The use of the Cortrak Enteral Access System TM for post-pyloric (PP) feeding tube placement in a Burns Intensive Care Unit S.J. Hemington-Gorse *, N.N. Sheppard, R. Martin, O. Shelley, B. Philp, P. Dziewulski St Andrew’s Centre for Burns, Broomfield Hospital, Court Road, Chelmsford, Essex CM1 7ET, United Kingdom 1. Introduction Burns greatly increase both daily calorie and protein require- ments and despite early feeding interventions can result in significant weight loss and subsequent healing delay [1,2]. Early feeding via the nasogastric (NG) route is therefore an established part of burn management [3]. It is recognised that 50% of critically ill patients fail to reach caloric targets with NG feeding and this may have a negative effect on clinical outcomes [4,5]. Both NG and PP feeding have been widely used in the critical care setting. NG feeding is hindered by gastric stasis, but PP feeding theoretically enhances caloric intake since small bowel motility is preserved even in the critically ill [6–8]. There is, however, no conclusive evidence that PP feeding is of benefit over NG feeding [9,10] in a general critical care population, though it may be specifically beneficial in burns patients [11]. PP feeding has the added benefit in burns patients that feeding can be continued throughout theatre trips in ventilated patients thus avoiding the significant calorie deficits which can occur as a result of repeated trips to theatre. PP tube placement poses its own challenges in the intensive care unit (ICU) setting. Blind tube placement can be difficult. Endoscopic guidance of tube placement may present logistical problems and delays. Other methods such as calorimetric CO 2 detectors and magnetically guided feeding tube placement require training and repetition in order to be utilised successfully [12]. X-ray confirmation of accurate PP placement despite using these methods can add to delays in feeding. Electromagnetic sensing devices have been successfully used to facilitate NG and PP tube placement and have burns 37 (2011) 277–280 article info Article history: Accepted 19 July 2010 Keywords: Post-pyloric feeding Cortrak System TM Nutrition abstract Introduction: 50% of critically ill patients fail to reach caloric targets with NG feeding. PP feeding may enhance caloric intake. PP feeding can be continued throughout theatre in patients with a secure airway. Blind PP tube placement is difficult. CEAS has been developed to assist tube placement and eliminate check X-rays of tube position. Method: All BITU patients with CEAS PP feeding tube placement were identified. Notes and X-rays were reviewed. Tube position, calorie deficit and time off feed were recorded. Results: 44 tubes were placed in 21 patients using CEAS. 84% were PP, 16% NG. Position correlated to X-ray findings in 86%. In 16% position was NG on CEAS but was PP on X-ray. 10 patients required both CXR and AXR to confirm position, the remainder required CXR only. Time off feed varied from 0–24 h (mean 7.4 h). Calorie deficit ranged from 0–2465 kCal (mean 858 kCal). Average wait for X-ray was 3.4 h. If X-ray wait was eliminated calorie deficit would be reduced by 45% to 393 kCal. Conclusion: The Cortrak system is safe and effective on BITU. It reduces calorie deficit, reduces X-ray exposure and is cost effective. We recommend its use on BITU. # 2010 Elsevier Ltd and ISBI. All rights reserved. * Corresponding author. Tel.: +44 (0) 1792 702222. E-mail address: sgorse@doctors.org.uk (S.J. Hemington-Gorse). available at www.sciencedirect.com journal homepage: www.elsevier.com/locate/burns 0305-4179/$36.00 # 2010 Elsevier Ltd and ISBI. All rights reserved. doi:10.1016/j.burns.2010.07.011