In my experience we stop the tube feedings too early and for too longer in weaning patients and especially in copd patients who are already nutritionally poor. Cant we run the tube feeds continuously and if breathing trial is successful can then attach a suction to OG tube and suck the tube feeds out to avoid stimulating gag reflex and avoiding aspiration ?
We don't stop tube feeding for a weaning trial. We just need to suck the gastric tube to ensure there is no large gastric residual volume
Stopping of tube feeds would only be needed in situations where aspiration is feared....as in (anticipated) extubation failure needing reintubation.
We do not stop feeds for weaning trials. Prior to extubation we hold the immediate feed ( if bolus) .
Sandeep,
I concur with Zhongheng and Swagata. I would add that bedside, trans abdominal, gastric ultrasound for residual measurements would be preferential than oral or nasal gastric tube placement.
Happy New Year!
Christopher
It is about practice more than evidence. The main goal is for an empty stomach if re-intubation will happen. As such, shorter feed stop, only if extubation, NG suction, anti-emetic prokinetics, gastric ultrasound - may all help.
However, I think the main issue is the increasingly frequent NIV post-extubation of COPD patients, with increased risk of vomiting and underfeeding. Optiflow is one of the solutions!
Agreed.....as long as we know that the intra-gastric volume is low,then you have a measure of safety regarding potential re-intubation and vomiting.
Optiflow is a very useful adjunct as Ashraf has said,and one that can sometimes preclude intubation in the first place,aside from facilitating adequate vetilation post-extubation.
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