Clinical Rounds

March 2010 
Volume 40  Number 3
Pages 19 - 21
  PDF Version Available!

To determine whether early postpyloric feeding offers an advantage over gastric feeding in critically ill patients, researchers studied 50 ICU patients on mechanical ventilation receiving postpyloric feeding and 54 receiving gastric feeding. The feeding tubes were placed by bedside ICU nurses who'd been trained to insert postpyloric tubes using a blind insertion technique. Nurses were required to pass a competency exam after completing training.The researchers found these benefits for patients in the gastric group: * a shorter time to initiation of feed * a shorter time to reach goal feed rate * lower average daily energy deficits.Finding no differences in length of stay, ventilator days, or complication rates between the two groups, researchers concluded that postpyloric feeding has no advantage over gastric feeding.Even so, postpyloric tube placement may be indicated for certain patients, such as those who can't tolerate gastric feeding. Placing these tubes endoscopically or under fluoroscopy has a high success rate, but these methods are costly and not always readily available, leading to significant delays in initiation of feeding. The researchers say their study shows that "bedside nursing staff can successfully and safely place postpyloric tubes in the majority of patients, potentially reducing delays in initiation of feeds."Source: White H, Sosnowski K, Tran K, Reeves A, Jones M. A randomized controlled comparison of early post-pyloric versus early gastric feeding to meet nutritional targets in ventilated intensive care patients. Crit Care. 2009;13(6):R187.New guidelines from the American Diabetes Association (ADA) recommend using the hemoglobin A1C blood test to diagnose type 2 diabetes and screen for prediabetes. This test has previously been used primarily to monitor blood glucose levels in patients known to have diabetes.Expressed as a percentage, A1C measures average blood glucose levels over 3 months. A normal reading is about 5%. Under the

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