythromycin is non-inferior to metoclopramide in facilitating post-pyloric placement of spiral NETs in critically ill patients. The success rates of post-D1, post-D2, post-D3, and proximal jejunum placement were not significantly different.
-
4.
Safety and Efficacy of Electromagnetic-Guided Bedside Placement of Nasoenteral Feeding Tubes versus Standard Placement.
Shadid, H, Keckeisen, M, Zarrinpar, A
The American surgeon. 2017;(10):1184-1187
Abstract
Although enteral feeding in critically ill patients has been shown to be beneficial, reliable postpyloric placement of feeding tubes remains a challenge. The standard of care involves blind placement, frequently requiring multiple attempts, and radiographs. To evaluate the effect of electromagnetic-guided bedside placement in reducing time to establishment of feeding, lung placement, use of radiography, and cost, we initiated a prospective trial using electromagnetic-guided bedside placement and compared them to a retrospective cohort. Fifty-three consecutive placements of nasoenteral feeding tubes were made using electromagnetic-guidance on patients requiring enteral nutrition in a surgical intensive care unit at a tertiary care center. Sixty-three placement attempts in the preceding seven months served as controls. There were no significant differences between the two groups in terms of age, sex, weight, body mass index, hiatal or ventral hernias, or previous esophageal/gastric operations. The number of radiographs needed per patient, need for fluoroscopy, radiology charge per patient for the tube placement, and time from first attempt at placement to confirmation of postpyloric location were lower for the electromagnetic-guided group. Use of electromagnetic guidance allows reliable and cost-effective postpyloric enteral feeding tube placement compared with blind insertion.
-
5.
Rhubarb to Facilitate Placement of Nasojejunal Feeding Tubes in Patients in the Intensive Care Unit.
Li, J, Gu, Y, Zhou, R
Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition. 2016;(1):105-10
Abstract
BACKGROUND Prokinetic agents are sometimes needed to aid in the placement of nasojejunal feeding tubes in patients at risk of malnutrition. The objective of the present study was to evaluate the feasibility of rhubarb as a new prokinetic agent to replace metoclopramide and erythromycin in the placement of nasojejunal feeding tubes. MATERIALS AND METHODS Ninety-four patients who required jejunal feeding tube insertion were included. They were divided into rhubarb (n = 34), metoclopramide (n = 31), and erythromycin groups (n = 29), depending on the use of rhubarb, metoclopramide, and erythromycin as the prokinetic agent. The jejunal feeding tube insertions were performed at the bedside. An abdominal x-ray was taken as the gold standard to determine the position of the tube. Cases in which insertion failed in either group were subjected to a second insertion attempt using rhubarb as the prokinetic agent. RESULTS The success rates in the rhubarb, metoclopramide, and erythromycin groups were 91.2%, 87.1%, and 89.7%, respectively. The difference in the success rates was not statistically significant (P = .916). The insertion times in the rhubarb, metoclopramide, and erythromycin groups were 16.0 ± 1.9 minutes, 18.0 ± 1.9 minutes, and 18.8 ± 2.2 minutes, respectively. The insertion time in the rhubarb group was significantly shorter than those in metoclopramide and erythromycin groups (P < .001). No side effects were noted in the rhubarb group. CONCLUSIONS Rhubarb could serve as an effective prokinetic agent to promote the insertion of nasojejunal feeding tubes.
-
6.
How to Promote Bedside Placement of the Postpyloric Feeding Tube: A Network Meta-Analysis of Randomized Controlled Trials.
Tiancha, H, Jiyong, J, Min, Y
JPEN. Journal of parenteral and enteral nutrition. 2015;(5):521-30
Abstract
BACKGROUND The optimal method of achieving fast, safe, and accurate postpyloric tube placement at the bedside remains controversial. This study investigated whether facilitating techniques of bedside placement would improve the rate of successful placement of postpyloric tubes when compared with the standard technique and whether strategies should be confined to adult or pediatric patients. METHODS We searched electronic databases for eligible literatures that compared different methods of postpyloric tube placement, evaluating the successful rate of postpyloric tube placement. Two reviewers reviewed the quality of the studies and performed data extraction independently. Pairwise and network meta-analyses were performed to integrate the efficacy. RESULTS Fourteen clinical trials involving 753 patients were included. Pairwise meta-analyses demonstrated that prokinetic agents (odds ratio [OR], 2.263; 95% confidence interval [CI]: 1.140-4.490; P = .02) were associated with a higher success rate as compared with the standard technique, and gastric air insufflation was associated with a higher success rate as compared with prokinetic agents (OR, 3.462; 95% CI, 1.63-7.346; P = .001) in adult patients. In network analyses, prokinetic agents and gastric air insufflation were also consistently associated with a higher success rate in adult patients. Trend analyses of rank probabilities revealed gastric air insufflation had the cumulative probability of being the most efficacious strategy (78%), especially in adult patients (88%). CONCLUSIONS Gastric air insufflation seems to be clinically better for promoting bedside placement of postpyloric feeding tubes in adults. Clinicians should no longer use prokinetic agents in pediatric patients or patients without impaired motility.
-
7.
Percutaneous endoscopic gastrostomy versus nasogastric tube feeding for patients with head and neck cancer: a systematic review.
