Comparison of immunoglobulin and malaria antibody values in rural Kenyans.

These two cases illustrate eight instances of aspiration of fine bore enteral feed. On three occasions the tube remained correctly placed and on five occasions the tube was noted to be in the oropharynx. Fine bore enteral feeding is popular in intensive care units because ofthe high patient acceptability and ease ofmanagement in conjunction with continuous feeding pumps. Severely ill patients, however, and those with either endotracheal or tracheostomy tubes in situ, have an impaired cough reflex. Gastric ileus is also common in these patients, predisposing to reflux or regurgitation especially in the supine position. The presence of a cuffed endotracheal or tracheostomy tube does not prevent aspiration. The narrow bore of the feeding tube precludes reliable aspiration to test for gastric pooling and we have seen that the tube itself being fine, soft, and designed for tolerance may be regurgitated into the pharynx. Pulmonary aspiration is a possible and dangerous complication of fine bore enteral feeding in compromised patients. We suggest that these at risk patients should have wide bore nasogastric tubes in situ to reduce the likelihood of the tube being regurgitated and to permit adequate gastric aspiration. There is a risk that a wider bore tube will render the cardiac sphincter incompetent, but we have not found this a problem in practice. We find that when severe aspiration occurs the only reliable method of performing adequate bronchial toilet is by both rigid and fibreoptic bronchoscopy in order to remove the feed, thick secretions, and sputum present.