Equal aspiration rates in gastrically and transpylorically fed critically ill patients.

OBJECTIVES

To determine the difference in aspiration rates between gastrically and transpylorically fed patients in the intensive care unit.

DESIGN

A prospective controlled study of critically ill patients randomized to receive either a gastrically placed feeding tube or a transpylorically placed feeding tube.

SETTING

University teaching hospital's medical intensive care unit. The study was conducted over 14 months.

PATIENTS: Fifty-four critically ill subjects (with an overall 40% mortality) with similar baseline age, severity of illness, and nutritional needs requiring enteral nutrition, with 51 completing the study.

INTERVENTIONS: All feeds were tagged with technetium-99m radiolabeled sulfur colloid, and the pulmonary secretions or lungs of each patient were scanned on a daily basis to determine whether aspiration had occurred. Patients were fed according to their assigned tube placement which was verified daily by continuous electromyography.

MEASUREMENTS AND

RESULTS

Of 27 gastrically fed patients 2 (7%) had evidence of scanned feed in pulmonary secretions or the lung, compared to 3 of 24 (13%) transpylorically fed patients (n.s.). Clinical suspicion of aspiration was insensitive and detected only 60% of isotopically documented aspirations with a positive predictive value of 27%.

CONCLUSION

There was no difference in aspiration rates between gastrically and transpylorically fed critically ill patients.