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Nasal bridling decreases feeding tube dislodgment and may increase caloric intake in the surgical intensive care unit: A randomized, controlled trial*

Seder, Christopher W. MD; Stockdale, William RN; Hale, Linda RN; Janczyk, Randy J. MD, FACS

doi: 10.1097/CCM.0b013e3181c311f8
Clinical Investigations

Objective: To determine whether nasal bridling is a low-morbidity practice that decreases feeding tube dislodgment and results in improved caloric intake.

Design: Randomized, controlled trial.

Setting: Private, tertiary-care referral center.

Patients: A total of 80 surgical intensive care unit patients requiring nasojejunal feeding.

Intervention: Nasal bridling of feeding tubes.

Measurements and Main Results: Between January 1, 2008 and July 31, 2008, 80 patients were randomized to have their nasojejunal feeding tubes secured with either a nasal bridle or an adhesive device. Baseline characteristics examined included age, sex, concurrent nasogastric tube presence, primary diagnosis, Acute Physiology and Chronic Health Evaluation III score, need for mechanical ventilation, need for emergent surgery, Riker Sedation Score, and Glascow Coma Scale. Patients were monitored daily for prevalence and cause of feeding tube removal, percentage of goal calories received, nasal ulceration, and sinusitis. Serum albumin and prealbumin levels were collected weekly. All patients were examined, using an intention-to-treat design. Except for a higher prevalence of emergent surgery in the bridled patients, the bridled and unbridled groups had no difference in baseline characteristics. Bridled tubes were less likely to be unintentionally dislodged than unbridled tubes (18% vs. 63%, p < .0001) resulting in bridled patients receiving a higher percentage of goal calories (median 78% [interquartile range, 65%–86%] vs. 62% [interquartile range, 47%–80%], p = .016) than unbridled patients. There were five cases of mild epistaxis upon bridle insertion and four cases of superficial nasal ulceration associated with the bridle. No bridled patients were diagnosed with sinusitis during the study period. Serum albumin and prealbumin levels did not differ between the groups.

Conclusions: Bridling of nasoenteric feeding tubes in critically ill patients is a low-morbidity practice that reduces the rate of unintentional tube dislodgment and may result in improved caloric intake.

From the Departments of Surgery (CWS, RJJ) and Nutritional Support Services (WS, LH), William Beaumont Hospitals, Royal Oak, MI.

Presented, in part, at the Society of Critical Care Medicine 38th Critical Care Congress, January 31–February 4, 2009, Nashville, TN.

The authors have not disclosed any potential conflicts of interest.

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© 2010 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins