Respiratory Insufficiency Clinical Trial
Official title:
The Efficacy and Safety of Gastric Feeding in Critically Ill Pediatric Patients Receiving Non-invasive Positive Pressure Ventilation: A Pilot Study
The investigators are studying whether it is safe and effective to provide enteral nutrition to critically ill children via the nasogastric route, as opposed to the nasojejunal route, while they are receiving noninvasive positive pressure ventilation.
It has been our experience that the placement of post-pyloric tubes can be difficult, and
that these tubes frequently become obstructed and are difficult to replace, resulting in
lost caloric intake for the patient. The population where this is most relevant is children
receiving Noninvasive Positive Pressure Ventilation (NPPV). NPPV has become increasingly
popular in the Pediatric Intensive Care Unit (PICU) population, due to its perception as a
safe and effective alternative to mechanical ventilation via an endotracheal tube.
Historically, NPPV has been used in children with chronic respiratory insufficiency, but its
application for acute respiratory compromise is increasing. It has been shown to be
effective in disease states associated with hypoventilation, and is now also being applied
to respiratory problems leading to decreased oxygenation. Infants and children receiving
noninvasive ventilation for respiratory failure, which is often infectious in origin, have
significant caloric needs. However, it is our practice not to allow gastric feeding in these
patients due to the fear of gastric distension and vomiting, which carries a risk of
aspiration.
There is no data available on the question of efficacy and safety of gastric feeding in
critically-ill children supported by noninvasive ventilation. Given the ease of
(re)placement, and the potential nutritional benefit of earlier feeding provided by gastric
feeding, it seems clinically important to question the bias against this route of enteral
nutrition in noninvasively ventilated patients. The investigators therefore propose a pilot
randomized trial of gastric versus post-pyloric feeds in patients on NPPV.
;
Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Single Group Assignment, Masking: Single Blind (Outcomes Assessor), Primary Purpose: Treatment
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