None listed
Conditions
Brief summary
Nutritional therapy is a vital component of standard care in critically ill patients, with nasogastric tubes being the preferred route of administration. Despite this, approximately 50% of patients fail to meet their caloric targets, potentially leading to adverse effects on clinical outcomes. Unsuccessful nasogastric feeding in the critically ill has many possible causes, but primary reflects delayed gastric emptying. As small-bowel motility remains relatively preserved, direct nutrient delivery into the duodenum may increase caloric intake. Furthermore, post-pyloric feeding may decrease the frequency of ventilator-associated pneumonia. However, inserting a post-pyloric feeding tube can be technically challenging, expensive, and requires a gastroenterologist which is not routinely available in the ICU. The Kangaroo feeding tube with IRIS technology has been specially designed to facilitate the insertion of feeding tubes post-pylorically by allowing clinicians to visualise insertion and duodenal placement. This visualisation feature may diagnose certain occult gastointestinal pathologies and obviate the need for radiological confirmation (abdominal x-ray), as is current practice. This prospective multicenter international cohort study will evaluate the success of this device in post-pyloric feeding tube insertion in critically ill patients.
Interventions
The Kangaroo feeding tube with IRIS technology placed post-pylorically in critically ill patients. In the ICU, as per standard care patients are assessed to determine whether there is a clinical requirement for post-pyloric feeding. To facilitate this, standard care dictates that a small feeding tube (i.e the Kangaroo feeding tube with IRIS technology), be inserted in the small intestine. This may be clinically indicated for a number of reasons, including large gastric residual volumes and decre
The Kangaroo feeding tube with IRIS technology placed post-pylorically in critically ill patients. In the ICU, as per standard care patients are assessed to determine whether there is a clinical requirement for post-pyloric feeding. To facilitate this, standard care dictates that a small feeding tube (i.e the Kangaroo feeding tube with IRIS technology), be inserted in the small intestine. This may be clinically indicated for a number of reasons, including large gastric residual volumes and decreased gastric motility. This study will be observing the success rate of the Kangaroo feeding tube with IRIS technology insertion, and no intervention outside of standard care will be carried out. The tube will be inserted by an ICU clinician once in each participant, and will remain in place as long as a post-pyloric feeding tube is clinically indicated in the participant. Once removed, the tube will only be reinserted if required in the opinion of the treating clinican. Study observation will only occur during insertion of the feeding tube (typically 30 minutes to one hour). The Kangaroo feeding tube with IRIS technology has a 3mm camera integrated within the tip that transmits images to a visual display. The picture quality is similar to the resolution obtained with the iPhone camera. The tube is single use, disposable, and has TGA approval for the intended purpose of ‘administration of nutrition, fluids and medications for patients who have an intact gastrointestinal tract but are physically unable to manage nutritional intake through normal mastication and deglutition'. The device has the potential to be superior to both the ‘blind’ placement of gastric tubes, and the endoscopic placement approach to post-pyloric tube insertion because it may facilitate more rapid placement, and the visualisation feature may diagnose certain occult gastrointestinal pathologies (e.g. ulceration), with fewer contraindications. Furthermore, direct visualisation of duodenal placement may eventually obviate the need for radiological confirmation (abdominal x-ray ~0.7mSv) as is current practice not only with 'blind' placement of gastric tubes but also endoscopically placed small intestinal catheter tubes.
Sponsors
Melbourne Health
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Critically-ill patients admitted to the ICU who: - require enteral feeding - are suitable to have a small intestinal feeding catheter inserted
Exclusion criteria
In the opinion of the treating clinician, there is a medical condition or concern that means that the patient would not be suitable for a post-pyloric tube, or there is a contraindication to post-pyloric tube placement.
Outcome results
None listed