Zusammenfassung
Hintergrund
Intensivpatienten scheinen von einer frühenteralen Ernährung über Sonden zu profitieren. Es wurden zwei Sondentypen untersucht, die bauartbedingt ohne technische Hilfsmittel selbstständig in das Jejunum vorwandern sollen. Die Zeitdauer bis zur erfolgreichen Platzierung, die Dauer bis zur kompletten enteralen Ernährung und möglicherweise auftretende Komplikationen wurden verglichen.
Patienten und Methode
Patienten, die frühenteral über eine Magensonde ernährt wurden und trotz Oberkörperhochlage sowie Prokinetikagabe einen erhöhten Reflux aufwiesen, erhielten nach dem Zufallsprinzip eine nasojejunale Tiger-Tube-Sonde (Cook) oder Bengmark-Sonde (Pfrimmer-Nutricia).
Ergebnis
Es wurden 28 Patienten einer chirurgischen Intensivstation in die Untersuchung aufgenommen. Es konnten 14 von 16 Tiger-Tubes erfolgreich platziert werden, von den 12 Bengmark-Sonden nur 2. In der Tiger-Tube-Gruppe wurde die vollständige Ernährung im Median nach 6, in der Bengmark-Gruppe nach 4 Tagen erreicht.
Schlussfolgerung
Verglichen mit der Bengmark-Sonde hat die Tiger-Tube-Sonde bei Intensivpatienten mit Magen-Darm-Atonie in Bezug auf die Platzierung eine höhere Erfolgsrate.
Abstract
Background
Critically ill patients with early enteral feeding seem to profit from post-pyloric administration. Two feeding tubes were studied that, due to their construction, are able to move into the duodenum without the necessity of technical support. The duration until successful positioning, time until total enteral feeding and possible complications were compared.
Patients and method
Patients with naso-gastric tubes and early enteral feeding, who had an increased reflux despite head of bed elevation and prokinetic drugs, were randomly assigned to either a Tiger tube (Cook) or a Bengmark tube (Pfrimmer Nutricia).
Results
A total of 28 patients from the surgical intensive care ward were included. Of the 16 Tiger tubes 14 could be successfully placed but only 2 out of the 12 Bengmark tubes. With Tiger tubes total enteral feeding was established within 6 days (median), with Bengmark tubes within 4 days.
Conclusion
In comparison to the Bengmark tube the Tiger tube has a higher success rate in terms of positioning in intensive care patients with impaired abdominal motility.
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Literatur
Berger MM, Bollmann MD, Revelly JP (2002) Progression rate of self-propelled feeding tubes in critically ill patients. Intensive Care Med 28: 1768–1774
Davies AR, Froomes PR, French CJ et al. (2002) Randomized comparison of nasojejunal and nasogastric feeding in critically ill patients. Crit Care Med 30: 586–590
Dubois A, Kopin IJ, Pettigrew KD, Jacobowitz DM (1974) Chemical and histochemical studies of postoperative sympathetic activity in the digestive tracts in rats. Gastroenterology 66: 403–407
Foote JA, Kemmeter PR, Prichard PA et al. (2004) A randomized trial of endoscopic and fluoroscopic placement of postpyloric feeding tubes in critically ill patients. JPEN J Parenter Enteral Nutr 28: 154–157
Gall JR le, Lemeshow S, Saulnier F (1993) A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA 270: 2957–2963
Haug K, Brügger L, Flüe M von (2004) Neue Aspekte in der Behandlung der postoperativen Darmatonie. Schweiz Med Forum 4: 108–114
Haslam D, Fang J (2006) Enteral access for nutrition in the intensive care unit. Curr Opin Clin Nutr Metab Care 9: 155–159
Heyland DK, Drover JW, MacDonald S (2001) Effect of postpyloric feeding on gastroesophageal regurgitation and pulmonary microaspiration: results of a randomized controlled trial. Crit Care Med 29: 1495–1501
Kalff JC, Carlos TM, Schraut WH et al. (1999) Surgically induced leukocytic infiltrates within the rat intestinal muscularis mediate postoperative ileus. Gastroenterology 117: 378–387
Kreymann KG, Berger MM, Deutz NE (2006) ESPEN Guidelines on Enteral Nutrition: Intensive care. Clin Nutr 25: 210–223
Lai CW, Barlow R, Barnes M, Hawthorne B (2003) Bedside placement of nasojejunal tubes: a randomised-controlled trial of spiral- vs straight-ended tubes. Clin Nutr 22: 267–270
Mann C, Pouzeratte Y, Boccara G et al. (2000) Comparison of intravenous or epidural patient-controlled analgesia in the elderly after major abdominal surgery. Anesthesiology 92: 433–441
Marik PE, Zaloga GP (2001) Early enteral nutrition in acutely ill patients: a systematic review. Crit Care Med 29: 2264–2270
Mentec H, Dupont H, Bocchetti M et al. (2001) Upper digestive intolerance during enteral nutrition in critically ill patients: frequency, risk factors, and complications. Crit Care Med 29: 1955–1961
Ott L, Annis K, Hatton J et al. (1999) Postpyloric enteral feeding costs for patients with severe head injury: blind placement, endoscopy, and PEG/J versus TPN. J Neurotrauma 16: 233–242
Vincent JL, Moreno R, Takala J et al. (1996) The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 22: 707–710
Winter BY de (2003) Study of the pathogenesis of paralytic ileus in animal models of experimentally induced postoperative and septic ileus. Verh K Acad Geneeskd Belg 65: 293–324
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Schröder, S., van Hülst, S., Raabe, W. et al. Nasojejunale Ernährungssonden bei Intensivpatienten. Anaesthesist 56, 1217–1222 (2007). https://doi.org/10.1007/s00101-007-1260-3
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DOI: https://doi.org/10.1007/s00101-007-1260-3