A New Critical Care Catheter Gabriel Feeding Tube

A New Critical Care Catheter Gabriel® Feeding Tube With Balloon Sabry Gabriel, M. D. Development of this feeding tube supported by DOD Award# W 81 XWH-09 -20097

Advantages of enteral feeding • • • More physiologic. Maintains intestinal mucosal barrier. Stimulates the immune system. Provides high calories at a small volume. High nutrition value at lower cost. Improves renal perfusion.

Gut Permeability • Channels between epithelial cells have a very dynamic function, and after a major insult, they open, increasing permeability • Can cause ARDS via inflammatory cytokine movement through gut lymphatics, to the thoracic duct, to the left subclavian vein, into the heart, and through the pulmonary artery to the 1 st capillary bed, the LUNGS! Gut Thoracic Duct Left Subclavian Vein Heart Pulmonary Artery Lungs

Advantages of enteral feeding • • • More physiologic. Maintains intestinal mucosal barrier. Stimulates the immune system. Provides high calories at a small volume. High nutrition value at lower cost. Improves renal perfusion.

Time to Feed is Limited! • Enteral feeding used to modulate immune system during stress or sepsis. • The “window of opportunity” to modulate immune system is limited – e. g. In burn victims this window is only 3 to 6 hours!

Advantages of enteral feeding • • • More physiologic. Maintains intestinal mucosal barrier. Stimulates the immune system. Provides high calories at a small volume. High nutrition value at lower cost. Improves renal perfusion.

Risks of Enteral Feeding Ø Aspiration Pneumonia Ø Placement in Lungs

Feeding tubes insertion problems Problem Resulting complication • Poor success rate in post pyloric placement • Inadvertent placement of feeding tubes into trachea & lungs (2%) of all feeding tubes • 125, 000 cases of aspiration pneumonia annually • 21, 000 pneumothorax annually • 4, 000 death per year in the US

Options Method Cost Repeat blind placement Three attempts cost $465 with X-ray confirmation. Over 36 h to 3 days Each X-ray = $155 Fluroscopy $430 Endoscopy $650