Top Tips for Direct Percutaneous Endoscopic Jejunostomy (DPEJ) Tube Placement.

Direct percutaneous endoscopic jejunostomy (DPEJ) provides post-pyloric enteral access in patients unable to meet long-term nutritional needs per os in situations where gastric feeding is neither tolerated nor feasible. Specific conditions associated with feeding intolerance due to due to nausea, vomiting, or ileus include gastric outlet obstruction, gastroparesis, or complications of acute or chronic pancreatitis; infeasibility may be due to high aspiration risk or prior gastric surgery. Since performing DPEJ is not an ACGME requirement for GI fellows or early career gastroenterologists, not all trainees are taught this technique. Hence, provider expertise for teaching and performing this technique varies widely across centers. In this article, we provide top tips for successful performance of DPEJ.

Safety and efficacy of direct percutaneous endoscopic jejunostomy tube placement compared with surgical jejunostomy: a tertiary care analysis.

BACKGROUND AND AIMS: Jejunostomy tube placements provides enteral access for feeding in eligible patients who cannot meet their nutritional needs by mouth. They can be surgically placed laparoscopically (lap-J) or with the use of a conventional open laparotomy approach (open-J). Recently, direct percutaneous endoscopic jejunostomy (DPEJ) has emerged as an alternative owing to its low cost and shorter recovery times. We sought to retrospectively compare the procedural success rates and adverse events of these methods. METHODS: Patients were identified by querying our health system patient database and the departmental database of patients who underwent DPEJ. The patients were divided into 3 cohorts based on the procedure: DPEJ, lap-J, or open-J. Patient age and body mass index, procedural success rate, and adverse event rate were compared among the 3 groups. RESULTS: A total of 201 patients met inclusion criteria (65 DPEJ, 111 lap-J, and 25 open-J). Procedural success rates were similar among the 3 groups (DPEJ 96.9%, lap-J 99.1%, open-J 100%; P = .702). Rates of infection and bleeding were also similar among the 3 groups. There were no cases of GI perforation. Tube dysfunction for any reason that required complete removal or replacement within 90 days occurred more often in the surgical groups than in the DPEJ group (DPEJ 0%, lap-J 35.1%, open-J 40.0%; P < .001). This was driven largely by increased rates of tube clogging and tube dislodgement in the surgical groups. CONCLUSIONS: DPEJ is a safe and effective alternative to surgical jejunostomy in eligible patients and may be associated with decreased adverse event rates at 90 days.

Intraoperative Transpyloric Tube Insertion for Congenital Diaphragmatic Hernia: Analysis of Japanese Study Group Data.

BACKGROUND: Congenital diaphragmatic hernia (CDH) is a severe congenital disease. Some CDH infants suffer from gastro-esophageal reflux disease (GERD), even after surgical correction of gastric position. A transpyloric tube (TPT) is inserted into CDH patients under direct observation intraoperatively in some hospitals in Japan to establish early enteral feeding. This strategy avoids gastric expansion to maintain a better respiratory condition. However, it is unclear whether the strategy has a secure effect for patient prognosis. This study aimed to evaluate the effectiveness of intraoperative TPT insertion on enteral feeding and postoperative weight gain. METHODS: The Japanese CDH Study Group database was used to identify infants with CDH born between 2011 and 2016, who were then divided into two groups: the TPT group and gastric tube (GT) group. In the TPT group, infants underwent intraoperative TPT insertion; postoperative insertion/extraction of TPT was irrelevant to the analysis. Weight growth velocity (WGV) was calculated using the exponential model. Subgroup analysis was performed using Kitano's gastric position classification. RESULTS: We analyzed 204 infants, of which 99 and 105 were in the TPT and GT groups, respectively. Enteral nutrition (EN) in the TPT and GT groups was 52 ± 39 and 44 ± 41 kcal/kg/day (p = 0.17) at age 14 days (EN14), respectively, and 83 ± 40 and 78 ± 45 kcal/kg/day (p = 0.46) at age 21 days (EN21), respectively. WGV30 (WGV from day 0 to day 30) in the TPT and GT groups was 2.3 ± 3.0 and 2.8 ± 3.8 g/kg/day (p = 0.30), respectively, and WGV60 (WGV from day 0 to day 60) was 5.1 ± 2.3 and 6.0 ± 2.5 g/kg/day (p = 0.03), respectively. In infants with Kitano's Grade 2 + 3, EN14 in the TPT and GT groups was 38 ± 35 and 29 ± 35 kcal/kg/day (p = 0.24), respectively, EN21 was 73 ± 40 and 58 ± 45 kcal/kg/day (p = 0.13), respectively, WGV30 was 2.3 ± 3.2 and 2.0 ± 4.3 g/kg/day (p = 0.76), respectively, and WGV60 was 4.6 ± 2.3 and 5.2 ± 2.3 g/kg/day (p = 0.30), respectively. CONCLUSION: Intraoperative TPT insertion did not improve nutritional intake and WGV30. WGV60 in TPT was less than that in GT. In Grade 2 + 3 subgroup analysis, TPT also had no advantage. We could not recommend routine TPT insertion at surgery. LEVEL OF EVIDENCE: III.

