The early institution of enteral nutrition is now accepted as the preferred
route of feeding in critically ill patients with a functioning
gastrointestinal tract. It is particularly important to establish early
enteral nutrition in mechanically ventilated patients because of the metabolic
demands associated with mechanical ventilation. The options for enteral access
in mechanically ventilated patients are reviewed, with an emphasis on those
techniques that may be performed at the bedside. The advantages,
disadvantages, and complications of the different techniques will be
considered.
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References
1.
The Veterans Affairs Total Parenteral Nutrition Cooperative Study
Group. Perioperative TPN in surgical patients. N Engl J
Med.1991;325:525–
532.
2.
Mentec H, Dupont H, Bocchetti M, Cani P, Ponche F, Bleichner G.
Upper digestive intolerance during enteral nutrition in critically ill
patients: frequency, risk factors, and complications. Crit Care
Med.2001;29:1955–
1961.
3.
Kudsk KA, Croce MA, Fabian TC, et al. Enteral versus parenteral
feeding: effects on septic morbidity following blunt and penetrating abdominal
trauma. Ann Surg.1992
;215:503–
513.
4.
Moore FA, Feliciano DV, Andrassy RJ, et al. Early enteral feeding,
compared with parenteral, reduces septic complications: the results of a
meta-analysis. Ann Surg.1992
;216:172–
183.
5.
DeWitt RC, Kudsk KA. The gut's role in metabolism, mucosal barrier
function, and gut immunology. Infect Dis Clin North
Am.1999;13:465–
481.
6.
Marik PE, Zaloga GP. Early enteral nutrition in acutely ill
patients: a systematic review. Crit Care Med.2001
;29:2264–
2270.
7.
Mutlu GM, Mutlu EA, Factor P. GI complications in patients
receiving mechanical ventilation. Chest.2001
;119:1222–
1241.
8.
Montejo JC. Enteral nutrition-related gastrointestinal
complications in critically ill patients: a multicenter study: the Nutritional
and Metabolic Working Group of the Spanish Society of Intensive Care Medicine
and Coronary Units. Crit Care Med.1999
;27:1447–
1453.
9.
Dark DS, Pingleton SK. Nonhemorrhagic gastrointestinal
complications in acute respiratory failure. Crit Care
Med.1989;17:755–
758.
10.
Ritz MA, Fraser R, Edwards N, et al. Delayed gastric emptying in
ventilated critically ill patients: measurement by 13 C-octanoic acid breath
test. Crit Care Med.2001
;29:1744–
1749.
11.
Metheny N, Reed L, Wiersema L, McSweeney M, Wehrle MA, Clark J.
Effectiveness of pH measurements in predicting feeding tube placement: an
update. Nursing Res.1993
;42:324–
331.
12.
McClave SA, Greene LM, Snider HL, et al. Comparison of the safety
of early enteral versus parenteral nutrition in mild acute pancreatitis.
JPEN J Parenter Enteral Nutr.1997
;21:14–
20.
13.
Abou-Assi S, Craig K, O'Keefe SJ. Hypocaloric jejunal feeding is
better than TPN in acute pancreatitis: results of a randomized comparative
study. Am J Gastroenterol.2002
;97:2255–
2262.
14.
Cresci G, Martindale R. Bedside placement of small bowel feeding
tubes in hospitalized patients: a new role for the dietitian.
Nutrition.2003
;19:843–
846.
15.
Stern MA, Wolf DC. Erythromycin as a prokinetic agent: a
prospective, randomized, controlled study of efficacy in nasoenteric tube
placement. Am J Gastroenterol.1994
;89:2011–
2013.
16.
Whatley K, Turner WW, Dey M, Leonard J, Guthrie M. When does
metoclopramide facilitate transpyloric intubation? JPEN J Parenter
Enteral Nutr.1984;8:679–
681.
17.
Kittinger JW, Sandler RS, Heizer WD. Efficacy of metoclopramide as
an adjunct to duodenal placement of small bore feeding tubes: a randomized,
placebo-controlled, double-blind study. JPEN J Parenter Enteral
Nutr.1987;11:33–
37.
18.
Levenson R, Turner WW, Dyson A, Zike L, Reisch J. Do weighted
nasoenteric feeding tubes facilitate duodenal intubations? JPEN J
Parenter Enteral Nutr.1988
;12:135–
137.
19.
Salasidis R, Fleiszer T, Johnston R. Air insufflation technique of
enteral tube insertion: a randomized, controlled trial. Crit Care
Med.1998;26:1036–
1039.
20.
Gutierrez ED, Balfe DM. Fluoroscopically guided nasoenteric feeding
tube placement: results of a 1-year study. Radiology.1991
;178:759–
762.
21.
Reed LR, Eachempati SR, Russel MK, Fahkry C. Endoscopic placement
of jejunal feeding catheters in critically ill patients by a“
push” technique. J Trauma Injury Infect Crit
Care.1998;45:388–
393.
22.
