October Tessie W, Hardart George E
New York State University School of Medicine, New York, NY, USA.
Pediatr Crit Care Med. 2009 Mar;10(2):196-200. doi: 10.1097/PCC.0b013e31819a3668.
Initiation of postpyloric feeding is often delayed by difficulties in placement of enteral tubes. We evaluated the effectiveness of bedside postpyloric enteral tube (PET) placement using an electromagnetic (EM)-guided device. We hypothesized that: 1) EM-guided placement of PETs would be successful more often than standard blind placement with a shorter total time to successful placement and 2) the EM-guided technique would have similar overall costs to the standard technique.
Prospective cohort trial with serial control groups in a pediatric intensive care unit at a tertiary care children's hospital.
We collected data on a cohort of consecutive pediatric intensive care unit patients who underwent PET placement by standard blind technique followed by a cohort who underwent EM-guided placement. The primary outcome measure was successful placement determined by abdominal radiography.
One hundred seven patients were evaluated in the trial: 57 in the standard group and 50 in the EM-guided group. Demographic data, percent intubated, and admission diagnosis were similar in both groups. Forty-one of 50 patients (82%) in the EM-guided group had successful placement compared with 22 of 57 in the standard group (38%) (p < 0.0001). The average time to successful placement was 1.7 vs. 21 hours in the EM-guided group and standard group, respectively (p < 0.0001). Children in the EM-guided group received fewer radiographs (p = 0.007) and were given more prokinetic drugs (p = 0.045). There were no episodes of pneumothorax in either group. After controlling for prokinetic drug use, EM-guided placement was more likely to result in successful placement than the standard blind technique (odds ratio 6.4, 95% confidence interval 2.5-16.3). An annual placement rate of 250 PETs by EM guidance, based on our institution's current utilization rates, is associated with a cost savings of $55.46 per PET placed.
EM guidance is an efficient and cost-effective method of bedside PET placement.
由于肠内管放置困难，幽门后喂养的起始常常延迟。我们评估了使用电磁（EM）引导装置进行床边幽门后肠内管（PET）放置的有效性。我们假设：1）与标准盲插法相比，EM引导下的PET放置成功率更高，成功放置的总时间更短；2）EM引导技术与标准技术的总体成本相似。
在一家三级儿童专科医院的儿科重症监护病房进行的前瞻性队列试验，设有连续对照组。
我们收集了一组连续接受标准盲插法进行PET放置的儿科重症监护病房患者的数据，随后收集了一组接受EM引导放置的患者的数据。主要结局指标是通过腹部X线片确定的成功放置情况。
试验共评估了107例患者：标准组57例，EM引导组50例。两组的人口统计学数据、插管百分比和入院诊断相似。EM引导组50例患者中有41例（82%）成功放置，而标准组57例中有22例（38%）成功放置（p<0.0001）。EM引导组和标准组成功放置的平均时间分别为1.7小时和21小时（p<0.0001）。EM引导组的儿童接受的X线检查较少（p=0.007），使用的促动力药物较多（p=0.045）。两组均未发生气胸。在控制促动力药物使用后，EM引导放置比标准盲插法更有可能成功放置（优势比6.4，95%置信区间2.5-16.3）。根据我们机构目前的使用率，每年通过EM引导放置250根PET，每根PET放置可节省成本55.46美元。
EM引导是一种高效且具有成本效益的床边PET放置方法。
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