Background: Aspiration is one of the leading complications for patients receiving enteral nutrition. Patients who experience an aspiration event are vulnerable to developing aspiration pneumonia further complicating their stay and increasing the risk of mortality. ¹ Some known risk factors for aspiration include a decreased level of consciousness, supine position, and bolus feeding. Therefore, we hypothesized that additional risk factors exist in the trauma patient population that increase the chance of aspiration when receiving enteral feeding. The goal of this project was to identify any factors placing the patient at higher risk for aspiration that could indicate the need for modified approach to tube feed administration.

Methods: After obtaining IRB approval, we retrospectively reviewed trauma patients charts at the Level 1 Fanny Meisler Trauma Center over a two-year span who received tube feeds while being monitored in a non-ICU level of care. Using this patient database we recorded route and method of tube feeding, spinal fractures, spinal cord injury, if the patient had prolonged need for a cervical collar, and age. Univariate analysis was then performed looking for statistical significance of the above factors (p value < 0.05)

Results: A query of the trauma patient database for the two-year span resulted in 742 patients for us to assess. Out of these patients, 154 (21%) were found to have been on tube feeds while in a non-ICU level of care. From that group, 19 (12%) patients were found to have experienced an aspiration event. The results for the other criteria assessed are listed below.

Route of Feeding: 56% of Non-ICU Tube Fed patients receiving PEG tube feeds experienced an aspiration event. 27% of Non-ICU Tube Fed patients receiving either NGT or OGT feedings experienced an aspiration event. 42% of Non-ICU Tube Fed patients receiving Duotube feeds experienced an aspiration event.

Method of Feeding: 141 (88%) non-ICU Tube Fed patients were strictly on Continuous feeds. 20 (12%) non-ICU Tube Fed patients were strictly on Bolus feeds. 1 (0.6%) non-ICU Tube Fed patient was on a mix of Continuous and Bolus feeds. 15 (10%) patients on Continuous feeds experienced an aspiration while 3 (15%) of patients on Bolus feeds experienced an aspiration. 1 (100%) patient on a mixture of Continuous and Bolus feeds aspirated.

Spinal Fracture: 50 (32%) non-ICU Tube Fed patients experienced a spinal fracture. 7 (37%) of patients experienced an aspiration event also had a spinal fracture

Spinal Cord Injury: 14 (10%) non-ICU Tube Fed patients experienced a spinal cord injury. 2 (11%) of patients who experienced an aspiration event had a spinal cord injury.

Prolonged Use of Cervical Collar:  53 (34%) Non-ICU Tube Fed patients had prolonged Cervical Collar use during their stay. 10 (53%) of the patients who experienced an aspiration event had prolonged use of a cervical collar during their stay.

Geriatric Age: 52 (34%) Non-ICU Tube Fed patients were of geriatric age. 7 (37%) of those patients experienced an aspiration event.

Conclusion: Based on these results, further evaluation needs to be done with a larger population to assess. Our study was limited by the two-year time span we decided to use and number of patients we reviewed

References and Resources

1. Shai Gavi D.O., et. al. Management of Feeding Tube Complications in the Long- Term Resident Care. Annals of Long-Term Care. April 2008.
2. James S. Scolapio M.D.. Decreasing Aspiration Risk With Enteral Feeding. Gastrointestinal Endoscopy Clinics of North America. October 2007.
   University of Western Ontario, Department of Critical Care. Post-pyloric versus gastric tube feeding for preventing pneumonia and improving nutritional outcomes in critically ill adults. Cochrane Library. August 2015.
3. Stephen A. McClave M.D., et al. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient. January 2016.
4. Irina Blumenstein, et al. Gastroenteric Tube Feeding: Techniques, Problems, and Solutions. World Journal of Gastroenterology. July 2014.