Comparisons between small intestinal and gastric feeding in severe traumatic brain injury: a systematic review and meta-analysis of randomized controlled trials

Wang, Dong; Zheng, Shaoqin; Chen, Xiancai; Jiang, Shi‐Wen; Chen, Hai-Bin

doi:10.3171/2014.11.jns141109

Cited by 25 publications

(10 citation statements)

References 29 publications

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“…Their study demonstrated that postpyloric EN reduces the incidence of VAP and decreases the incidence of gastric residuals. Additionally, a meta-analysis involving five randomized controlled studies revealed that severe TBI patients who were administered postpyloric EN exhibited a reduced incidence of VAP (RR 0.52, 95% CI 0.34–0.81; P = 0.003; I 2 = 0.0%) and fewer total complications compared with patients who were administered gastric EN [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Gastric versus postpyloric enteral nutrition in elderly patients (age ≥ 75 years) on mechanical ventilation: a single-center randomized trial

et al. 2018

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BackgroundThe risk of ventilator-associated pneumonia (VAP) is reduced when postpyloric enteral nutrition (EN) is administered compared to when gastric EN is administered in specific populations. In the present study, we tested the hypothesis that postpyloric EN is superior to gastric EN in reducing the incidence of VAP in elderly patients (age ≥ 75 years) who are admitted to the intensive care unit (ICU) and require mechanical ventilation.MethodsWe performed a single-center randomized clinical trial involving elderly patients (age ≥ 75 years) who were admitted to the ICU and required mechanical ventilation. The patients were randomly assigned to either the postpyloric EN group or the gastric EN group. The primary outcome was the VAP rate.ResultsOf the 836 patients screened, 141 patients were included in the study (70 in the postpyloric EN group and 71 in the gastric EN group). The patients in the postpyloric EN group were 82.0 (75.0–99.0) years old (male 61.4%), and those in the gastric EN group were 82.0 (75.0–92.0) years old (male 63.4%). The Acute Physiology and Chronic Health Evaluation II scores were 28.09 ± 6.75 in the postpyloric EN group and 27.80 ± 7.60 in the gastric EN group (P = 0.43). VAP was observed in 8 of 70 patients (11.4%) in the postpyloric EN group and in 18 of 71 patients (25.4%) in the gastric EN group, which resulted in a significant between-group difference (OR 0.38, 95% CI 0.15–0.94; P = 0.04). In the postpyloric EN group, there were significant reductions in vomiting (12 patients in the postpyloric EN group vs 29 patients in the gastric EN group; OR 0.30, 95% CI 0.14–0.65; P = 0.002) and abdominal distension (18 patients in the postpyloric EN group vs 33 patients in the gastric EN group; OR 0.40, 95% CI 0.20–0.81; P = 0.01). No significant differences were observed between the two groups regarding mortality and other secondary outcomes.ConclusionsOur study demonstrated that, compared with gastric EN, postpyloric EN reduced the VAP rate among elderly patients who were admitted to the ICU and required mechanical ventilation.Trial registrationChinese Clinical Trial Registry, ChiCTR-IPR-16008485. Registered on 17 May 2016.

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Section: Discussionmentioning

confidence: 99%

Gastric versus postpyloric enteral nutrition in elderly patients (age ≥ 75 years) on mechanical ventilation: a single-center randomized trial

et al. 2018

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“…The incidence of severe pneumonia was significantly higher in the PEG group. This result was expected and clinically plausible because enteral nutrition administered via PEG poses a risk of gastroesophageal reflux and aspiration pneumonia owing to the underlying pharyngeal and laryngeal dysfunction of patients who require feeding through this modality [23,35,47]. Switching from PEG feeding to TPN may be an option for patients who underwent PEG feeding and repeatedly suffered from aspiration pneumonia because TPN is more effective in reducing the risk of severe pneumonia than PEG feeding.…”

Section: Discussionmentioning

confidence: 99%

Comparison of long-term outcomes between enteral nutrition via gastrostomy and total parenteral nutrition in the elderly with dysphagia: A propensity-matched cohort study