[Design and application of a new type of biliary-intestinal nutrient tube].

The establishment of a nutritional pathway is the premise and basis of nutritional therapy for patients with malignant tumor. The nasogastric tube, nasoenteric tube, and percutaneous endoscopic gastric/jejunostomy are commonly used clinical pathways for enteral nutrition (EN) therapy. However, these EN pathways are often difficult to establish in patients with malignant obstructive jaundice (MOJ) with pyloric or duodenum primary obstruction. For this reason, a new type biliary-intestinal nutrient tube placed through percutaneous transhepatic cholangiography drainage (PTCD) pathway was designed by the medical staff of hepatobiliary surgery department of Yinchuan First People's Hospital, and National Utility Model Patent of China were obtained (ZL 2020 2 0283951.5, ZL 2020 2 0288938.9). The new biliary-intestinal nutrient tube has two types: double-lumen tube and single-lumen tube, which consists of tube head, tube body, tail ring and developing ring. The double lumen tube realizes bile internal drainage and EN simultaneously through the double lumen structure of the tube body. The single-lumen tube is used for nutrient infusion after bile duct metal stent implantation, which is not limited by the type of nutrient solution. The tail ring of the two types of nutrient tube is placed in the upper jejunum to reduce retrograde infection and unexpected extubation. Compared with the prior art, the utility model has the advantages of simple structure, reasonable design, safe and effective placement through PTCD pathway, and opens up a new EN path for MOJ patients.

The PRO-ACTIVE trial protocol: a randomized study comparing the effectiveness of PROphylACTic swallow InterVEntion for patients receiving radiotherapy for head and neck cancer.

BACKGROUND: Swallowing therapy is commonly provided as a treatment to lessen the risk or severity of dysphagia secondary to radiotherapy (RT) for head and neck cancer (HNC); however, best practice is not yet established. This trial will compare the effectiveness of prophylactic (high and low intensity) versus reactive interventions for swallowing in patients with HNC undergoing RT. METHODS: This multi-site, international randomized clinical trial (RCT) will include 952 adult patients receiving radiotherapy for HNC and who are at high risk for post-RT dysphagia. Participants will be randomized to receive one of three interventions for swallowing during RT: RE-ACTIVE, started promptly if/when dysphagia is identified; PRO-ACTIVE EAT, low intensity prophylactic intervention started before RT commences; or, PRO-ACTIVE EAT+EXERCISE, high intensity prophylactic intervention also started before RT commences. We hypothesize that the PRO-ACTIVE therapies are more effective than late RE-ACTIVE therapy; and, that the more intensive PRO-ACTIVE (EAT + EXERCISE) is superior to the low intensive PRO-ACTIVE (EAT). The primary endpoint of effectiveness is duration of feeding tube dependency one year post radiation therapy, selected as a pragmatic outcome valued equally by diverse stakeholders (e.g., patients, caregivers and clinicians). Secondary outcomes will include objective measures of swallow physiology and function, pneumonia and weight loss, along with various patient-reported swallowing-related outcomes, such as quality of life, symptom burden, and self-efficacy. DISCUSSION: Dysphagia is a common and potentially life-threatening chronic toxicity of radiotherapy, and a priority issue for HNC survivors. Yet, the optimal timing and intensity of swallowing therapy provided by a speech-language pathologist is not known. With no clearly preferred strategy, current practice is fraught with substantial variation. The pragmatic PRO-ACTIVE trial aims to specifically address the decisional dilemma of when swallowing therapy should begin (i.e., before or after a swallowing problem develops). The critical impact of this dilemma is heightened by the growing number of young HNC patients in healthcare systems that need to allocate resources most effectively. The results of the PRO-ACTIVE trial will address the global uncertainty regarding best practice for dysphagia management in HNC patients receiving radiotherapy. TRIAL REGISTRATION: The protocol is registered with the US Patient Centered Outcomes Research Institute, and the PRO-ACTIVE trial was prospectively registered at ClinicalTrials.gov , under the identifier NCT03455608 ; First posted: Mar 6, 2018; Last verified: Jun 17, 2021. Protocol Version: 1.3 (January 27, 2020).

