TRANSPYLORIC PASSAGE OF FEEDING TUBES IN PATIENTS WITH HEAD-INJURIES DOES NOT DECREASE COMPLICATIONS

Early enteral nutrition is reported to improve outcome of patients wit h severe closed head injuries (CHI). The efficacy and safety of nasoen teric tube (NET) feeds, however, has been questioned; the risk of aspi ration is the major concern. Our purpose was to determine the rate of transpyloric migration, the efficacy of adjunctive measures to promote passage, and the effect on pulmonary complications. Seventy-four cons ecutive patients with moderate to severe CHI received enteral nutritio n. Glasgow Coma Scale (GSC) score was 5.2 on admission and 6.9 at 48 h ours, NETs were placed an average of 5.6 days after admission; an aver age of three abdominal films per patient mere used to assess tube posi tion, No patients had endoscopic NET placement during this period. Ten patients required fluoroscopic placement after failure to pass sponta neously by 5 days, Overall, transpyloric passage was achieved in 32 pa tients (43%), whereas 42 (57%) remained intragastric, There were no di fferences between the postpyloric and intragastric groups in days to f ull feeding (5 vs. 7 days), ventilator days (11.9 vs, 12.5), intensive care unit length of stay (15.5 vs, 15.1), or incidence of pneumonia ( 81 vs, 69%) or aspiration (6 vs 7%), Sixty-two patients (83%) were tra nsferred to extended care facilities and 50 (68%) were still receiving NET feedings, Spontaneous transpyloric passage of NET occurred in les s than one-half of patients with severe CHI. The routine use of adjunc tive measures to promote transpyloric passage was not particularly suc cessful, had no obvious benefit, and therefore may not he necessary.