Stomach position evaluated using computed tomography is related to successful post-pyloric enteral feeding tube placement in critically ill patients: a retrospective observational study
Abstract Background Post-pyloric enteral feeding reduces respiratory complications and shortens the duration of mechanical ventilation. Blind placement of post-pyloric enteral feeding tubes (EFT) in patients with critical illnesses is often the first-line method because endoscopy or fluoroscopy cann...
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| Format: | Article |
| Language: | English |
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BMC
2023-05-01
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| Series: | Journal of Intensive Care |
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| Online Access: | https://doi.org/10.1186/s40560-023-00673-4 |
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| author | Masashi Yokose Shunsuke Takaki Yusuke Saigusa Takahiro Mihara Yoshinobu Ishiwata Shingo Kato Keiichi Horie Takahisa Goto |
| author_facet | Masashi Yokose Shunsuke Takaki Yusuke Saigusa Takahiro Mihara Yoshinobu Ishiwata Shingo Kato Keiichi Horie Takahisa Goto |
| author_sort | Masashi Yokose |
| collection | DOAJ |
| description | Abstract Background Post-pyloric enteral feeding reduces respiratory complications and shortens the duration of mechanical ventilation. Blind placement of post-pyloric enteral feeding tubes (EFT) in patients with critical illnesses is often the first-line method because endoscopy or fluoroscopy cannot be easily performed at bedside; however, difficult placements regularly occur. We reported an association between the stomach position caudal to spinal level L1–L2, evaluated by abdominal radiographs after placement, and difficult placement; however, this method could not indicate difficulty before EFT placement. The aim of our study was to evaluate the association between stomach position, estimated using computed tomography (CT) images taken before the blind placement of the post-pyloric EFT, and the difficulty of EFT placement. Methods Data from patients aged ≥ 20 years who underwent post-pyloric EFT in our intensive care unit were obtained retrospectively. Logistic regression analysis was used to evaluate the association between successful initial EFT placement and explanatory variables, including stomach position estimated by CT. Two cut-off values were used: caudal to L1–L2 based on a previous study and the best cut-off value calculated by the receiver operating characteristic curve. Variable selection was performed backward stepwise using Akaike's Information Criterion. Results Of the total of 453 patients who were enrolled, the success rate of the initial EFT placement was 43.5%. The adjusted odds ratio for successful initial EFT placement of the stomach position caudal to L1–L2 was 0.61 (95% confidence interval: 0.41–1.07). Logistic regression analysis, including the stomach position caudal to L2–L3, calculated as the best cut-off value, indicated that stomach position was an independent factor for failure of initial EFT placement (adjusted odds ratio, 0.55; 95% confidence interval: 0.33–0.91). Conclusions Stomach position evaluated using CT images was associated with successful initial post-pyloric EFT placement. The best cut-off value of the greater curvature of the stomach to predict the success or failure of the first attempt was spinal level L2–L3. Trial registration University Hospital Medical Information Network Clinical Trials Registry (UMIN000046986; February 28, 2022). https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000052151 |
| first_indexed | 2024-03-13T07:30:12Z |
| format | Article |
| id | doaj.art-20490a49fbfd493fb924da2d6101b65b |
| institution | Directory Open Access Journal |
| issn | 2052-0492 |
| language | English |
| last_indexed | 2024-03-13T07:30:12Z |
| publishDate | 2023-05-01 |
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| series | Journal of Intensive Care |
| spelling | doaj.art-20490a49fbfd493fb924da2d6101b65b2023-06-04T11:07:41ZengBMCJournal of Intensive Care2052-04922023-05-0111111010.1186/s40560-023-00673-4Stomach position evaluated using computed tomography is related to successful post-pyloric enteral feeding tube placement in critically ill patients: a retrospective observational studyMasashi Yokose0Shunsuke Takaki1Yusuke Saigusa2Takahiro Mihara3Yoshinobu Ishiwata4Shingo Kato5Keiichi Horie6Takahisa Goto7Department of Anesthesiology and Critical Care Medicine, Yokohama City University Graduate School of MedicineDepartment of Anesthesiology and Critical Care Medicine, Yokohama City University Graduate School of MedicineDepartment of Biostatistics, Yokohama City University Graduate School of MedicineDepartment of Anesthesiology and Critical Care Medicine, Yokohama City