Shah Jamil, Shahidullah Abul, Richards Stanlee
Division of Gastroenterology and Hepatology, Department of Medicine, Rutgers New Jersey Medical School, University Hospital, 185 South Orange Avenue, Medical Science Building, Room H-538, Newark, NJ 07103, USA.
Department of Medicine, Henry J. Carter Specialty Hospital and Nursing Facility, 1752 Park Avenue, New York, NY 10035, USA.
Gastroenterology Res. 2018 Oct;11(5):369-373. doi: 10.14740/gr1084w. Epub 2018 Oct 1.
Since their introduction in 1980, gastrostomy tubes have become effective means of providing both short-term and long-term enteral access and nutritional support. These feeding tubes are ubiquitous in many health care facilities that care for the elderly, but carry high rates of unintended dislodgement - a complication that, if not detected promptly, is associated with substantial morbidity and health care costs. This study determined the dislodgment rate of gastrostomy tubes at 90 days in a cohort of 221 patients and tested the hypothesis that the implementation of a concise protocol to care for patients' gastrostomy tubes would reduce these unintended dislodgements.
The dislodgment rate of gastrostomy tubes at 90 days in a cohort of 221 patients was determined. In addition, a randomized controlled trial was conducted in a long-term acute care hospital in which patients were alternately allocated to either of two geographically separate units: 1) a selected unit where a concise protocol to care for patients' gastrostomy tubes was implemented, and 2) a separate unit where standard care was provided. Enrollment included patients diagnosed with dysphagia - who were receiving mechanical ventilatory support for chronic respiratory failure - who were being administered feedings, fluids and medications via a balloon gastrostomy tube. The primary endpoint was the number of unintended dislodgements of gastrostomy tubes during a 90-day study period.
In a cohort of 221 patients with balloon gastrostomy tubes placed that was observed for a period of 90 days, 64 (29.0%) had unintended gastrostomy tube dislodgement (P < 0.028). A total of 34 patients were enrolled in the randomized controlled trial with 17 in the treatment group and 17 in the control group. All subjects were followed for a maximum of 90 days. During the study period, there was one episode of unintended gastrostomy tube dislodgement (5.9%) in the treatment group, compared with six episodes (35.3%) in the control group (P < 0.047) and the previous cohort of 221 patients (P < 0.028).
This study showed a significant reduction in dislodgements after implementation of a protocol that is an innovative, straightforward and economical solution to the problem of the unintended dislodgement of gastrostomy tubes.
自1980年引入以来，胃造口管已成为提供短期和长期肠内通路及营养支持的有效手段。这些饲管在许多照顾老年人的医疗机构中很常见，但意外拔管率很高——如果不能及时发现这种并发症，会导致相当高的发病率和医疗费用。本研究确定了221例患者队列中胃造口管90天的拔管率，并检验了以下假设：实施一项简明的胃造口管护理方案将减少这些意外拔管情况。
确定了221例患者队列中胃造口管90天的拔管率。此外，在一家长期急性护理医院进行了一项随机对照试验，患者被交替分配到两个地理位置分开的科室：1）实施简明胃造口管护理方案的选定科室；2）提供标准护理的单独科室。纳入的患者包括被诊断为吞咽困难、因慢性呼吸衰竭接受机械通气支持、通过球囊胃造口管接受喂食、补液和药物治疗的患者。主要终点是90天研究期内胃造口管意外拔管的次数。
在观察90天的221例放置球囊胃造口管的患者队列中，64例（29.0%）发生了胃造口管意外拔管（P<0.028）。共有34例患者纳入随机对照试验，治疗组17例，对照组17例。所有受试者最多随访90天。在研究期间，治疗组发生1次胃造口管意外拔管事件（5.9%），而对照组为6次（35.3%）（P<0.047），与之前221例患者队列相比（P<0.028）。
本研究表明，实施一项方案后拔管情况显著减少，该方案是解决胃造口管意外拔管问题的一种创新、直接且经济的方法。