Dranoff JA, Angood PJ, Topazian M. Transnasal endoscopy for enteral
feeding tube placement in critically ill patients. Am J
Gastroenterol.1999;94:2902–
2904.
23.
Foote JA, Kemmeter PR, Prichard PA. A randomized trial of
endoscopic and fluoroscopic placement of postpyloric feeding tubes in
critically ill patients. JPEN J Parenter Enteral Nutr.2004
;28:154–
157.
24.
George DL, Falk PS, Umberto Meduri G, et al. Nosocomial sinusitis
in patients in the medical intensive care unit: a prospective epidemiological
study. Clin Infect Dis.1998
;27:463–
470.
25.
Vanek VW. Ins and outs of enteral access: part 1: long term access,
short-term enteral access. Nutr Clin Pract.2002
;17:275–
283.
26.
McClave SA, DeMeo MT, DeLegge MH, et al. North American Summit on
Aspiration in the Critically Ill Patient: consensus statement. JPEN
J Parenter Enteral Nutr.2002
;26(Suppl):S80–
S85.
27.
Lazarus BA, Murphy JB, Culpepper L. Aspiration associated with
long-term gastric versus jejunal feeding: a critical analysis of the
literature. Arch Phys Med Rehabil.1990
;71:46–
53.
28.
Montecalvo MA, Steger KA, Farber HW, et al. Nutritional outcome and
pneumonia in critical care patients randomized to gastric versus jejunal tube
feedings: the Critical Care Research Team. Crit Care
Med.1992;20:1377–
1387.
29.
Marian M, Rappaport W, Cunningham D, et al. The failure of
conventional methods to promote spontaneous transpyloric feeding tube passage
and the safety of intragastric feeding in the critically ill ventilated
patient. Surg Gynecol Obstet.1993
;176:475–
479.
30.
McClave SA, Chang WK. Feeding the hypotensive patient: does enteral
feeding precipitate or protect against ischemic bowel? Nutr Clin
Pract.2003;18:279–
284.
31.
Minard G. Enteral access. Nutr Clin Pract.1994
;9:172–
182.
32.
Gauderer MW, Ponsky JL, Izant RZ Jr. Gastrostomy without
laparotomy: a percutaneous endoscopic technique. J Pediatr
Surg.1980;15:872–
875.
33.
Jain NK, Larson DE, Schroeder KW, et al. Antibiotic prophylaxis for
percutaneous endoscopic gastrostomy: a prospective, randomized, double-blind
clinical trial. Ann Intern Med.1987
;107:824–
828.
34.
Gossner L, Keymling J, Hahn EG, Ell C. Antibiotic prophylaxis in
percutaneous endoscopic gastrostomy (PEG): a prospective randomized clinical
trial. Endoscopy.1999
;31:119–
124.
Sachs BA, Vine HS, Palestrant AM. A nonoperative technique for the
establishment of gastrostomy in the dog. Invest
Radiol.1983;18:485–
487.
37.
Russell TR, Brotman M, Norris F. Percutaneous gastrostomy.
Am J Surg.1984
;148:132–
137.
38.
Wu TK, Pietrocola D, Welch HF. New method of percutaneous
endoscopic gastrostomy using anchoring devices. Am J
Surg.1987;153:230–
232.
39.
Larson DE, Burton DD, Schroeder KW, DiMagno EP. Percutaneous
endoscopic gastrostomy: indications, success, complications, and mortality in
314 consecutive patients. Gastroenterology.1987
;93:48–
51.
40.
Barkmeier JM, Trerotola SO, Wiebke EA, et al. Percutaneous
radiological, surgical endoscopic, and percutaneous endoscopic
gastrostomy/gastrojejunostomy: comparative study and cost analysis.
Cardiovasc Intervent Radiol.1998
;21:324–
328.
41.
Stiegmann GV, Goff JS, Silas D, Pearlman N, Sun J, Norton L.
Endoscopic versus operative gastrostomy: final results of a prospective
randomized trial. Gastrointest Endosc.1990
;36:1–
5.
42.
Ferguson DR, Harig JM, Kozarek RA, Kelsey PB, Picha GJ. Placement
of a feeding button (“One-Step Button”) as the initial procedure.
Am J Gastroenterol.1993
;88:501–
504.
43.
Marion MT, Zweng TN, Strodel WE. One-stage gastrostomy button: an
assessment. Endoscopy.1994
;26:666–
670.
44.
Kozarek RA, Payne M, Barkin J, Goff J, Gostout C. Prospective
multicenter evaluation of an initially placed button gastrostomy.
Gastrointest Endosc.1995
;41:105–
108.
45.
Ponsky JL, Aszodi A. Percutaneous endoscopic jejunostomy.
Am J Gastroenterol.1984
;79:113–
116.
46.
Adler DG, Gostout CJ, Baron TH. Percutaneous transgastric placement
of jejunal feeding tubes with an ultrathin scope. Gastrointest
Endosc.2003;55:106–
110.
47.
