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Low success rates of “blind” placement

Comparison of a new unguided self-advancing jejunal tube with the endoscopic guided technique: A prospective, randomized study.

Holzinger U, Kitzberger R, Bojic A, et al.                                                                        Intensive Care Med 2009, Jun [Epub ahead of print]

Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Intensive Care Unit 13H1, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.

Nutrition support is an important link between the response to injury and recovery in critically ill patients admitted to an intensive care unit (ICU) in order to offset malnutrition and prevent starvation-induced immune depletion. Therefore nutrition support has become a part of ICU standard-therapy. Enteral nutrition (EN) has shown to be superior to total parenteral nutrition since it preserves gut integrity, barrier and immune functions and reduces infectious complications (Cerra FB; Chest 1997; 111:769). Consequently, EN should be the first choice in patients without contraindications for enteral feeding. However, although EN is beneficial for the patient it may also be associated with complications because of gastroduodenal motility disorders, which are common in critically ill patients, especially when they receive analgosedation. Clinical studies have shown that up to 63% of patients receiving EN have gastrointestinal complications like high gastric residuals (≥200ml), vomiting, abdominal distension and regurgitation (Montejo FC; Crit Care Med 1999; 27:1447). These complications frequently lead to interruptions of EN, which may result in a low caloric intake of the patient. There­fore patients receive only 49 to 78% of the pre­scribed amount of enteral nutrition (Rubinson L; Crit Care Med 2004; 32:350).

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