Effect of rotational therapy on aspiration risk of enteral feeds

Valerie G. Sams, Christy Lawson, Ceba L. Humphrey, Susan L. Brantley, Leah M. Schumacher, Michael Karlstad, Jamison E. Norwood, Julie A. Jungwirth, Caroline P. Conley, Stanley Kurek, Patrick B. Barlow, Brian Daley

Research output: Contribution to journalReview article

2 Citations (Scopus)

Abstract

Background: Enteral nutrition has been demonstrated to reduce ventilator days and the incidence of pneumonia, but the safest route for providing enteral nutrition to mechanically ventilated patients is unclear. Our objective was to determine if there is a difference between the incidences of microaspiration of gastric secretions in patients fed via a nasogastric tube vs a postpyloric tube while undergoing rotational therapy for acute respiratory distress syndrome (ARDS). Materials and Methods: Institutional review board approval was obtained for this prospective, randomized study. Patients were randomized to gastric or postpyloric enteral feedings. Daily tracheal secretion samples were collected, and we used an immunoassay to detect pepsin. Using the data for aspiration and tube type, a univariate unadjusted odds ratio was calculated to assess the risk of aspiration between the 2 tube types. An independent samples t test was used to analyze the hypothesis that microaspiration significantly affects lung recovery from ARDS. Results: Of the 20 study patients, 9 (45%) received nasogastric feeds and 11 (55%) received postpyloric feeds. Western blot analysis for the presence of pepsin in each tracheal aspirate revealed microaspiration in 2 nasogastric (22%) and 2 (18%) postpyloric patients. The nasogastric tube provided a protective effect for aspirating with an odds ratio of.778 (95% confidence interval,.09-6.98). An independent samples t test was used and showed no significant change in PaO2:FiO2 ratio in the aspirating vs nonaspirating group (P =.552). Conclusion: The results of this study indicate that enteral nutrition should not be delayed or stopped to position the tube in patients with ARDS on rotational therapy.

Original languageEnglish (US)
Pages (from-to)808-811
Number of pages4
JournalNutrition in Clinical Practice
Volume27
Issue number6
DOIs
StatePublished - Dec 1 2012

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Small Intestine
Enteral Nutrition
Adult Respiratory Distress Syndrome
Pepsin A
Stomach
Therapeutics
Odds Ratio
Research Ethics Committees
Incidence
Mechanical Ventilators
Immunoassay
Pneumonia
Western Blotting
Prospective Studies
Confidence Intervals
Lung

All Science Journal Classification (ASJC) codes

  • Medicine (miscellaneous)
  • Nutrition and Dietetics

Cite this

Effect of rotational therapy on aspiration risk of enteral feeds. / Sams, Valerie G.; Lawson, Christy; Humphrey, Ceba L.; Brantley, Susan L.; Schumacher, Leah M.; Karlstad, Michael; Norwood, Jamison E.; Jungwirth, Julie A.; Conley, Caroline P.; Kurek, Stanley; Barlow, Patrick B.; Daley, Brian.

In: Nutrition in Clinical Practice, Vol. 27, No. 6, 01.12.2012, p. 808-811.

Research output: Contribution to journalReview article

Sams, VG, Lawson, C, Humphrey, CL, Brantley, SL, Schumacher, LM, Karlstad, M, Norwood, JE, Jungwirth, JA, Conley, CP, Kurek, S, Barlow, PB & Daley, B 2012, 'Effect of rotational therapy on aspiration risk of enteral feeds', Nutrition in Clinical Practice, vol. 27, no. 6, pp. 808-811. https://doi.org/10.1177/0884533612462897
Sams, Valerie G. ; Lawson, Christy ; Humphrey, Ceba L. ; Brantley, Susan L. ; Schumacher, Leah M. ; Karlstad, Michael ; Norwood, Jamison E. ; Jungwirth, Julie A. ; Conley, Caroline P. ; Kurek, Stanley ; Barlow, Patrick B. ; Daley, Brian. / Effect of rotational therapy on aspiration risk of enteral feeds. In: Nutrition in Clinical Practice. 2012 ; Vol. 27, No. 6. pp. 808-811.
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abstract = "Background: Enteral nutrition has been demonstrated to reduce ventilator days and the incidence of pneumonia, but the safest route for providing enteral nutrition to mechanically ventilated patients is unclear. Our objective was to determine if there is a difference between the incidences of microaspiration of gastric secretions in patients fed via a nasogastric tube vs a postpyloric tube while undergoing rotational therapy for acute respiratory distress syndrome (ARDS). Materials and Methods: Institutional review board approval was obtained for this prospective, randomized study. Patients were randomized to gastric or postpyloric enteral feedings. Daily tracheal secretion samples were collected, and we used an immunoassay to detect pepsin. Using the data for aspiration and tube type, a univariate unadjusted odds ratio was calculated to assess the risk of aspiration between the 2 tube types. An independent samples t test was used to analyze the hypothesis that microaspiration significantly affects lung recovery from ARDS. Results: Of the 20 study patients, 9 (45{\%}) received nasogastric feeds and 11 (55{\%}) received postpyloric feeds. Western blot analysis for the presence of pepsin in each tracheal aspirate revealed microaspiration in 2 nasogastric (22{\%}) and 2 (18{\%}) postpyloric patients. The nasogastric tube provided a protective effect for aspirating with an odds ratio of.778 (95{\%} confidence interval,.09-6.98). An independent samples t test was used and showed no significant change in PaO2:FiO2 ratio in the aspirating vs nonaspirating group (P =.552). Conclusion: The results of this study indicate that enteral nutrition should not be delayed or stopped to position the tube in patients with ARDS on rotational therapy.",
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T1 - Effect of rotational therapy on aspiration risk of enteral feeds