Adams GF, Guest DP, Ciraulo DL, Lewis PL, Hill RC, Barker DE.
Maximizing tolerance of enteral nutrition in severely injured trauma patients:
a comparison of enteral feedings by means of percutaneous endoscopic
gastrostomy versus percutaneous endoscopic gastrojejunostomy. J
Trauma.2000;48:459–
465.
48.
Fan AC, Baron TH, Rumalla A, Harewood GC. Comparison of direct
percutaneous endoscopic jejunostomy and PEG with jejunal extension.
Gastrointest Endosc.2002
;56:890–
894.
49.
Vanek VW. Ins and outs of enteral access: part 3: long-term access:
jejunostomy. Nutr Clin Pract.2003
;18:201–
220.
50.
Shike M, Schroy P, Ritchie MA, Lightdale CJ, Morse R. Percutaneous
endoscopic jejunostomy in cancer patients with previous gastric resection.
Gastrointest Endosc.1987
;33:372–
374.
51.
Shike M, Wallach C, Likier H. Direct percutaneous endoscopic
jejunostomies. Gastrointest Endosc.1991
;37:62–
65.
52.
Shike M, Latkany L, Gerdes H, Bloch AS. Direct percutaneous
endoscopic jejunostomies for enteral feeding. Gastrointest
Endosc.1996;44:536–
540.
53.
Shike M, Latkany L. Direct percutaneous endoscopic jejunostomy.
Gastrointest Endosc Clin North Am.1998
;8:569–
580.
54.
Rumalla A, Baron TH. Results of direct percutaneous endoscopic
jejunostomy, an alternative method for providing jejunal feeding.
Mayo Clin Proc.2000
;75:807–
810.
55.
Shetzline MA, Suhocki PV, Workman MJ. Direct percutaneous
endoscopic jejunostomy with small bowel enteroscopy and fluoroscopy.
Gastrointest Endosc.2001
;53:633–
638.
56.
Kobayashi K, Cooper GS, Chak A, Sivak MV Jr, Wong RC. A prospective
evaluation of outcomes in patients referred for PEG placement.
Gastrointest Endosc.2002
;55:500–
506.
57.
McClave SA, Chang WK. Complications of enteral access.
Gastrointest Endosc.2003
;58:739–
751.
58.
Amann W, Mischinger HJ, Berger A, et al. Percutaneous endoscopic
gastrostomy (PEG): 8 years of clinical experience in 232 patients.
Surg Endosc.1997
;11:741–
744.
59.
Martindale R, Witte M, Hodges G, Kelley J, Harris S, Andersen C.
Necrotizing fasciitis as a complication of percutaneous endoscopic
gastrostomy. JPEN J Parenter Enteral Nutr.1987
;11:583–
585.
60.
Preshaw RM. A percutaneous method for inserting a feeding
gastrostomy tube. Surg Gynecol Obstet.1981
;152:658–
660.
61.
Bleck JS, Reiss B, Gebel M, et al. Percutaneous sonographic
gastrostomy: method, indications, and problems. Am J
Gastroenterol.1998;93:941–
945.
62.
Cosentini EP, Sautner T, Gnant M, Winkelbauer F, Teleky B, Jakesz
R. Outcomes of surgical, percutaneous endoscopic, and percutaneous radiologic
gastrostomies. Arch Surg.1998;1076–
1083.
63.
Vanek VW. Ins and outs of enteral access: part 2: long term access:
esophagostomy and gastrostomy. Nutr Clin Pract.2003
; 18:50–
74.
64.
Gray RR, St. Louis EL, Grosman H. Modified catheter for
percutaneous gastrojejunostomy. Radiology.1989
;173:276–
278.
65.
Gray RR, Ho CS, Yee A, Montanera W, Jones DP. Direct percutaneous
jejunostomy. Am J Roentgenol.1987
;149:931–
932.
66.
Rosenblum J, Taylor FC, Lu CT, Martich V. A new technique for
direct percutaneous jejunostomy tube placement. Am J
Gastroenterol.1990;85:1165–
1167.
67.
Van Overhagen H, Ludviksson MA, Laméris JS, et al. US and
fluoroscopic-guided percutaneous jejunostomy: experience in 49 patients.
J Vasc Interv Radiol.2000
;11:101–
106.
68.
Stamm M. Gastrostomy: a new method. Med
News.1894;54:324–
326.
69.
Haggie JA. Laparoscopic tube gastrostomy. Ann Royal Coll
Surg Engl.1992;74:258–
259.
70.
Ho HS, Ngo H. Gastrostomy for enteral access: a comparison among
placement by laparotomy, laparoscopy, and endoscopy. Surg
Endosc.1999;13:941–
944.
71.
Bergstrom LR, Larson DE, Zinsmeister AR. Utilization and outcomes
of surgical gastrostomies and jejunostomies in a era of percutaneous
endoscopic gastrostomy: a population-based study. Mayo Clin
Proc.1995;70:829–
836.
