scholarly journals Intravenous Metoclopramide to Improve the Success Rate of Blind Bedside Post-pyloric Placement of Feeding Tube in Critically Ill Children: A Randomized, Double-Blind, Placebo-Controlled Study

2021 ◽  
Vol 9 ◽  
Author(s):  
Sirima Ketsuwan ◽  
Pornthep Tanpowpong ◽  
Nichanan Ruangwattanapaisarn ◽  
Supatra Phaopant ◽  
Nattanicha Suppalarkbunlue ◽  
...  
Keyword(s):  
Intensive Care ◽  
Success Rate ◽  
Critically Ill ◽  
Pediatric Intensive Care ◽  
Feeding Tube ◽  
Tube Placement ◽  
Critically Ill Children ◽  
Tube Insertion ◽  
Double Blind ◽  
Feeding Tube Placement

Objective: Impaired gastric emptying is a common cause of delayed feeding in critically ill children. Post-pyloric feeding may help improve feeding intolerance and nutritional status and, hence, contribute to a better outcome. However, post-pyloric feeding tube insertion is usually delayed due to a technical difficulty. Therefore, prokinetic agents have been used to facilitate blind bedside post-pyloric feeding tube insertion. Metoclopramide is a potent prokinetic agent that has also been used to improve motility in adults and children admitted to intensive care units. The objective of this study was to determine the efficacy of intravenous metoclopramide in promoting the success rate of blind bedside post-pyloric feeding tube placement in critically ill children.Design: The design of this study is randomized, double blind, placebo controlled.Setting: The setting of the study is a single-center pediatric intensive care unit.Patients: Children aged 1 month−18 years admitted to the pediatric intensive care unit with severe illness or feeding intolerance were enrolled in this study.Intervention: Patients were randomly selected to receive intravenous metoclopramide or 0.9% normal saline solution (the placebo) prior to the tube insertion. The study outcome was the success rate of post-pyloric feeding tube placement confirmed by an abdominal radiography 6–8 h after the insertion.Measurements and Main Results: We found that patients receiving metoclopramide had a higher success rate (37/42, 88%) of post-pyloric feeding tube placement than the placebo (28/40, 70%) (p = 0.04). Patients who received sedative drug or narcotic agent showed a tendency of higher success rate (p = 0.08).Conclusion: Intravenous metoclopramide improves the success rate of blind bedside post-pyloric placement of feeding tube in critically ill children.Trial Registration: Thai Clinical Trial Registry TCTR20190821002. Registered 15th August 2019.

scholarly journals Erythromycin for Promoting the Postpyloric Placement of Feeding Tubes: A Systematic Review and Meta-Analysis

2018 ◽  
Vol 2018 ◽  
pp. 1-8
Author(s):  
Qing-Jun Jiang ◽  
Cai-Feng Jiang ◽  
Qi-Tong Chen ◽  
Jian Shi ◽  
Bin Shi
Keyword(s):  
Systematic Review ◽  
Adverse Effects ◽  
Success Rate ◽  
Meta Analysis ◽  
Feeding Tube ◽  
Tube Placement ◽  
Intravenous Route ◽  
Tube Insertion ◽  
Feeding Tubes ◽  
Feeding Tube Placement

Background. Critically ill patients can benefit from enteral nutrition with postpyloric feeding tubes, but the low success rate limits its wide use. Erythromycin could elevate the success rate of tube insertion, but its clinical efficiency still remains controversial. Methods. Included studies must be RCTs which assessed the success rate of postpyloric feeding tube insertion using erythromycin. Results. 284 patients were enrolled in six studies. Meta-analysis showed that erythromycin significantly increases the rate of successful postpyloric feeding tube placement (RR 1.45, 95% CI (1.12, 1.86)) and did not increase the risk of adverse effects (RR 2.15, 95% CI (0.20, 22.82)). Subgroup analysis showed that unweighted feeding tubes (RR 1.47, 95% CI (1.03, 2.11)) could significantly increase the success rate. Country of study, intravenous route of erythromycin, and year of participant enrollment did not influence these results. Conclusions. Erythromycin significantly increases the success rate of postpyloric feeding tube placement. This suggests that erythromycin can be used as an auxiliary method to improve the success rate of bedside insertion.

TRANSPYLORIC FEEDING TUBE PLACEMENT IN CRITICALLY ILL CHILDREN.

2005 ◽  
Vol 33 ◽  
pp. A21
Author(s):  
Mary Porter ◽  
Lisa Knapp ◽  
Dinah Cooper ◽  
Natalie Dunn ◽  
Mary-Ann Groeschen ◽  
...  
Keyword(s):  
Critically Ill ◽  
Feeding Tube ◽  
Tube Placement ◽  
Critically Ill Children ◽  
Feeding Tube Placement

scholarly journals Use of body composition and phase angle analysis for the assessment of nutritional status and clinical outcomes in critically ill children

2021 ◽  
Author(s):  
Zi-Hong Xiong ◽  
Xue-Mei Zheng ◽  
Guo-Ying Zhang ◽  
Meng-Jun Wu ◽  
Yi Qu
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Nutritional Status ◽  
Clinical Outcomes ◽  
Critically Ill ◽  
Pediatric Intensive Care Unit ◽  
Phase Angle ◽  
Pediatric Intensive Care ◽  
Critically Ill Children ◽  
Duration Time

