Evaluation of a Nasoenteral Feeding Tube With Balloon to Facilitate Placement.

BACKGROUND: Enteral feeding is essential for critically ill, head trauma, and burn patients who are unable to swallow. OBJECTIVE: To evaluate a new nasoenteral feeding tube with distal tip balloon designed to facilitate post-pyloric migration and avoid misplacement in the trachea. METHODS: A case series was conducted in 50 critically ill patients aged 19 to 89 years receiving mechanical ventilation and requiring enteral nutrition in a teaching hospital. Patients received a soft, flexible, kink-resistant nasoenteral feeding tube with a balloon near the distal tip to enhance postpyloric migration by peristalsis. The feeding tube was inserted with a novel thread technique to reduce posterior nasopharyngeal trauma and tube misplacement. Pulse oximetry provided early detection of misplacement into the trachea. Placement was verified by abdominal radiography performed shortly after the procedure and repeated within 24 hours if needed. RESULTS: Postpyloric placement was achieved at 30 minutes in 24% of patients and by the following morning in 70% of patients. Tracheal intubation occurred in 1 patient but was recognized and corrected without injury. No tube occlusion from kinking occurred. CONCLUSIONS: Early gastric or postpyloric feeding can be provided with this novel feeding tube. Its use facilitates quick bedside recognition of accidental misplacement in the trachea, reducing the chance of pneumothorax. The tip balloon reduces deeper placement into a lung and promotes distal migration into the small intestine. The design prevents occlusion from kinking, which is common with conventional feeding tubes. Nurses easily adopted the tube and insertion technique.

The impact of continuous lateral rotation therapy in overall clinical and financial outcomes of critically ill patients.

BACKGROUND: Significant pulmonary complications are prevalent in intubated and mechanically ventilated patients. OBJECTIVES: This study was conducted to determine the impact of continuous lateral rotation therapy (CLRT) on patients considered to be at high risk for pulmonary complications. Overall study objectives included hospital length of stay, critical care length of stay, ventilator days, and cost to treat. METHODS: Patients at risk for pulmonary complications as defined by Pao2/Fio2 ratio < 300, Fio2 > 50% for more than 1 hour, positive end-expiratory pressure > or = 8, or a Predicus score of > or = 5 were compared with a historical comparison group that met the high-risk criteria given above and did not receive CLRT. Patients who received CLRT were separated into 2 groups, early CLRT group (began therapy within 48 hours, n = 49) or late CLRT group (n = 46). RESULTS: The early CLRT group had a reduction in critical care LOS, (P = .04) as compared with the non-CLRT group. Total hospital costs were reduced (P = .01) in the early intervention group compared to the late intervention group, as well as ICU LOS (P = .02). Nonsignificant trends were seen in reduced ventilator days and hospital LOS. Reintubation rates and readmissions to critical care were also lower in the early intervention group. CONCLUSIONS: Continuous lateral rotation therapy, when introduced early in course of treatment of high-risk patients, reduces critical care LOS and cost to treat.