Masaki

Kimura

2019

Preprint

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21Background 22 The long-term outcomes of artificial nutrition and hydration (ANH) in the elderly with 23 dysphagia remain uncertain. Enteral nutrition via percutaneous endoscopic gastrostomy 24 (PEG) and total parenteral nutrition (TPN) are major methods of ANH. Although both 25 can be a life-prolonging treatments, Japan has recently come to view PEG as 26 representative of unnecessary life-prolonging treatment. Consequently, TPN is often 27 chosen for ANH instead. This study aimed to compare the long-term outcomes between 28 PEG and TPN in the elderly. 29 Methods 30This single-center retrospective cohort study identified 253 elderly patients with 31 dysphagia who received enteral nutrition via PEG (n=180) or TPN (n=73) between 32 January 2014 and January 2017. The primary outcome was survival time. Secondary 33 outcomes were oral intake recovery, discharge to home, and the incidence of severe 34 pneumonia and sepsis. We performed one-to-one propensity score matching using a 0.05 35 caliper. The Kaplan-Meier method, log-rank test, and Cox proportional hazards model 36 were used to analyze the survival time between groups. 37 Results 38Older patients with lower nutritional states, and severe dementia were more likely to 39 receive TPN. Propensity score matching created 55 pairs. Survival time was significantly 40 longer in the PEG group (median, 317 vs 195 days; P=0.017). The hazard ratio for PEG 41 relative to TPN was 0.60 (95% confidence interval: 0.39-0.92; P=0.019). There were no 42 significant differences between the groups in oral intake recovery and discharge to home. 43The incidence of severe pneumonia was significantly higher in the PEG group (50.9% vs 44 25.5%, P=0.010), whereas sepsis was significantly higher in the TPN group (10.9% vs 45 30.9%, P=0.018). 46 Conclusions 47PEG was associated with a significantly longer survival time, a higher incidence of 48 severe pneumonia, and a lower incidence of sepsis compared with TPN. These results can 49 be used in the decision-making process before initiating ANH. 50 51 4 56 developed as an enteral feeding technique for pediatric patients with dysphagia [1,2]. 57Compared to feeding via a nasogastric tube, enteral feeding via PEG can relieve 58 laryngopharyngeal discomfort and prevent intervention failure; therefore, its use has 59 become widespread for long-term enteral feeding in multiple patient groups including 60 pediatric and geriatric populations [3]. However, studies have reported worse outcomes 61 following PEG feeding in patients with dementia [4,5]; therefore, the use of PEG in 62 elderly populations is controversial [6,7]. 63TPN is another common method of nutritional management [8,9]. Similar to tube 64 feeding, TPN is also occasionally used for ANH in elderly patients with dysphagia [10]. 65 Comparing the outcomes of enteral nutrition and parenteral nutrition are major concerns 66 among clinicians. Previous studies have demonstrated conflicting results among patients 67 who received enteral nutrition versus those who received parenteral nutr...

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“…A study of 74 critically ill children randomly assigned to gastric or post-pyloric feeds demonstrated no difference in complications, and patients receiving post-pyloric feeds received more of their prescribed calories ( 120 ). A large meta-analysis of adult patients with severe traumatic brain injury demonstrated a decreased risk of pneumonitis with post-pyloric feeds ( 121 ). Other researchers found an increased risk of gastrointestinal complications when post-pyloric feeds were used in septic patients or patients on epinephrine (Table 1 ) ( 37 , 122 ).…”

Section: Route Of Nutritionmentioning

confidence: 99%

“…Despite the results of the PEPaNIC study, equipoise remains in the pARDS population. The optimal macronutrient dose, timing, and formulation of EN and PN support has yet to be elucidated as increasing evidence demonstrates links between the immune system, homeostasis, and nutritional intake ( 121 , 126 – 129 ).…”

Section: Route Of Nutritionmentioning

confidence: 99%

Nutrition: A Primary Therapy in Pediatric Acute Respiratory Distress Syndrome

Wilson

Typpo

2016

Front. Pediatr.

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Appropriate nutrition is an essential component of intensive care management of children with acute respiratory distress syndrome (ARDS) and is linked to patient outcomes. One out of every two children in the pediatric intensive care unit (PICU) will develop malnutrition or have worsening of baseline malnutrition and present with specific micronutrient deficiencies. Early and adequate enteral nutrition (EN) is associated with improved 60-day survival after pediatric critical illness, and, yet, despite early EN guidelines, critically ill children receive on average only 55% of goal calories by PICU day 10. Inadequate delivery of EN is due to perceived feeding intolerance, reluctance to enterally feed children with hemodynamic instability, and fluid restriction. Underlying each of these factors is large practice variation between providers and across institutions for initiation, advancement, and maintenance of EN. Strategies to improve early initiation and advancement and to maintain delivery of EN are needed to improve morbidity and mortality from pediatric ARDS. Both, over and underfeeding, prolong duration of mechanical ventilation in children and worsen other organ function such that precise calorie goals are needed. The gut is thought to act as a “motor” of organ dysfunction, and emerging data regarding the role of intestinal barrier functions and the intestinal microbiome on organ dysfunction and outcomes of critical illness present exciting opportunities to improve patient outcomes. Nutrition should be considered a primary rather than supportive therapy for pediatric ARDS. Precise nutritional therapies, which are titrated and targeted to preservation of intestinal barrier function, prevention of intestinal dysbiosis, preservation of lean body mass, and blunting of the systemic inflammatory response, offer great potential for improving outcomes of pediatric ARDS. In this review, we examine the current evidence regarding dose, route, and timing of nutrition, current recommendations for provision of nutrition to children with ARDS, and the current literature for immune-modulating diets for pediatric ARDS. We will examine emerging data regarding the role of the intestinal microbiome in modulating the response to critical illness.

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Comparisons between small intestinal and gastric feeding in severe traumatic brain injury: a systematic review and meta-analysis of randomized controlled trials

Cited by 25 publications

References 29 publications

Gastric versus postpyloric enteral nutrition in elderly patients (age ≥ 75 years) on mechanical ventilation: a single-center randomized trial

Gastric versus postpyloric enteral nutrition in elderly patients (age ≥ 75 years) on mechanical ventilation: a single-center randomized trial

Comparison of long-term outcomes between enteral nutrition via gastrostomy and total parenteral nutrition in the elderly with dysphagia: A propensity-matched cohort study

Nutrition: A Primary Therapy in Pediatric Acute Respiratory Distress Syndrome

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