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Báo cáo y học: "Feed the ICU patient ‘gastric’ first, and go post-pyloric only in case of failure"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học quốc tế cung cấp cho các bạn kiến thức về ngành y đề tài: Feed the ICU patient ‘gastric’ first, and go post-pyloric only in case of failure. | Berger and Soguel Critical Care 2010 14 123 http ccforum.eom content 14 1 123 CRITICAL CARE COMMENTARY L__ Feed the ICU patient gastric first and go post-pyloric only in case of failure Mette M Berger1 and Ludivine Soguel2 See related research by White etal. http ccforum.eom content 13 6 R187 Abstract In a randomised trial comparing early enteral feeding by gastric and post-pyloric routes White and colleagues have shown that gastric feeding is possible and efficient in the vast majority of critically ill patients. But the authors conclusion that gastric is equivalent to post-pyloric is true in only the least severe patients. Given the extra workload and costs post-pyloric is now clearly indicated in case of gastric feeding failure. Randomised trials contribute to the determination of optimal nutritional treatment strategies. In a well-designed study reported in the previous issue of Critical Care White and colleagues 1 have investigated the impact of gastric versus post-pyloric PP route on early enteral feeding efficiency. Several interesting results are presented. First the authors achieved a remarkable 80 successful blind PP tube placement. They showed that the usual delay in initiation of PP feeding due to tube placement techniques 2 can be minimized by bedside tube placement by trained nurses. But although gastric enteral nutrition EN can be initiated faster median 2.3 hours earlier than the PP achieving the energy target 3.6 hours earlier the difference is minor. The authors should be congratulated on a very efficient feeding protocol to be able to initiate EN within 3 to 13 hours of admission and to achieve the target 3 to 5 hours later is great. Complications did not differ significantly between groups pneumonias 5 in the gastric group versus 11 in the PP group . The authors attempted to solve the controversy of gastric versus post-pyloric feeding in critical illness after Correspondence mette.berger@chuv.ch Service of Adult Intensive Care and Burns