Concordancia entre observadores en la aplicación de la lista de verificación para la administración segura de la nutrición enteral / Interobserver agreement in using a checklist for the safe administration of enteral nutrition

Objetivo: describir una evaluación de la concordancia entre observadores en el uso de una lista de verificación en la atención a pacientes con sonda nasoenteral (SNE) como premisa de la recogida de datos. Método: este estudio de fiabilidad se realizó en 2018 en un hospital brasileño, antes de la recogida de datos para un ensayo clínico abierto. Ocho observadores independientes, previamente capacitados y “cegados” con respecto a las evaluaciones de los demás, evaluaron a pacientes con SNE por medio de una lista de comprobación de 25 elementos. Los datos obtenidos por estos asistentes de investigación (AI) se compararon con los obtenidos por una enfermera experimentada. Se midió la concordancia mediante los coeficientes kappa y PABAK. Resultados: se realizaron 451 observaciones por pares. Considerando la totalidad de los elementos, hubo una concordancia casi perfecta (k > 0,80) en todos los pares de observación (enfermera vs. cada AI): AI 1 (k = 0,91; IC 95 % = 0,89-0,93); AI 2 (k = 0,83; IC 95 % = 0,80-0,85); AI 3 (k = 0,92; IC 95 % = 0,90-0,94 ); AI 4 (k = 0,83; IC 95 % = 0,80-0,86); AI 5 (k = 0,94; IC 95 % = 0,92-0,96); AI 6 (k = 0,94; IC 95 % = 0,92-0,96); AI 7 (k = 0,96; IC 95 % = 0,95-0,98); AI 8 (k = 0,73; IC 95 % = 0,70-0,77). Se identificó un menor número de concordancia en los elementos individuales y en determinados AI. La recapacitación y supervisión de los AI mejoró su desempeño y la concordancia entre observadores. Conclusión: la evaluación de la concordancia entre observadores resultó fundamental para asegurar la fiabilidad de la recogida de datos y, por consiguiente, evitar sesgos de medición en los estudios clínicos de enfermería. (AU)

Objective: to describe an evaluation of interobserver agreement in the use of a checklist related to the use of nasoenteral tube (NSS) as a presupposition for quality in obtaining data. Method: a methodological study conducted in 2018 in a Brazilian hospital, preceding the data collection of an open-label clinical trial. Independent observers, blinded to the evaluation of their peers, evaluated patients with NSS through a 25-item checklist. The data collected by eight previously trained research assistants (RA) were compared to those obtained by an experienced nurse (reference standard). Agreement was measured using the kappa coefficient and PABAK. Results: a total of 451 observations were made in pairs. Considering the total items on the checklist there was almost perfect agreement (k > 0.80) in all observation pairs (nurse vs. each RA): RA 1 (k = 0.91; 95 % CI = 0.89-0.93); RA 2 (k = 0.83; 95 % CI = 0.80-0.85); RA 3 (k = 0.92; 95 % CI = 0.90-0.94); RA 4 (k = 0.83; 95 % CI = 0.80-0.86); RA 5 (k = 0.94; 95 % CI = 0.92-0.96); RA 6 (k = 0.94; 95 % CI = 0.92-0.96); RA 7 (k = 0.96; 95 % CI = 0.95-0.98); RA 8 (k = 0.73; 95 % CI = 0.70-0.77). However, for isolated items, and in specific RAs, there were fair agreements, unacceptable to effectively collect data from a clinical trial. Retraining and supervision of RAs were able to improve agreement between observers. Conclusion: an evaluation of interobserver agreement proved to be fundamental to ensure the reliability of data collection and, therefore, to avoid measurement biases. (AU)

