Serum paracetamol concentration: an alternative to X-rays to determine feeding tube location in the critically ill

Détails

ID Serval
serval:BIB_ADAD356DF10A
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Serum paracetamol concentration: an alternative to X-rays to determine feeding tube location in the critically ill
Périodique
JPEN: Journal of Parenteral and Enteral Nutrition
Auteur(s)
Berger  M. M., Werner  D., Revelly  J. P., Cayeux  M. C., Tappy  L., Bachmann  C., Chiolero  R. L.
ISSN
0148-6071 (Print)
Statut éditorial
Publié
Date de publication
04/2003
Volume
27
Numéro
2
Pages
151-5
Notes
Journal Article --- Old month value: Mar-Apr
Résumé
BACKGROUND: Placement of enteral feeding tubes is an important clinical issue. Previous studies suggest that paracetamol absorption is very fast after jejunal administration. The aim was to determine whether paracetamol serum concentration measured by immunoassay can determine the tip position of the feeding tube. METHODS: Thirty-three critically ill patients requiring enteral nutrition with either gastric or post-pyloric feeding tubes were enrolled prospectively in the surgical intensive care unit of a university hospital. Paracetamol was administered in the feeding tube (15 mg/kg) after a baseline blood sample (T0). Thereafter, 8 blood samples were taken between 2.5 and 240 minutes. Paracetamol was analyzed using an automated homogenous immunoassay. RESULTS: The patients did not differ with respect to age or severity of disease. Peak paracetamol concentrations were significantly higher after post-pyloric administration with 42.6 +/- 13.5 versus 20.5 +/- 7.5 mg/L (p < .0001). Time-to-peak paracetamol concentration was significantly shorter with post-pyloric tubes (median, 5 versus 60 minutes; p < .0001). The receiver operating characteristic (ROC) curves showed the highest sensitivity and specificity at 5 minutes with 94.1% and 100%, respectively, for discriminating between gastric and post-pyloric location. CONCLUSIONS: Because of paracetamol's rapid absorption after jejunal administration, the test seems to be a safe and inexpensive alternative to X-ray control for assessment of the enteral feeding tube location. Its value in clinical practice remains to be established.
Mots-clé
Acetaminophen/blood/*pharmacokinetics Area Under Curve Critical Care Critical Illness/*therapy Enteral Nutrition/instrumentation/*methods Female Humans Immunoassay/methods/standards Intensive Care *Intubation, Gastrointestinal/methods Male Middle Aged Predictive Value of Tests Prospective Studies Pylorus Sensitivity and Specificity
Pubmed
Web of science
Création de la notice
24/01/2008 14:36
Dernière modification de la notice
20/08/2019 16:17
Données d'usage