Abstract BackgroundMalnutrition is highly prevalent in critically ill children in the pediatric intensive care unit .We aimed to investigate the efficiency of bioelectrical impedance analysis (BIA) measurements and phase angle (PhA) analysis for the assessment of nutritional risk and clinical outcomes in critically ill children.MethodsThis single-center observational study included patients admitted to the Pediatric Intensive Care Unit (PICU) of Chengdu Women’s and Children’s Central Hospital. All patients underwent anthropometric measurement in the first 24 h of admission and underwent BIA measurements within 3 days after the admission. The patients were classified into different groups based on body mass index (BMI) for age. Electronic hospital medical records were reviewed to collect clinical data for each patient. All the obtained data were analyzed by the statistics method.ResultsThere were 204 patients enrolled in our study, of which 32.4% were diagnosed with malnutrition. We found that BMI, arm muscle circumference, fat mass, and %body fat were lower in the group with poorer nutritional status (P < 0.05). Evident differences in the score of the Pediatric Risk of Mortality and the duration of mechanical ventilation (MV) among the three groups with different nutritional statuses were observed (P < 0.05). Patients in the severely malnourished group had the longest duration of MV. In the MV groups, there were significant differences (P < 0.05) in albumin level, PhA, and extracellular water/total body water (ECW/TBW ratio). The ECW/TBW ratio and the time for PICU stay had a weak degree of correlation (Pearson correlation coefficient = 0.375). PhA showed a weak degree of correlation with the duration time of medical ventilation (coefficient of correlation = 0.398).ConclusionBIA can be considered an alternative way to assess nutritional status in critically ill children. ECW/TBW ratio and PhA were correlated with PICU stay and duration time of medical ventilation, respectively.

Rapid Placement of Transpyloric Feeding Tubes: A Comparison of pH-assisted and Standard Insertion Techniques in Children

PEDIATRICS ◽  
1996 ◽  
Vol 98 (2) ◽  
pp. 242-248
Author(s):  
Brian Krafte-Jacobs ◽  
Melody Persinger ◽  
Jeannean Carver ◽  
Lori Moore ◽  
Richard Brilli
Keyword(s):  
Hospital Costs ◽  
Caloric Intake ◽  
Feeding Tube ◽  
Cost Comparison ◽  
Tube Placement ◽  
Critically Ill Children ◽  
Standard Group ◽  
Feeding Tubes ◽  
Feeding Tube Placement ◽  
Placement Technique

Objective. To compare transpyloric feeding tube placement using a pH-assisted placement technique versus a standard placement technique in pediatric patients requiring enteral nutrition. Methods. Critically ill children younger than 4 years were prospectively and randomly assigned to either a pH-assisted or a standard feeding tube placement group. Identical pH-assisted feeding tubes were used in both groups; however, feeding tubes in the standard group were not attached to a portable pH meter. Successful transpyloric placement was confirmed by radiography before beginning feedings. If placement was not successful, a second placement attempt was made after metoclopramide administration. Information regarding tube placement success, number of radiographs, time to initiaction of feedings, and daily caloric intake was collected. A cost comparison between the two groups was performed. Results. Thirty-four patients were enrolled in the pH-assisted group, and 34 were enrolled in the standard feeding tube group. Ninety-seven percent of patients in the pH-assisted group had successful placement after the first attempt, compared with 53% of patients in the standard group. The average time to successful placement of pH-assisted feeding tubes was 6 minutes. All patients in the pH-assisted group had successful placement after the second attempt, compared with 78% of patients in the standard group. A pH of greater than 5.6 accurately predicted transpyloric placement in 97% (33 of 34) of individuals in the pH-assisted group. Children in the pH-assisted group required significantly fewer radiographs than those in the standard group. Hospital costs were $114 per patient in the pH-assisted group and $135 per patient in the standard group. Conclusions. Our findings indicate that bedside transpyloric placement of pH-assisted feeding tubes can be accomplished rapidly and with a high success rate. This method is associated with decreased radiation exposure and economic savings when compared with a standard placement technique.

scholarly journals Assessment of delirium in children admitted into the Intensive Care Unit: psCAM-ICU Tool

2020 ◽  
Vol 38 (2) ◽  
pp. 140-148
Author(s):  
Ángela María Henao Castaño ◽  
Edwar Yamith Pinzon Casas
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Pediatric Intensive Care ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Primary Diagnosis ◽  
Critically Ill Children ◽  
Associated Risk Factors ◽  
Prolonged Hospital

Background: Delirium has been identified as a risk factor for the mortality of critically ill patients, generating great social and economic impacts, since patients require more days of mechanical ventilation and a prolonged hospital stay in the intensive care unit (ICU), thus increasing medical costs. Objective: To describe the prevalence and characteristics of delirium episodes in a sample of 6-month to 5-year-old children who are critically ill. Methods: Cohort study at a Pediatric Intensive Care Unit (PICU) in Bogotá (Colombia). Participants were assessed by the Preschool Confusion Assessment Method for the ICU (psCAM-ICU) within the first twenty-four hours of hospitalization. Results: One quarter of the participants (25.8%) presented some type of delirium. Among them, two sub-types of delirium were observed: 62.5% of the cases were hypoactive and 37.5% hyperactive. Moreover, from them, six were male (75%) and 2 female (25%). Primary diagnosis was respiratory tract infection in 62.55% of the patients, while respiratory failure was diagnosed in the remaining 37.5%. Conclusions: The implementation of delirium monitoring tools in critically ill children provides a better understanding of the clinical manifestation of this phenomenon and associated risk factors in order to contribute to the design of efficient intervention strategies.

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