CE: Monitoring Adult Patients for Intolerance to Gastric Tube Feedings.

ABSTRACT: Gastric tube feeding is a common and valuable intervention for patients in a variety of care settings. While tube feeding can save the lives of patients for whom oral feeding isn't possible, intolerance to tube feeding is a potential complication. This article discusses risk factors for feeding intolerance; the assessment of signs and symptoms of feeding intolerance; the various means of assessing gastric emptying, including the practice of monitoring gastric residual volume (GRV); the controversy surrounding GRV monitoring in assessing feeding tolerance; and the special considerations for monitoring feeding tolerance in acutely and critically ill adults with coronavirus disease 2019. The author, a nurse researcher with extensive experience in the area of enteral feeding, briefly summarizes recommendations and guidelines for enteral feeding published by national and international health care organizations between 2015 and 2020, and offers her perspective on best nursing practices for monitoring food tolerance in adults.

[Interobserver agreement in using a checklist for the safe administration of enteral nutrition]. / Concordancia entre observadores en la aplicación de la lista de verificación para la administración segura de la nutrición enteral.

INTRODUCTION: Objective: to describe an evaluation of interobserver agreement in the use of a checklist related to the use of nasoenteral tube (NSS) as a presupposition for quality in obtaining data. Method: a methodological study conducted in 2018 in a Brazilian hospital, preceding the data collection of an open-label clinical trial. Independent observers, blinded to the evaluation of their peers, evaluated patients with NSS through a 25-item checklist. The data collected by eight previously trained research assistants (RA) were compared to those obtained by an experienced nurse (reference standard). Agreement was measured using the kappa coefficient and PABAK. Results: a total of 451 observations were made in pairs. Considering the total items on the checklist there was almost perfect agreement (k > 0.80) in all observation pairs (nurse vs. each RA): RA 1 (k = 0.91; 95 % CI = 0.89-0.93); RA 2 (k = 0.83; 95 % CI = 0.80-0.85); RA 3 (k = 0.92; 95 % CI = 0.90-0.94); RA 4 (k = 0.83; 95 % CI = 0.80-0.86); RA 5 (k = 0.94; 95 % CI = 0.92-0.96); RA 6 (k = 0.94; 95 % CI = 0.92-0.96); RA 7 (k = 0.96; 95 % CI = 0.95-0.98); RA 8 (k = 0.73; 95 % CI = 0.70-0.77). However, for isolated items, and in specific RAs, there were fair agreements, unacceptable to effectively collect data from a clinical trial. Retraining and supervision of RAs were able to improve agreement between observers. Conclusion: an evaluation of interobserver agreement proved to be fundamental to ensure the reliability of data collection and, therefore, to avoid measurement biases.

