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Ultrasound-Guided Postpyloric Feeding Tube Placement in Critically Ill Pediatric Patients*

Supplemental Digital Content is available in the text. OBJECTIVES: Various methods to insert postpyloric feeding tubes at the bedside have been reported, but the optimal method remains controversial. The objective of this study was to evaluate the effect of ultrasound-guided postpyloric feeding tube placement in critically ill children. DESIGN: Single-center retrospective observational study. SETTING: PICU of tertiary children’s hospital. PATIENTS: Children under the age of 16 who underwent postpyloric feeding tube placement in our PICU between September 2017 and August 2019. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A total of 115 patients were included in this study: 30 patients underwent ultrasound-guided postpyloric feeding tube placement and 85 patients underwent blind postpyloric feeding tube placement; the insertion attempts were 32 and 93, respectively. There were no significant differences in patient demographics between the ultrasound-guided group and the blind group. The first-pass success rate of the ultrasound-guided group was higher than that of the blind group (94% [30/32] vs 57% [53/93]; p < 0.001). The median insertion time in the ultrasound-guided group with successful postpyloric feeding tube insertion was 18 minutes (interquartile range, 15–25; range, 8–45; n = 21). There were no complications or adverse events during the placement. CONCLUSIONS: In this single-center study, ultrasound-guided postpyloric feeding tube placement was feasible and a significantly high first-pass success rate was observed for critically ill children. Additional investigation with a larger pool of operators and randomized controlled patient assignment is required.