A team from Ontario, Canada, determined the extent to which postpyloric feeding reduces gastroesophageal regurgitation and pulmonary microaspiration in critically ill patients.
A total of 33 intensive care unit patients (42% female, mean age 59 years), who were expected to remain ventilated for more than 72 hours, were included in the randomized trial. Those with esophageal, gastric, or small bowel surgery in the last week and patients with overt or clinically significant gastrointestinal bleeding were excluded.
The subjects mean Acute Physiology and Chronic Health Evaluation II score was 22.5.
Patients were randomized to either gastric or postpyloric enteral feeds. Technetium 99-sulphur colloid was added to the feeds for 6 hours of each of the first 3 days of the study.
The oropharynx and trachea were sampled hourly for the 6 hours per day that patients received radioisotope-labeled enteral feeds. The level of radioactivity in these specimens was then measured.
|Regurgitation and microaspiration episodes:|
Stomach feeding: 40% and 8%
Postpyloric feeding: 25% and 4%
|Critical Care Medicine|
The researchers defined an episode of gastroesophageal regurgitation and microaspiration as an increase in radioactivity of more than 100 counts per minute/g.
Patients fed into the stomach were found to have more episodes of gastroesophageal regurgitation (40% vs. 25%) compared with patients fed beyond the pylorus. They also trended toward more microaspiration (8% vs. 4%).
The logarithmic mean of the radioactivity count was also compared across groups. There was found to be a trend toward an increase in gastroesophageal regurgitation (3.7 vs. 2.9 counts/g) and a trend toward increased microaspiration (1.9 vs. 1.4 counts/g) in patients fed into the stomach.
Patients who had gastroesophageal regurgitation were much more likely to aspirate than patients who did not have gastroesophageal regurgitation (odds ratio: 3.2).
Dr Daren K. Heyland, of the Queen's University, Kingston, Ontario, concluded on behalf of fellow authors, "Feeding beyond the pylorus is associated with a significant reduction in gastroesophageal regurgitation and a trend toward less microaspiration."