Williams Teresa A, Leslie Gavin, Mills Lauren, Leen Tim, Davies Hugh, Hendron David, Dobb Geoffrey J
Prehospital Resuscitation and Emergency Care Research Unit, Faculty of Health Sciences, Curtin University and Research Fellow, ICU Royal Perth Hospital, Bentley, Western Australia Intensive Care Unit, Royal Perth Hospital, Perth, Western Australia
School of Nursing & Midwifery, Curtin Health Innovation Research Institute, Faculty Health Science, Curtin University, Perth, Western Australia.
JPEN J Parenter Enteral Nutr. 2014 Sep;38(7):809-16. doi: 10.1177/0148607113497223. Epub 2013 Aug 23.
Enteral nutrition (EN) tolerance is often monitored by aspirating stomach contents by syringe at prescribed intervals. No studies have been conducted to assess the most appropriate time interval for aspirating gastric tubes. We compared gastric tube aspirations every 4 hours (usual care) with a variable regimen (up to every 8 hours aspirations).
This randomized controlled trial (RCT) enrolled patients who stayed in the intensive care unit (ICU) for >48 hours, had a gastric tube, and were likely to receive EN for 3 or more days. Patients were randomized (computer-generated randomization) to either the control (every 4 hours) or intervention group (variable regimen). The primary outcome was number of gastric tube aspirations per day from randomization until EN was ceased or up to 2 weeks postrandomization.
Following Institutional Ethics Committee approval, 357 patients were recruited (control group, n = 179; intervention group, n = 178). No differences were found in age, sex, worst APACHE II score, or time to start of EN. In the intention-to-treat analysis, the intervention group had fewer tube aspirations per day (3.4 versus 5.4 in the control group, P < .001). Vomiting/regurgitation was increased in the intervention group (2.1% versus 3.6%, P = .02). There were no other differences in complications.
This is the first RCT to examine the frequency of gastric tube aspirations. The frequency of gastric tube aspirations was reduced in the variable-regimen group with no increase in risk to the patient. Reducing the frequency of aspirations saves nursing time, decreases risk of contamination of feeding circuit, and minimizes risk of body fluid exposure.
肠内营养（EN）耐受性通常通过按规定间隔用注射器抽吸胃内容物来监测。尚未进行研究来评估抽吸胃管的最合适时间间隔。我们将每4小时进行一次胃管抽吸（常规护理）与可变方案（最长每8小时抽吸一次）进行了比较。
这项随机对照试验（RCT）纳入了在重症监护病房（ICU）住院超过48小时、有胃管且可能接受EN治疗3天或更长时间的患者。患者通过计算机生成的随机化方法被随机分为对照组（每4小时一次）或干预组（可变方案）。主要结局是从随机分组至EN停止或随机分组后长达2周期间每天的胃管抽吸次数。
经机构伦理委员会批准后，招募了357例患者（对照组，n = 179；干预组，n = 178）。在年龄、性别、最差APACHE II评分或开始EN的时间方面未发现差异。在意向性分析中，干预组每天的胃管抽吸次数较少（对照组为5.4次，干预组为3.4次，P <.001）。干预组的呕吐/反流有所增加（2.1%对3.6%，P = .02）。并发症方面没有其他差异。
这是第一项研究胃管抽吸频率的RCT。可变方案组的胃管抽吸频率降低，且患者风险未增加。减少抽吸频率可节省护理时间，降低喂养回路污染风险，并将体液暴露风险降至最低。
