Lee Andrew J, Eve Richard, Bennett Mark J
Department of Anaesthesia, Derriford Hospital, PL6 8DH, Plymouth, UK.
Intensive Care Med. 2006 Apr;32(4):553-6. doi: 10.1007/s00134-006-0095-8. Epub 2006 Feb 25.
To evaluate a blind 'active' technique for the bedside placement of post-pyloric enteral feeding tubes in a critically ill population with proven gastric ileus.
An open study to evaluate the success rate and duration of the technique in cardiothoracic and general intensive care units of a tertiary referral hospital.
20 consecutive, ventilated patients requiring enteral nutrition, where feeding had failed via the gastric route.
Previously described insertion technique-the Corpak 10-10-10 protocol-for post-pyloric enteral feeding tube placement, modified after 20 min if placement had not been achieved, by insufflation of air into the stomach to promote pyloric opening.
A standard protocol and a set method to identify final tube position were used in each case. In 90% (18/20) of cases tubes were placed on the first attempt, with an additional tube being successfully placed on the second attempt. The median time for tube placement was 18 min (range 3-55 min). In 20% (4/20) insufflation of air was required to aid trans-pyloric passage.
The previously described technique, modified by insufflation of air into the stomach in prolonged attempts to achieve trans-pyloric passage, proved to be an effective and cost efficient method to place post-pyloric enteral feeding tubes. This technique, even in the presence of gastric ileus, could be incorporated by all critical care facilities, without the need for any additional equipment or costs. This approach avoids the costs of additional equipment, time-delays and necessity to transfer the patient from the ICU for the more traditional techniques of endoscopy and radiographic screening.
评估一种盲法“主动”技术，用于在已证实存在胃麻痹的危重症患者床边放置幽门后肠内喂养管。
一项开放性研究，旨在评估该技术在一家三级转诊医院的心胸外科和综合重症监护病房中的成功率及操作时长。
20例连续的需要肠内营养且经胃途径喂养失败的通气患者。
采用先前描述的用于幽门后肠内喂养管放置的插入技术——Corpak 10 - 10 - 10方案，若20分钟内未完成放置，则通过向胃内注入空气以促进幽门开放，对该方案进行调整。
每种情况均使用标准方案及一套确定导管最终位置的方法。90%（18/20）的病例在首次尝试时成功放置导管，另有1例在第二次尝试时成功放置。导管放置的中位时间为18分钟（范围3 - 55分钟）。20%（4/20）的病例需要注入空气以辅助通过幽门。
先前描述的技术，经长时间尝试通过向胃内注入空气以辅助通过幽门进行调整后，被证明是一种放置幽门后肠内喂养管的有效且经济高效的方法。即使在存在胃麻痹的情况下，所有重症监护机构均可采用该技术，无需任何额外设备或费用。这种方法避免了额外设备的成本、时间延迟以及将患者从重症监护病房转出以采用更传统的内镜检查和影像学筛查技术的必要性。
