In intensive care, many gastric tubes are inserted on a regular basis. There are different practices in terms of the location of the gastric tube. In some cases, the tube is inserted through the nose and in others, it is inserted through the mouth. In the literature and in practice, these gastric tubes create discomfort and complications that have an impact not only on the patient, but also on the treatments and the length of the patient's stay in hospital. Nosocomial Ventilator Associated Pneumonia is the most serious common complication for patients intubated with a gastric tube. It is possible that placement site may have an impact on the risk of developing Ventilator Associated Pneumonia, particularly by increasing the risk of bacterial pullulation opposite the sinuses when the tube is placed via the nasal route. Investigator hypothesises that placing the gastric tube orally will reduce the rate of ventilator-associated pneumonia compared with the nasal route in mechanically ventilated intensive care patients.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
OTHER
Masking
NONE
Enrollment
2,400
nasogastric tube in period 1 and orogastric tube in period 2
orogastric tube in period 1 and nasogastric tube in period 2
CHU Angers
Angers, France
RECRUITINGCH Cholet
Cholet, France
RECRUITINGCHU Grenoble
Grenoble, France
RECRUITINGCHD Vendée
La Roche-sur-Yon, France
RECRUITINGCentre Hospitalier Du Mans
Le Mans, France
RECRUITINGAPHM - Hôpital Nord
Marseille, France
RECRUITINGCHU Nantes
Nantes, France
RECRUITINGCHRU Orléans
Orléans, France
RECRUITINGAPHP - Hôpital Saint-Antoine
Paris, France
RECRUITINGCH Périgueux
Périgueux, France
RECRUITING...and 6 more locations
Compare impact of insertion site of gastric tube on the incidence of ventilator associated pneumoniae
The impact is measured by the number of ventilator associated peumonia
Time frame: Day 28
Number of attempts before successful insertion or reinsertion confirmed by control according to service protocol
Time frame: At gastric tube insertion or reinsertion procedure
Pain monitoring (pain scale) during insertion or reinsertion of the gastric tube
Assessed based on the patient's neurological status : * The Visual Analog Score for pain for vigilant patients (Glasgow score greater than or equal to 12). * The algo plus scale for patients with a Glasgow score below 12 or who are unable to rate their pain. * The Behavioral Pain Scale BPS if the patient is sedated. * If the patient is curarized, there will be no pain monitoring.
Time frame: From Day 0 to Day 28
Pain monitoring (pain scale) during daily repair of the fixation system of the gastric tube
Assessed based on the patient's neurological status : * The Visual Analog Score for pain for vigilant patients (Glasgow score greater than or equal to 12). * The algo plus scale for patients with a Glasgow score below 12 or who are unable to rate their pain. * The Behavioral Pain Scale BPS if the patient is sedated. * If the patient is curarized, there will be no pain monitoring.
Time frame: From Day 0 to Day 28
Absence or presence of skin lesions qualified by location and according to the NPUAP classification of pressure ulcer stages
NPUAP classification of pressure ulcer stages : * Stage 1: erythema that does not disappear with pressure. * Stage 2: de-epidermalization (Epidermal loss). * Stade 3: necrosis. * Stage 4: Deep-tissue involvement.
Time frame: From Day 0 to Day 28
Absence or presence and qualification of nasal discharge
Qualification according to the following four criteria: * No flow. * Serous discharge. * Bloody discharge. * Purulent discharge.
Time frame: From Day 0 to Day 28
Presence of bleeding during gastric tube insertion or reinsertion
Presence of bleeding during insertion or reinsertion, requiring a change in the course of treatment (bloody buccal aspirations - or IOT-related trauma -compression, packing, change of insertion site, endoscopic haemostasis, Blakemore probe insertion, therapeutic modification, etc.).
Time frame: At gastric tube insertion or reinsertion procedure
Presence of diagnosed and treated ulcer and/or diagnosed and treated esophagitis
Time frame: From Day 0 to Day 28
Morbidity
Duration of artificial ventilation and length of stay in intensive care unit.
Time frame: From admission to discharge from the intensive care unit
Mortality
Mortality in intensive care unit and Mortality at D28.
Time frame: From Day 0 to Day 28
Number and type of adverse events
Nature of adverse events can be : * Ablation * Mobilization of probe * Plicature of probe * Probe obstruction * Coiling of probe * False path.
Time frame: From Day 0 to Day 28
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