Endoscopic placement of nasoenteric feeding tubes in critically ill patients: A reliable alternative

Spontaneous transpyloric passage of nasoenteric feeding tubes is often unsu ccessful in critically ill patients due to gastric ileus. The purpose of th is study was to evaluate the success rate of endoscopic placement of postpy loric nasoenteric tubes and the time required to achieve goal enteral nutri tional support in critically ill patients with gastric ileus. Surgical ICU patients with gastric ileus, documented by recorded high gastric residual v olumes via a nasogastric tube, were identified for placement of a nasoenter ic postpyloric tube via esophagogastroduodenoscopy (EGD). EGD was performed bedside in the ICU, using intravenous sedation, for placement of a 43-inch (109 cm) 8 French tungsten-weighted nasoenteric tube with an inner stylet into the duodenum, and the tube was advanced as far distally as possible. A bdominal radiograph was obtained to confirm final tube position postprocedu re. Enteral feedings were initiated immediately with a full-strength formul a and increased to the goal enteral feeding rate as tolerated. Thirty-four patients underwent successful placement of postpyloric nasoenteric tubes by EGD. One procedure was aborted in a patient with adult respiratory distres s syndrome (ARDS) who developed hypoxemia with gastric insufflation during the EGD. The mean time to achievement of goal enteral nutritional support w as 20.8 hours. Tubes remained in place for a range of 6 to 37 days. Endosco pic placement of postpyloric enteral feeding tubes is highly successful, an d allows for prompt achievement of goal enteral nutritional requirements. I t has two main advantages: it eliminates the risk of patient travel to radi ology for fluoroscopic placement, and allows for earlier initiation of ente ral feedings because spontaneous passage of weighted nasoenteric tubes into the duodenum in critically ill patients is often unsuccessful.