Wang, J, Liu, M, Liu, C, Ye, Y, Huang, G
Journal of radiation research. 2014;(3):559-67
Abstract
There are two main enteral feeding strategies-namely nasogastric (NG) tube feeding and percutaneous gastrostomy-used to improve the nutritional status of patients with head and neck cancer (HNC). But up till now there has been no consistent evidence about which method of enteral feeding is the optimal method for this patient group. To compare the effectiveness of percutaneous gastrostomy and NGT feeding in patients with HNC, relevant literature was identified through Medline, Embase, Pubmed, Cochrane, Wiley and manual searches. We included randomized controlled trials (RCTs) and non-experimental studies comparing percutaneous gastrostomy-including percutaneous endoscopic gastrostomy (PEG) and percutaneous fluoroscopic gastrostomy (PFG) -with NG for HNC patients. Data extraction recorded characteristics of intervention, type of study and factors that contributed to the methodological quality of the individual studies. Data were then compared with respect to nutritional status, duration of feeding, complications, radiotherapy delays, disease-free survival and overall survival. Methodological quality of RCTs and non-experimental studies were assessed with separate standard grading scales. It became apparent from our studies that both feeding strategies have advantages and disadvantages.
-
8.
Randomized clinical trial: nasoenteric tube or jejunostomy as a route for nutrition after major upper gastrointestinal operations.
Torres Júnior, LG, de Vasconcellos Santos, FA, Correia, MI
World journal of surgery. 2014;(9):2241-6
Abstract
BACKGROUND Curative treatment of upper gastrointestinal tract neoplasms is complex and associated with high morbidity and mortality. In general, the patients are already malnourished, and early postoperative enteral nutrition is recommended. However, there is no consensus concerning the best enteral access route in these cases. METHODS A prospective randomized trial was performed from 2008 to 2012 with 59 patients who underwent esophagectomy, total gastrectomy, or pancreaticoduodenectomy. In all, 4 patients declined to participate, and 13 did not meet the inclusion criteria and were excluded. Of the 42 included patients, 21 had nasoenteric tubes, and 21 had a jejunostomy. RESULTS The two groups were similar in demographic and clinical aspects. The nasoenteric (NE) and jejunostomy groups underwent early enteral therapy in 71 and 62 % of cases (p > 0.05), respectively. The median length of enteral therapy use was less in the NE group (5.0 vs. 8.5 days), but the difference was not statistically significant. The NE group required introduction of parenteral therapy more frequently than the jejunostomy group (p < 0.05). Complications related to the enteral route occurred in 38.0 and 28.5 % of patients (p > 0.05) in the NE and jejunostomy groups, respectively. In the NE group, there were four losses and four tube obstructions. In the jejunostomy group, there were two losses, four obstructions, and two cases of leakage around the tube. In the latter group, patients who underwent therapy for a longer time had tubal complications (p < 0.05) and longer intensive care unit and hospital stays (p < 0.05). CONCLUSION The two enteral routes were associated with the same number of complications. However, the presence of a jejunostomy allowed enteral therapy for longer periods, especially in patients with complications, thus avoiding the need for parenteral nutrition.
-
9.
Comparison of postpyloric tube feeding and gastric tube feeding in intensive care unit patients: a meta-analysis.
Zhang, Z, Xu, X, Ding, J, Ni, H
Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition. 2013;(3):371-80
Abstract
BACKGROUND AND OBJECTIVE Enteral feeding is vital in the critical care setting; however, the optimal route of enteral feeding (postpyloric vs gastric feeding) remains debated. We aimed to systematically review the current evidence to see whether postpyloric feeding could provide additional benefits to intensive care unit (ICU) patients. METHOD Randomized controlled trials (RCTs) comparing the efficacy and safety of postpyloric feeding vs gastric feeding were included in our systematic review. Odds ratio (OR) was used for binary outcome data and weighted mean difference (WMD) was used for continuous outcome data. Summary effects were pooled using a fixed or random effects model as appropriate. RESULTS Seventeen RCTs were included in our meta-analysis. Postpyloric tube feeding could deliver higher proportions of estimated energy requirement (WMD, 12%; 95% confidence interval [CI], 5%-18%) and reduce the gastric residual volume (GRV) (WMD, -169.1 mL; 95% CI, -291.995 to -46.196 mL). However, the meta-analysis failed to demonstrate any benefits to critically ill patients with postpyloric tube feeding in terms of mortality (OR, 1.05; 95% CI, 0.77-1.44), new-onset pneumonia (OR, 0.77; 95% CI, 0.53-1.13), and aspiration (OR, 1.20; 95% CI, 0.64-2.25). There was no significant publication bias as represented by an Egger's bias coefficient of 0.21 (95% CI, -1.01 to 1.43; P = .7). CONCLUSION As compared with gastric feeding, postpyloric feeding is able to deliver higher proportions of the estimated energy requirement and can help reduce the GRV.
-
10.
Intravenous fluids versus gastric-tube feeding in hospitalized infants with viral bronchiolitis: a randomized, prospective pilot study.
Kugelman, A, Raibin, K, Dabbah, H, Chistyakov, I, Srugo, I, Even, L, Bzezinsky, N, Riskin, A
The Journal of pediatrics. 2013;(3):640-642.e1
Abstract
The American Academy of Pediatrics recommends intravenous fluids for infants with bronchiolitis who are unable to sustain oral feedings. Our randomized, prospective pilot study shows that gastric tube feeding (in 31 infants) is feasible and demonstrated comparable clinical outcomes with intravenous fluids (in 20 infants) among hospitalized infants ≤6 months of age with moderate bronchiolitis.