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Postpylorische Ernährungssonden bei operativen Intensivpatienten

Pilotserie zur Bewertung von zwei Methoden zur bettseitigen Anlage

Postpyloric feeding tubes for surgical intensive care patients

Pilot series to evaluate two methods for bedside placement

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Zusammenfassung

Intensivpatienten scheinen von einer frühenteralen Ernährung über Sonden zu profitieren. Für die Untersuchung werden Sonden zur postpylorischen Ernährung der Firmen Cook (Tiger 2™) und PortaMedical (Corflo-Tube®) hinsichtlich der Zeitdauer der erfolgreichen Platzierung geprüft. Die Tiger-2™-Sonde wird mit dem Argument beworben, dass sie bauartbedingt (nichtinvasiv) selbstständig durch eine geringe Restperistaltik über den Magen in das Jejunum wandern kann. Die Corflo-Tube®-Sonde wird ebenfalls bettseitig platziert und zwar aktiv mit Unterstützung eines Detektors und Monitors, auf dem der Verlauf der magnetisierten Spitze vom Mandrin beim Sondenvorschub abgebildet wird. Patienten, die frühenteral über eine Magensonde ernährt werden und trotz Oberkörperhochlage und der Gabe von Prokinetika einen erhöhten Reflux aufweisen, erhalten nach dem Zufallsprinzip entweder eine Tiger-2™- oder Corflo-Tube®-Sonde. Es wurden 41 Patienten einer operativen Intensivstation in die Studie aufgenommen. Es konnten 13 von 20 Tiger-2™-Sonden (65%) und 16 von 21 Corflo-Tube®-Sonden (76%) erfolgreich platziert werden (p>0,05). Die Platzierungsdauer war mit den Corflo-Tube®-Sonden im Median mit 0,83 h (Spannweite 0,06–2,5 h) im Vergleich zu den Tiger-2™-Sonden im Median mit 24 h (Spannweite 2–72 h) signifikant kürzer (p<0,001). Beide Gruppen unterschieden sich nicht signifikant hinsichtlich der postpylorischen Liegedauer der Sonden und des Erreichens der vollständigen enteralen Ernährung bis zum errechneten individuellen Kalorienbedarf. Durch ihre einfache Handhabung und schnelle Verfügbarkeit stellen die Sonden eine gute Alternative zu aufwendigeren Verfahren dar. Sie ermöglichen die zügige Applikation enteraler Ernährung und haben auch als Versuch eine gerechtfertigte Indikation, wenn die Möglichkeit der endoskopischen Anlage postpylorischer Sonden fehlt, z. B. an Wochenenden oder bei logistischen Engpässen.

Abstract

Bedside placement of postpyloric feeding tubes in surgical intensive care patients: a pilot series to evaluate two methods. Early enteral feeding is thought to be a key factor in maintaining the integrity of the gastrointestinal tract mucosal barrier associated with less bacterial translocation and decreased stimulation of the systemic inflammatory response and subsequent improved outcome in intensive care patients. Thus enteral feeding by nasogastric tubes is the preferred route of nutritional support for most surgical intensive care patients. However, intensive care patients with delayed gastric emptying and poor intestinal motility may not tolerate gastric feeding and may therefore benefit from postpyloric feeding. Postpyloric feeding tube placement may be achieved by endoscopic procedures or different bedside techniques with variable success. In the present study two feeding tubes for bedside postpyloric placement without endoscopic assistance were compared. The time to successful positioning was compared for jejunal feeding tubes from the companies Cook (Tiger 2™) and PortaMedical (Corflo-Tube®). The description for the Tiger 2™ states that because of its design slight residual peristalsis can cause it to migrate from the stomach to the jejunum. The Corflo-Tube® is also positioned at the bedside with the help of a detector and a monitor which maps the movements of the magnetic tip of the mandrin as it is pushed forward. Patients receiving early enteral nutrition through a gastric tube and exhibiting enhanced reflux, in spite of the head of the bed being raised and the administration of prokinetics randomly received either a Tiger 2™ or a Corflo-Tube®. The study included 41 patients from an intensive care ward for surgical patients and 13 out of 20 Tiger 2™-Tubes (65%) and 16 out of 21 Corflo-Tubes® (76%) were successfully positioned (p>0.05). The median time to successful positioning with the Corflo-Tubes® was 0.83 h (range 0.06–2.5 h), which was significantly shorter than the 24 h (range 2–72 h) found with the Tiger 2™ (p<0.001). There was no significant difference between the groups with respect to the period between the insertion of the tubes and the attainment of complete enteral nutrition, corresponding to the calculated individual calorie requirements. These tubes offer a good alternative to more demanding procedures as they are easy to handle and rapidly available. They confer clinical and cost advantages in terms of the early establishment of enteral feeding, no routine X-ray confirmation in the case of the Corflo-Tube® and avoidance of endoscopic guidance for tube placement or parenteral nutrition. In addition they are always justified in the event of a lack of endoscopic positioning.

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Interessenkonflikt

Frau Claussen und Herr Schröder beteiligen sich an praktischen Einweisungen zur Anlage postpylorischer Ernährungssonden der Fa. PortaMedical, beziehen aber kein Honorar. Alle anderen Autoren geben keinen Interessenkonflikt an.

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Authors and Affiliations

  1. Klinik für Anästhesie und Intensivmedizin, Westküstenklinikum Heide, Esmarchstr. 50, 25746, Heide, Deutschland

    S. Schröder, S. van Hülst, M. Claussen, K. Petersen, B. Pich & T. von Spiegel

  2. Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Kiel, Deutschland

    B. Bein

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  1. S. Schröder
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  2. S. van Hülst
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  3. M. Claussen
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  4. K. Petersen
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  5. B. Pich
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  6. B. Bein
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  7. T. von Spiegel
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Correspondence to S. Schröder.

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Schröder, S., van Hülst, S., Claussen, M. et al. Postpylorische Ernährungssonden bei operativen Intensivpatienten. Anaesthesist 60, 214–220 (2011). https://doi.org/10.1007/s00101-010-1814-7

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  • DOI: https://doi.org/10.1007/s00101-010-1814-7

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