INTRODUCCIÓN: Objetivo: describir una evaluación de la concordancia entre observadores en el uso de una lista de verificación en la atención a pacientes con sonda nasoenteral (SNE) como premisa de la recogida de datos. Método: este estudio de fiabilidad se realizó en 2018 en un hospital brasileño, antes de la recogida de datos para un ensayo clínico abierto. Ocho observadores independientes, previamente capacitados y "cegados" con respecto a las evaluaciones de los demás, evaluaron a pacientes con SNE por medio de una lista de comprobación de 25 elementos. Los datos obtenidos por estos asistentes de investigación (AI) se compararon con los obtenidos por una enfermera experimentada. Se midió la concordancia mediante los coeficientes kappa y PABAK. Resultados: se realizaron 451 observaciones por pares. Considerando la totalidad de los elementos, hubo una concordancia casi perfecta (k > 0,80) en todos los pares de observación (enfermera vs. cada AI): AI 1 (k = 0,91; IC95 % = 0,89-0,93); AI 2 (k = 0,83; IC95 % = 0,80-0,85); AI 3 (k = 0,92; IC95 %= 0,90-0,94 ); AI 4 (k = 0,83; IC95 % = 0,80-0,86); AI 5 (k = 0,94; IC95 % = 0,92-0,96); AI 6 (k = 0,94; IC95 % = 0,92-0,96); AI 7 (k = 0,96; IC95 % = 0,95-0,98); AI 8 (k = 0,73; IC95 % = 0,70-0,77). Se identificó un menor número de concordancia en los elementos individuales y en determinados AI. La recapacitación y supervisión de los AI mejoró su desempeño y la concordancia entre observadores. Conclusión: la evaluación de la concordancia entre observadores resultó fundamental para asegurar la fiabilidad de la recogida de datos y, por consiguiente, evitar sesgos de medición en los estudios clínicos de enfermería.

Factors Influencing Breast Milk Fat Loss during Administration in the Neonatal Intensive Care Unit.

The objective of this study was to investigate factors influencing fat loss during tube feeding of breast milk to preterm infants. An experimental study with 81 feeding simulations was performed, with nine continuous infusions in each of six modalities: Horizontal Higher, Horizontal Matched, Horizontal Lower, Tilted Higher, Tilted Matched, and Tilted Lower, and for comparison, 27 bolus feedings: nine flushed with air, nine with water, and nine that were not flushed, done at matched height. Each simulation utilized 16 mL of breast milk given over four hours. Continuous infusions were given with a flow rate of 4 mL/h. Bolus was given as 8 mL over the course of 15-20 min every other hour. Analysis for fat, true protein, carbohydrate, total solids, and energy was performed before and after each simulation. The percent of macronutrient loss was compared between all simulations. Continuous infusion resulted in an average fat loss of 40%. Bolus feedings resulted in an average fat loss of 11% (p ≤ 0.001). Considerable fat loss is seen during continuous tube feeding. Neither height in relation to the infant nor tilting of the pump reduce fat loss. To limit fat loss, the bolus feeding method should be utilized.

Enteral Nutrition by Nasogastric Tube in Adult Patients under Palliative Care: A Systematic Review.

Nutritional management of patients under palliative care can lead to ethical issues, especially when Enteral Nutrition (EN) is prescribed by nasogastric tube (NGT). The aim of this review is to know the current status in the management of EN by NG tube in patients under palliative care, and its effect in their wellbeing and quality of life. The following databases were used: PubMed, Web of Science (WOS), Scopus, Scielo, Embase and Medline. After inclusion and exclusion criteria were applied, as well as different qualities screening, a total of three entries were used, published between 2015 and 2020. In total, 403 articles were identified initially, from which three were selected for this review. The use of NGT caused fewer diarrhea episodes and more restrictions than the group that did not use NG tubes. Furthermore, the use of tubes increased attendances to the emergency department, although there was no contrast between NGT and PEG devices. No statistical difference was found between use of tubes (NGT and PEG) or no use, with respect to the treatment of symptoms, level of comfort, and satisfaction at the end of life. Nevertheless, it improved hospital survival compared with other procedures, and differences were found in hospital stays in relation to the use of other probes or devices. Finally, there are not enough quality studies to provide evidence on improving the health status and quality of life of the use of EN through NGT in patients receiving palliative care. For this reason, decision making in this field must be carried out individually, weighing the benefits and damages that they can cause in the quality of life of the patients.

Prophylactic gastrostomy in locally advanced head and neck cancer: results of a national survey among radiation oncologists.

