Department of Anaesthesiology and Intensive Care Medicine, University Medical Centre Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße, 24105 Kiel, Germany.
Crit Care. 2011;15(1):R8. doi: 10.1186/cc9407. Epub 2011 Jan 7.
To accomplish early enteral feeding in the critically ill patient a new transnasal endoscopic approach to the placement of postpyloric feeding tubes by intensive care physicians was evaluated.
This was a prospective cohort study in 27 critically ill patients subjected to transnasal endoscopy and intubation of the pylorus. Attending intensive care physicians were trained in the handling of the new endoscope for transnasal gastroenteroscopy for two days. A jejunal feeding tube was advanced via the instrument channel and the correct position assessed by contrast radiography. The primary outcome measure was successful postpyloric placement of the tube. Secondary outcome measures were time needed for the placement, complications such as bleeding and formation of loops, and the score of the placement difficulty graded from 1 (easy) to 4 (difficult). Data are given as mean values and standard deviation.
Out of 34 attempted jejunal tube placements, 28 tubes (82%) were placed correctly in the jejunum. The duration of the procedure was 28 ± 12 minutes. The difficulty of the tube placement was judged as follows: grade 1: 17 patients, grade 2: 8 patients, grade 3: 7 patients, grade 4: 2 patients. In three cases, the tube position was incorrect, and in another three cases, the procedure had to be aborted. In one patient bleeding occurred that required no further treatment.
Fast and reliable transnasal insertion of postpyloric feeding tubes can be accomplished by trained intensive care physicians at the bedside using the presented procedure. This new technique may facilitate early initiation of enteral feeding in intensive care patients.
为了在危重症患者中实现早期肠内喂养，我们评估了一种由重症监护医师实施的新的经鼻内镜幽门后喂养管置管方法。
这是一项前瞻性队列研究，共纳入 27 例接受经鼻内镜和幽门插管的危重症患者。参与研究的重症监护医师接受了为期两天的新内镜经鼻胃镜检查和经鼻胃管插入术的操作培训。经器械通道推进空肠喂养管，并通过对比放射检查评估其正确位置。主要观察指标为管成功置幽门后。次要观察指标为置管所需时间、出血和形成环等并发症以及根据 1（容易）至 4（困难）分级的置管难度评分。数据以平均值和标准差表示。
在 34 例尝试的空肠管置管中，28 例（82%）管正确置入空肠。手术时间为 28±12 分钟。管置难度评定如下：1 级：17 例；2 级：8 例；3 级：7 例；4 级：2 例。有 3 例管位置不正确，3 例手术不得不中止。1 例患者出现出血，但无需进一步治疗。
经过培训的重症监护医师可在床边使用本研究介绍的程序快速、可靠地经鼻插入幽门后喂养管。这种新技术可能有助于重症患者早期开始肠内喂养。