University Graduate School of MedicineDepartment of Diagnostic Radiology, Yokohama City University Graduate School of MedicineDepartment of Diagnostic Radiology, Yokohama City University Graduate School of MedicineDepartment of Diagnostic Radiology, Yokohama City University Graduate School of MedicineDepartment of Anesthesiology and Critical Care Medicine, Yokohama City University Graduate School of MedicineAbstract Background Post-pyloric enteral feeding reduces respiratory complications and shortens the duration of mechanical ventilation. Blind placement of post-pyloric enteral feeding tubes (EFT) in patients with critical illnesses is often the first-line method because endoscopy or fluoroscopy cannot be easily performed at bedside; however, difficult placements regularly occur. We reported an association between the stomach position caudal to spinal level L1–L2, evaluated by abdominal radiographs after placement, and difficult placement; however, this method could not indicate difficulty before EFT placement. The aim of our study was to evaluate the association between stomach position, estimated using computed tomography (CT) images taken before the blind placement of the post-pyloric EFT, and the difficulty of EFT placement. Methods Data from patients aged ≥ 20 years who underwent post-pyloric EFT in our intensive care unit were obtained retrospectively. Logistic regression analysis was used to evaluate the association between successful initial EFT placement and explanatory variables, including stomach position estimated by CT. Two cut-off values were used: caudal to L1–L2 based on a previous study and the best cut-off value calculated by the receiver operating characteristic curve. Variable selection was performed backward stepwise using Akaike's Information Criterion. Results Of the total of 453 patients who were enrolled, the success rate of the initial EFT placement was 43.5%. The adjusted odds ratio for successful initial EFT placement of the stomach position caudal to L1–L2 was 0.61 (95% confidence interval: 0.41–1.07). Logistic regression analysis, including the stomach position caudal to L2–L3, calculated as the best cut-off value, indicated that stomach position was an independent factor for failure of initial EFT placement (adjusted odds ratio, 0.55; 95% confidence interval: 0.33–0.91). Conclusions Stomach position evaluated using CT images was associated with successful initial post-pyloric EFT placement. The best cut-off value of the greater curvature of the stomach to predict the success or failure of the first attempt was spinal level L2–L3. Trial registration University Hospital Medical Information Network Clinical Trials Registry (UMIN000046986; February 28, 2022). https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000052151https://doi.org/10.1186/s40560-023-00673-4Enteral nutritionPost-pyloric feedingIntensive care unitGreater curvature of stomachComputed tomography |
| spellingShingle | Masashi Yokose Shunsuke Takaki Yusuke Saigusa Takahiro Mihara Yoshinobu Ishiwata Shingo Kato Keiichi Horie Takahisa Goto Stomach position evaluated using computed tomography is related to successful post-pyloric enteral feeding tube placement in critically ill patients: a retrospective observational study Journal of Intensive Care Enteral nutrition Post-pyloric feeding Intensive care unit Greater curvature of stomach Computed tomography |
| title | Stomach position evaluated using computed tomography is related to successful post-pyloric enteral feeding tube placement in critically ill patients: a retrospective observational study |
| title_full | Stomach position evaluated using computed tomography is related to successful post-pyloric enteral feeding tube placement in critically ill patients: a retrospective observational study |
| title_fullStr | Stomach position evaluated using computed tomography is related to successful post-pyloric enteral feeding tube placement in critically ill patients: a retrospective observational study |
| title_full_unstemmed | Stomach position evaluated using computed tomography is related to successful post-pyloric enteral feeding tube placement in critically ill patients: a retrospective observational study |
| title_short | Stomach position evaluated using computed tomography is related to successful post-pyloric enteral feeding tube placement in critically ill patients: a retrospective observational study |
| title_sort | stomach position evaluated using computed tomography is related to successful post pyloric enteral feeding tube placement in critically ill patients a retrospective observational study |
| topic | Enteral nutrition Post-pyloric feeding Intensive care unit Greater curvature of stomach Computed tomography |
| url | https://doi.org/10.1186/s40560-023-00673-4 |
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