GASTRIC TUBE PLACEMENT IN YOUNG CHILDREN

这个子项目是许多研究子项目中利用 资源由NIH/NCRR资助的中心拨款提供。子项目和 调查员(PI)可能从NIH的另一个来源获得了主要资金， 并因此可以在其他清晰的条目中表示。列出的机构是 该中心不一定是调查人员的机构。 当胃肠系统功能正常，预计短期内需要辅助喂养时，最好使用鼻胃/口胃(NG/OG)管喂养。据估计，在美国，每年大约有100万根肠道导管被放置在成人和儿童身上。对儿童的初步研究表明，其中21%到44%的管子放置不正确。当管子不到位时，儿童可能会受到严重伤害，导致发病率增加，有时甚至死亡。儿童输卵管放置的研究尤其不足。在这一人群中增加NG/OG喂养的安全性需要三个方面的知识发展--预测正确放置管子的插入距离，确定管子位置，以及保持正确的管子位置。拟议的研究解决了这些知识需求中的前两个问题。目的是确定预测放置NG/OG管的插入距离的最佳方法，以及确定插入NG/OG管后测试其位置的最佳临床方法。此外，由于二氧化碳监测仪以前没有经过充分的测试，本研究将提供有关该方法的关键初步信息。 样本将是300名需要胃管的100个月大的住院儿童。受试者将使用三个随机分配的插入长度预测指标之一放置输卵管：与年龄相关的、基于身高的；鼻子-耳朵-剑形；或鼻子-耳朵-中脐。插入后，立即通过测量管子内的二氧化碳(CO2)水平来测试管子的位置是否意外地错放到呼吸树中。下一步，将测量导管抽吸物的pH值和胆红素水平，以确定胃或肠道的位置。实际的导管位置将由腹部X线片确定，以评估插入长度预测和放置定位方法的充分性。Logistic回归将用于比较插入长度预测因子中意外错位的比例以及不同放置定位方法之间的准确性。这项研究的结果将增加幼儿使用胃管的安全性。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Feeding by a nasogastric/orogastric (NG/OG) tube is preferred when the gastrointestinal system is functional and the need for assisted feeding is expected to be short-term. It is estimated that approximately one million enteral tubes are placed in adults and children in the United States annually. Preliminary studies in children show that between 21% and 44% of these tubes are placed incorrectly. When tubes are out of place, children can be seriously harmed, causing increased morbidity and occasionally death. Tube placement in children is especially understudied. Increasing the safety of NG/OG feeding in this population requires knowledge development in three areas-predicting the insertion distance for correct tube placement, determining tube position, and maintaining correct tube positioning. The proposed study addresses the first two of these knowledge needs. Goals are to determine the best method to predict the insertion distance for placing NG/OG tubes and to determine the best clinical methods of testing the location of NG/OG tubes once they are inserted. In addition, because the CO2 monitor has not been adequately tested previously, this study will provide critical preliminary information about this method. The sample will be 300 hospitalized children < 100 months of age requiring gastric tubes. Subjects will have their tubes placed using one of three randomly assigned insertion-length predictors: age-related, height-based; nose-ear-xiphoid; or nose-ear-midumbilicus. Immediately after insertion the position of the tube will be tested for unsuspected misplacement into the respiratory tree by measuring carbon dioxide (CO2) levels within the tube. Next pH and bilirubin levels of tube aspirate will be measured to detect gastric or intestinal location. Actual tube location will then be determined by abdominal radiograph to assess the adequacy of both the insertion length predictors and placement-locating methods. Logistic regression will be used to compare the proportions of unsuspected misplacements among the insertion-length predictors and to compare the accuracies among the placement-locating methods. Results from this study will increase the safety of using gastric tubes in young children.