BACKGROUND: Nutritional complications in patients with locally advanced head and neck cancer (LA-HNC) treated by concurrent chemoradiotherapy (CCRT) often lead to placement of a prophylactic gastrostomy (PG) tube, while indication lacks harmonization. Our aim was to explore the current PG tube utilization among Belgian radiation oncology centers. METHODS: A survey was distributed to all 24 Belgian Radiation oncology departments, with questions about the number of patient treated per year, whether the PG indication is discussed at the multidisciplinary board, placement technique, time of starting nutrition and removal, its impact on swallowing function and importance of clinical factors. For the latter Relative Importance and Discordance Indexes were calculated to describe the ranking and agreement. RESULTS: All 24 centers submitted the questionnaire. Twenty three treat more than 20 head and neck (HNC) patients per year, while four (1 in 21-50; 3 in 51-100) are not discussing the gastrostomy tube indication at the multidisciplinary board. For the latter, endoscopic placement (68%) is the dominant technique, followed by the radiologic (16%) and laparoscopic (16%) methods. Seventy-five percent start the enteral nutrition when clinically indicated, 17% immediately and 8% from the start of radiotherapy. Majority of specialists (19/24) keep the gastrostomy tube until the patient assume an adequate oral feeding. Fifteen centres are considering PG decrease swallowing function. Regarding factors and their importance in the decision for the PG, foreseen irradiated volume reached highest importance, followed by 'anatomical site', 'patients' choice' and 'postoperative versus definitive' and 'local expertise', with decreasing importance respectively. Disagreement indexes showed moderate variation. CONCLUSIONS: The use of a PG tube for LAHNC patients treated by CCRT shows disparity at national level. Prospective studies are needed to ensure proper indication of this supportive measure.

Nutrição enteral: posicionamento adequado das sondas / Enteral nutrition proper positioning of the probes

Elucidar, em tempo oportuno, as diferenças, riscos e benefícios, da administração da NE com tubos em posição nasogástrica ou pós-pilórica, bem como informar o que traz a literatura acerca das técnicas para confirmação do posicionamento da sonda com eficácia e segurança.

Elucidate, in a timely manner, the differences, risks and benefits of the administration of tubes in nasogastric or post-pyloric position, as well as inform what the literature about the techniques to confirm the positioning of the probe effectively and safely.

Outcomes for gastrostomy-fed children and their parents: qualitative findings from the 'Your Tube' study.

AIM: To identify child and parent outcomes relevant to having a gastrostomy, and to specify outcomes believed to be particularly salient to type of diet (formula vs blended food). METHOD: Twenty parents, two children (both 12y), and 41 professionals (dietitians [n=10]; nurses [n=12]; paediatricians [n=12]; speech and language therapists [n=7)]) were recruited. Parents and children were interviewed; professionals participated in focus groups. Children (2-18y) represented included those on formula (n=11), blended-food (n=7), and mixed (n=2) diets. All had been tube-fed for at least 6 months. Neurological, genetic, and metabolic conditions were represented. RESULTS: Participants identified a range of children's outcomes relevant to a gastrostomy, including physical health, gastrointestinal symptoms, sleep, and time spent feeding. The children described experiences of exclusion caused by being tube-fed. Time, sleep, and emotional health were regarded as most salient to understanding parents' gastrostomy outcomes. Participants believed type of diet would most likely effect gastrointestinal symptoms, time spent feeding, sleep, and physical health. INTERPRETATION: Findings indicate a number of refinements to, and allow further specification of, the current 'initial' core outcome set for tube-fed children. Findings also have implications for choice of outcomes measures. Further qualitative research with children and young people is needed. What this paper adds Sleep is a key outcome for children and parents. Gastrointestinal symptoms and physical health were regarded as outcomes most likely to be affected by type of diet. Well-being and participation were identified as key distal outcomes. Gastrostomies are complex interventions. Further specification of the core outcome set is possible.

Bacterial Contamination during Continuous Administration of Liquid Enteral Nutrition Formula in a Sterile Sealed Bag: A Prospective Interventional Study.

