Aspiration And Gastric Residual In NICU Patients Receiving Enteral Nutrition

Objective:To describe the correlation between aspiration and gastric residual(the gastric residual volumes and the consistency of gastric residual)in the patients of NICU and explore the influencing factors of gastric residual concentration.Methods:Collected patients from NICU of First Hospital of Shanxi Medical University from June 2016 to December 2016,who met the following criterias:more than 18 years old,fed via nasogastric diet with enteral nutrition of four days or more.Exclusion criterions were physician-diagnosed gastroesophageal reflux,serious lung diseases,gastrointestinal bleeding and the patients of congenital malformations in the digestive tract at the time of enrollment.All patients were fed by at the head of a bed up 30 ° to 45 ° and used the same type of nasogastric tube,nasal bowel loops.The nasal feeding nutrient solutions used were enteral nutrition emulsion TPF-T,enteral nutrition emulsion TPF-D,enteral nutrition emulsion TP-HE and enteral nutrition mixed suspension TPF1.5.When patients received nasogastric enteral nutrition emulsion,we withdrawed gastric residual Q4 h during 10:00-22:00 a day.Meanwhile,using the handheld refractometer measure the refractive index of gastric contents and calculate the gastric residual volume and the residual concentration.Asked the professional nurses to collect sputum specimens,then the pepsin of sputum specimens were detected by ELISA method.The patients were divided into frequent aspirators and infrequent aspirators by the results of pepsin content test.According to the consistency of gastric residual,the patients were divided into high,medium and low residual concentration groups.An analysis of whether there was a significant difference between the two groups on gastric residual volume and the residual concentration,exploring the influencing factors of the consistency of gastric residual.Results:1.The study included 30 cases of NICU patients in total,of these,male 22 cases,8 patients were female,age 36-83 years old,the average age was 59.83±14.82 years old.The GCS score of all cases was 3 to 15 points,with an average of 8.10±3.01,the APACHE ? score was 14-38,the average score 24.93±6.12.In all patients,the gastric residual volume ranged frome 0 to 310 ml,the average was(23.02 + 27.78)ml,gastric residual concentration ranged from 0 to 100%,the average(50.28 + 28.13)%.19 cases were cerebrovascular disease,11 cases of non-cerebrovascular disease,the NIHSS score of cerebrovascular disease arranged 9-43 points,an average of 24.79±9.07.In all patients with tracheal intubation in 5 cases,tracheotomy in 2 cases,breathing machine auxiliary breathing in 4 cases.A total of 174 sputum specimens were collected.2.A value of 6.5 ng/m L or greater was considered positive for aspiration of gastric contents,those having >25% pepsin-positive tracheal secretions were divided into frequent aspiration group,those having 0% to 25% pepsinpositive tracheal secretions were divided into infrequent aspiration group.Frequent aspiration group,a total of 16 people,the infrequent aspiration group of 14 people.In the frequent aspiration group,GCS score was 7.06±2.79,however,in the infrequent aspiration group,GCS score was 9.29±2.89,there is statistically significant difference between two groups(P values was 0.041).There was no statistically significant difference between two groups in age,gender,and the way of tube feedings.3.The gastric residual volume of frequent aspiration group was(27.30±29.75)ml,the frequent aspiration group was(18.13±25.55)ml,the difference between the two groups has no statistical significance(P=0.376).Compared with the two group,the times of increase in gastric residual volum(50,100,150 ml)also has no statistical difference.4.The concentration of gastric residual in frequent aspiration group was higher than the frequent aspiration group,respectively was(59.70 ± 28.11)%?(39.53 ± 24.90)%(P=0.048).Compared the number of occurrences of different gastric residual concentration in the two groups,gastric residual concentration of at least 1 time in 60%,70%,80% or more,the difference between the two groups has no statistical significance,however,when there are at least three times gastric residual concentration ?60%,70%,more frequent of aspiration.The number of gastric residual concentration ?80% appear at least 2 times or at least one time it was?90%,which was much higher in frequent aspiration group than in frequent aspiration group.5.According to the gastric residual concentration,patients were divided into < 30%,30%-60% and > 30% group(low concentration of gastric remnant,medium gastric residual concentration and high gastric residual concentration).Compared with NICU patients in low,medium and high concentration of gastric residual groups,the difference of GCS score was statistically significant;The way of nasogastric also statistically significant difference between the three groups.There is no statistically significant difference between the three groups of age,gender,and APACHE ?score.Conclusion:For the patients of NICU with nasogastric enteral nutrition,monitoring the gastric residual volume can't be used to assess the risk of aspiration,frequent aspiration is still happen even when gastric residual volume is low.Aspiration occurs more commonly in patients with gastric residual concentration increased,monitoring gastric residual concentration and the number of times of the residual concentration increased can be used to assess the risk of frequent aspiration.The gastric residual concentration is influenced by the level of consciousness and the way of nasal feeding,the post-pyloric feeding tube can obviously decrease the gastric residual concentration.