WESTPORT, CT (Reuters Health) – Gastroesophageal regurgitation in critically ill patients is significantly reduced by tube feeding beyond the pylorus; this results in less pulmonary microaspiration, Canadian researchers report.
As described in the August issue of Critical Care Medicine, Dr. Daren K. Heyland and colleagues from Queen's University in Kingston, Ontario, randomly assigned 33 critically ill patients to gastric or postpyloric feeding. The patients received radioisotope-labeled enteral feeds, and levels of radioactivity in the oropharynx and trachea were measured hourly during feeds.
Among these patients, 29 had at least one episode of gastroesophageal regurgitation–17 in the gastric group and all of the12 patients in the postpyloric group, the researchers report. However, patients in the gastric group had more episodes of gastroesophageal regurgitation compared with patients in the postpyloric group (39.8% versus 24.9% respectively, p = 0.04).
Episodes of gastroesophageal regurgitation became significantly less the more distally the tube was placed in the small bowel, Dr. Heyland's group found.
In addition, 15 patients had at least one episode of aspiration–11 in the gastric group and four among patients in the postpyloric group. Although patients in the postpyloric group had fewer episodes of aspiration compared with patients in the gastric group it was not a statistically significant difference, the investigators note.
Aspiration was much more likely in patients who regurgitated (odds ratio 3.2), Dr. Heyland and colleagues add.
"Given the extent to which gastric colonization, duodenogastric reflux, gastroesophageal regurgitation and pulmonary microaspiration are linked with subsequent pulmonary infection in critically ill patients, we conclude that it is plausible, that by feeding in the distal small bowel, we may be able to prevent subsequent pulmonary infections in this high-risk population," the researchers conclude.