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Updated: Nov 14, 2025
Author Spotlight: Point-of-Care Ultrasound for Gastric Content Assessment and Risk Stratification in Perioperative Care
Published on: September 22, 2023
Ultrasound-Guided Postpyloric Feeding Tube Placement in Critically Ill Pediatric Patients
Ichiro Osawa1, Norihiko Tsuboi, Hisataka Nozawa
1All authors: Department of Critical Care and Anesthesia, National Center for Child Health and Development, Tokyo, Japan.
Insights
Ultrasound guidance significantly improves the first-pass success rate for placing postpyloric feeding tubes in critically ill children. This method is feasible and safe, offering a better bedside option for pediatric intensive care units.
Area of Science:
- Pediatric critical care medicine
- Medical imaging applications
- Gastroenterology
Background:
- Postpyloric feeding tube placement is crucial for nutritional support in critically ill children.
- Current bedside methods for insertion have variable success rates and remain controversial.
- Optimizing insertion techniques is essential for patient outcomes.
Purpose of the Study:
- To evaluate the efficacy of ultrasound-guided postpyloric feeding tube placement in critically ill children.
- To compare the success rates and feasibility of ultrasound-guided versus blind insertion methods.
- To assess the safety and procedural characteristics of the ultrasound-guided technique.
Main Methods:
- A retrospective observational study was conducted in a pediatric intensive care unit (PICU).
- Data from 115 children under 16 requiring postpyloric feeding tubes were analyzed.
- Patients were divided into two groups: ultrasound-guided placement (n=30) and blind placement (n=85).
Main Results:
- The first-pass success rate was significantly higher in the ultrasound-guided group (94%) compared to the blind group (57%) (p < 0.001).
- No significant differences in patient demographics were observed between the groups.
- The median insertion time for successful ultrasound-guided placements was 18 minutes, with no reported complications.
Conclusions:
- Ultrasound-guided postpyloric feeding tube placement is a feasible and effective method in critically ill children.
- The technique demonstrates a significantly higher first-pass success rate compared to blind insertion.
- Further randomized controlled trials are recommended to validate these findings across diverse settings and operators.
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.
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