Detection of gastroesophageal reflux by multichannel intraluminal impedance technology during mechanical ventilation: the first case series

Summary: Background & Aims: Gastroesophageal reflux (GER) is a common event among mechanically ventilated and tube-fed critically ill patients and it is associated with an increased risk of ventilator-associated pneumonia. Most of the available tools for the detection of GER are experimental and not available bedside. Intraluminal impedance was suggested as a technique for real-time detection and quantification of GER. This study aimed to evaluate the frequency and duration of GER events in mechanically ventilated and tube-fed patients and to determine their correlation with routine procedures performed during patient care. Methods: This was a prospective observational study of 20 critically ill patients hospitalized in a university hospital general intensive care unit. We included adult, mechanically ventilated patients receiving continuous enteral feeding by feeding tube (FT). A FT with multichannel intraluminal impedance sensors capable of detecting movement of gastro-esophageal content above the lower esophageal sphincter was used for GER detection. The frequency, duration, and association with routine procedures (position change, suction, and fluid bolus administration) were evaluated. Results: During the median monitoring time of 2.9 days (IQR 2.8–3) per patient, a median number of 2.7 (IQR 2.1–3.8) GER events were detected every hour. 61% of GERs lasted 10–30 seconds. Position changes, endotracheal suctions, and fluid bolus administrations were associated with a high frequency of GERs. Conclusions: Multichannel impedance sensors embedded on a FT enable real-time bedside detection of GER. This technology provides an opportunity for the development of new strategies aimed to decrease GER prevalence and prevent aspiration. Registration: The study was registered at http://www.clinicaltrials.gov (NCT02705781).