AU - Sams, Valerie G.

AU - Lawson, Christy

AU - Humphrey, Ceba L.

AU - Brantley, Susan L.

AU - Schumacher, Leah M.

AU - Karlstad, Michael

AU - Norwood, Jamison E.

AU - Jungwirth, Julie A.

AU - Conley, Caroline P.

AU - Kurek, Stanley

AU - Barlow, Patrick B.

AU - Daley, Brian

PY - 2012/12/1

Y1 - 2012/12/1

N2 - Background: Enteral nutrition has been demonstrated to reduce ventilator days and the incidence of pneumonia, but the safest route for providing enteral nutrition to mechanically ventilated patients is unclear. Our objective was to determine if there is a difference between the incidences of microaspiration of gastric secretions in patients fed via a nasogastric tube vs a postpyloric tube while undergoing rotational therapy for acute respiratory distress syndrome (ARDS). Materials and Methods: Institutional review board approval was obtained for this prospective, randomized study. Patients were randomized to gastric or postpyloric enteral feedings. Daily tracheal secretion samples were collected, and we used an immunoassay to detect pepsin. Using the data for aspiration and tube type, a univariate unadjusted odds ratio was calculated to assess the risk of aspiration between the 2 tube types. An independent samples t test was used to analyze the hypothesis that microaspiration significantly affects lung recovery from ARDS. Results: Of the 20 study patients, 9 (45%) received nasogastric feeds and 11 (55%) received postpyloric feeds. Western blot analysis for the presence of pepsin in each tracheal aspirate revealed microaspiration in 2 nasogastric (22%) and 2 (18%) postpyloric patients. The nasogastric tube provided a protective effect for aspirating with an odds ratio of.778 (95% confidence interval,.09-6.98). An independent samples t test was used and showed no significant change in PaO2:FiO2 ratio in the aspirating vs nonaspirating group (P =.552). Conclusion: The results of this study indicate that enteral nutrition should not be delayed or stopped to position the tube in patients with ARDS on rotational therapy.

AB - Background: Enteral nutrition has been demonstrated to reduce ventilator days and the incidence of pneumonia, but the safest route for providing enteral nutrition to mechanically ventilated patients is unclear. Our objective was to determine if there is a difference between the incidences of microaspiration of gastric secretions in patients fed via a nasogastric tube vs a postpyloric tube while undergoing rotational therapy for acute respiratory distress syndrome (ARDS). Materials and Methods: Institutional review board approval was obtained for this prospective, randomized study. Patients were randomized to gastric or postpyloric enteral feedings. Daily tracheal secretion samples were collected, and we used an immunoassay to detect pepsin. Using the data for aspiration and tube type, a univariate unadjusted odds ratio was calculated to assess the risk of aspiration between the 2 tube types. An independent samples t test was used to analyze the hypothesis that microaspiration significantly affects lung recovery from ARDS. Results: Of the 20 study patients, 9 (45%) received nasogastric feeds and 11 (55%) received postpyloric feeds. Western blot analysis for the presence of pepsin in each tracheal aspirate revealed microaspiration in 2 nasogastric (22%) and 2 (18%) postpyloric patients. The nasogastric tube provided a protective effect for aspirating with an odds ratio of.778 (95% confidence interval,.09-6.98). An independent samples t test was used and showed no significant change in PaO2:FiO2 ratio in the aspirating vs nonaspirating group (P =.552). Conclusion: The results of this study indicate that enteral nutrition should not be delayed or stopped to position the tube in patients with ARDS on rotational therapy.

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DO - 10.1177/0884533612462897

M3 - Review article

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JF - Nutrition in Clinical Practice

SN - 0884-5336

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