INTRODUCTION: In nutrition therapy for critically ill patients, it is recommended that enteral nutrition (EN) formula be changed every 8 h to avoid bacterial contamination. However, it remains unknown whether long-term administration of EN formula from a sterile sealed bag without changing the formula can cause bacterial contamination. This study investigates the association between bacterial contamination and administration of liquid EN formula from a sterile sealed bag without changing the formula for 24 h. METHODS: This single-center, prospective, interventional study included patients aged ≥20 years who were admitted to an intensive care unit and received 24-h continuous liquid EN formula from a sterile sealed bag. A 3-mL sample of the formula was collected from each bag every 4 h for bacterial culture. The primary outcome was the detection of bacterial colonies. RESULTS: A total of 630 specimens from 30 patients were cultured. No bacterial colonies were detected. CONCLUSION: There was no association between bacterial contamination and continuous administration of liquid EN formula from a sterile sealed bag for 24 h. Therefore, this study recommends continuous administration of EN from a sterile sealed bag for 24 h without changing the EN formula under those limited conditions.

Innovation of Distal Refeeding in Infants.

Background: Temporary diverting enterostomy might be the initial step while treating gastrointestinal disorders in infants. According to the level of the stoma, calorie, fluid, and electrolyte imbalance might occur. Totally parenteral nutrition (TPN), parenteral fluid, and electrolyte balancing are the choice of support. Owing to limitations of both, distal refeeding (DR) has been suggested as an alternative. However, in English literature, there is no recommended technique for how DR should apply. This article is aimed at evaluating our innovative DR approach, which was not reported earlier. Materials and Methods: Between 2015 and 2019, patients on whom DR was performed by a cuffed silicon-based tunneled catheter were obtained. Results: A total of 8 patients aged between 1 day and 7.5 years were included. Dislocation of the catheter and skin erosion were the minor complications that were observed. None of them necessitated TPN and vascular access. Moreover, patients could be discharged and were fully fed orally by their guardian at home, and any problem was observed during survival. Conclusion: Consequently, patients did not necessitate vascular access or TPN. They were all fully fed orally, and DR could be performed without a failure to thrive. Therefore, we believe that tunneled catheter DR is a safe and reliable method in infants. Institutional Review Board at Eskisehir Osmangazi University (Protocol no. 07/01/2020-26).

Small-bore feeding tube versus large-bore sump tube for early enteral nutrition in mechanically ventilated patients: A nationwide inpatient database study.

BACKGROUND & AIMS: When physicians start nasogastric tube feeding in mechanically ventilated patients, they have two choices of feeding tube device: a large-bore sump tube or a small-bore feeding tube. Some physicians may prefer to initiate enteral nutrition via the large-bore sump tube that is already in place, and others may prefer to use the small-bore feeding tube. However, it remains unknown whether small-bore feeding tubes or large-bore sump tubes are better for early enteral nutrition. The present study aimed to compare outcomes between these two types of feeding tubes in mechanically ventilated patients. METHODS: Using the Japanese Diagnosis Procedure Combination inpatient database from July 2010 to March 2018, we identified adult patients who underwent invasive mechanical ventilation for ≥2 days in intensive care units and received nasogastric tube feeding within 2 days of starting mechanical ventilation. We categorized these patients as receiving early enteral nutrition via small-bore feeding tube (8- to 12-Fr single-lumen tubes) or via large-bore sump tube. Propensity score-matched analyses were performed to compare 28-day in-hospital mortality and hospital-acquired pneumonia between the two groups. RESULTS: A total of 79,656 patients were included. Of these patients, 20,178 (25%) were in the small-bore feeding tube group. One-to-one propensity score matching created 20,061 matched pairs. Compared with those in the large-bore sump tube group, patients in the small-bore feeding tube group had significantly higher 28-day in-hospital mortality (17.0% versus 15.6%; hazard ratio, 1.08; 95% confidence interval, 1.03 to 1.14) and a significantly higher prevalence of hospital-acquired pneumonia (9.3% versus 8.5%; odds ratio, 1.11; 95% confidence interval, 1.02 to 1.21). CONCLUSIONS: This nationwide observational study suggests that small-bore feeding tubes may not be associated with better clinical outcomes but rather with increased mortality and hospital-acquired pneumonia. Because of the uncertainty regarding the mechanism of our findings, further studies are warranted.