Summary
Aim
To compare the efficacy of blind transpyloric placement using a specifically designed
nasojejunal tube (NJT) versus a standard nasogastric tube (NGT) in severe head injury (SHI).
Methods
This was a randomised trial conducted in a neurosurgical intensive care unit. Fourteen
patients were enrolled with a Glasgow Coma Score (GCS) less than 8 (mean 6.8 SEM ± 0.36). Patients were randomised to receive either NJT or NGT.
Results
There was an 83% (5/6 patients) spontaneous jejunal placement rate of NJT past the
ligament of Treitz. The 17% (1/6 patients) jejunal placement failure rate for NJT
was due to inappropriate technique. A 100% (8/8 patients) failure of the unweighted
NGTs to pass through the pylorus into the jejunum was recorded (P = 0.002).
Conclusion
In SHI, the specifically designed self-propelling NJT was effective in spontaneous
transpyloric placement past the ligament of Treitz within 12 h of introduction into the gastric cavity. The standard un-weighted NGT was ineffective.
Additional studies are warranted to determine the clinical efficacy of this self-propelling
NJT.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Clinical NeuroscienceAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Intolerance to enteral feeding in the brain injured patient.J Neurosurg. 1988; 68: 62-66
- Erythromycin improves gastric emptying in critically ill patients intolerant of nasogastric feeding.Crit Care Med. 2000; 28: 2334-2337
- Impaired gastric emptying in mechanically ventilated, critically ill patients.Intensive Care Med. 1996; 22: 1339-1344
- Gastric emptying in head injured patients.Am J Gastroenterol. 1998; 93: 1108-1112
- To determine the effect of metoclopramide on gastric emptying in severe head injuries: a prospective, randomised, controlled clinical trial.Br J Neurosurg. 2003; 17: 24-28
- Enteral versus parenteral nutrition after severe closed head injury.J Trauma. 1994; 37: 459-468
- Lower oesophageal sphincter dysfunction precludes safe gastric feeding after head trauma.J Trauma. 1994; 37: 581-586
- Routine intragastric feeding following traumatic brain injury is safe and well tolerated.Am J Surg. 2000; 179: 168-171
- Altered gastric emptying in the head injured patient: relationship to feeding intolerance.J Neurosurg. 1991; 74: 738-742
- Pulmonary complications from nasoenteral feeding tube insertion in an intensive care unit: incidence and prevention.Crit Care Med. 1986; 14: 917-919
- Complications of nasoenteric feeding tubes.Am J Surg. 1988; 155: 253-257
- Value of fluoroscopic assistance through transpyloric intubation.Crit Care Med. 1986; 14: 151-152
- Pneumonia: incidence, risk factors and outcome in injured patients.J Trauma. 1991; 31: 907-912
- Inexpensive, safe and simple nasoenteral intubation: an alternative for the cost conscious.JPEN J Parenter Enteral Nutr. 1986; 10: 78-81
- Bedside enteral feeding tube placement into duodenum and jejunum.JPEN J Parenter Enteral Nutr. 1986; 10: 104-105
- Spontaneous transpyloric migration of a ballooned nasojejunal tube: a randomised controlled trial.JPEN J Parenter Enteral Nutr. 2000; 24: 240-243
- Erythromycin facilitates post-pyloric placement of nasoduodenal feeding tubes in intensive care patients. Randomised, double blind placebo controlled study.JPEN J Parenter Enteral Nutr. 1996; 20: 385-388
- Post-pyloric enteral feeding for patients with severe head injury: blind placement, endoscopy and PEG/J versus TPN.J Neurotrauma. 1999; 16: 233-242
- Technical development: a new self-propelling nasoenteric feeding tube.Clin Nutr. 1992; 11: 373-375
- Progress in perioperative enteral tube feeding.Clin Nutr. 1998; 17: 145-152
Vender JR, Cresci GA, Lee MR. Nutritional considerations in severe brain injury. In: Shikora, SA, American Society for Parenteral and Enteral Nutrition, Martindale G, et al. (eds). Nutritional Considerations in the Intensive Care Unit: Science, Rationale and Practice. Kendall/Hunt Publishing Company, Aspen; 2002: 259–266
- Post-pyloric enteral feeding costs for patients with severe head injury: blind placement, endoscopy and PEG/J versus TPN.J Neurotrauma. 1999; 16: 233-242
- The benefits of early jejunal hyperalimentation in the head injured patient.Neurosurgery. 1989; 25: 729-735
Article info
Publication history
Accepted:
April 19,
2004
Received:
December 28,
2003
Identification
Copyright
© 2005 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
