Continuation of transpyloric feeding during weaning of mechanical ventilation and tracheal extubation in children: a randomized controlled trial

Abstract

BACKGROUND: Nutrition support is essential in the management of critically ill children. There is no current literature to support the common practice of discontinuing enteral nutrition delivered through a transpyloric feeding tube during the tracheal extubation process. We conducted a prospective, randomized controlled trial in mechanically ventilated children to examine the safety and efficacy of continuous transpyloric feeding compared with interrupted transpyloric feeding at the time of tracheal extubation. METHODS: Subjects were randomly assigned to receive transpyloric feeding throughout the tracheal extubation process (Continuous Group) or to have transpyloric feeding discontinued 4 hours before tracheal extubation and restarted 4 hours after tracheal extubation (Interrupted Group). Data consisting of patient demographics, admission pediatric risk of mortality (PRISM) score, diagnoses, adverse events (feeding intolerance, gastroesophageal reflux, and pulmonary aspiration), daily feeding volume, and caloric intake were recorded for the 3 days surrounding tracheal extubation. RESULTS: Fifty-nine patients completed the study (29 in Continuous Group, 30 in Interrupted Group). There was no episode of pulmonary aspiration in either group. The Continuous Group experienced 4 adverse events, whereas the Interrupted Group experienced 3 adverse events (p = not significant). The Continuous Group received 92 +/- 2.5% of their caloric goal on the day of weaning from the ventilator (day 1) and 93 +/- 3.2% on the day of tracheal extubation (day 2) compared with 76 +/- 4.2% and 43 +/- 4.3%, respectively, in the Interrupted Group (p < .004 and p < .0001, respectively). CONCLUSIONS: Continuous transpyloric feeding during weaning from the ventilator and tracheal extubation is safe and results in the delivery of more optimal nutrition.

Nutrition support is essential in the management of critically ill children. Current practice involves discontinuing enteral nutrition before tracheal extubation to reduce the risk of pulmonary aspiration. This study shows that continuous transpyloric feeding during tracheal extubation is safe and results in the delivery of more optimal nutrition.