The use of transpyloric enteral nutrition in the critically ill child

To assess the use and complications of transpyloric enteral nutrition (TEN) in the critically ill child we evaluated prospectively all children who re ceived TEN in a pediatric intensive care unit (PICU) of a tertiary universi ty hospital. The type of nutrition used, its duration, medication administe red, tolerance, gastrointestinal complications (vomiting, abdominal distens ion or excessive gastric residue, diarrhea, and pulmonary aspiration), nong astrointestinal complications, and mortality were assessed. A comparative a nalysis was made between the first 2 years of the study and the remaining p eriod. Over a period of 4.5 years, 152 patients between the ages of 3 days and 17 years received TEN for a duration of 19 +/- 32.3 days (range 1-240 d ays). Forgone patients received TEN during the first 2 years; 100 patients received TEN in the postoperative period after cardiac surgery (66%). One h undred seventeen patients (77%) received sedation and 65 (43%) received mus cle relaxants, presenting no extra complications. Twenty-four patients (15. 8%) presented with gastrointestinal complications: abdominal distension and /or excessive gastric residue in 17 and diarrhea in 11. Gastrointestinal in tolerance was associated with pulmonary infection (p < 0.05), altered hepat ic function (p < 0.001), and hypokalemia or hypocalcemia (p < 0.05). Diarrh ea was more frequent in patients with shock (p < 0.05), altered hepatic fun ction (p < 0.05), excessive gastric residue (p < 0.001), and hypokalemia or hypocalcemia (p < 0.05). In the second study period, the number of patient s on TEN and the doses of sedatives, muscle relaxants, and vasoactives were higher (p < 0.05), with no increase in the incidence of complications. TEN is a useful method of nutrition with few complications in the critically i ll child.