Effect of gastric versus post-pyloric feeding on the incidence of pneumonia in critically ill patients: Observations from traditional and Bayesian random-effects meta-analysis

Jing, Jiyong; Huang, Tongwang; Wang, Huiqin; Jin, Jingfen

doi:10.1016/j.clnu.2012.07.002

Cited by 69 publications

(57 citation statements)

References 39 publications

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“…Systematic reviews and meta-analysis have been published that evaluated small bowel and gastric feeding in the critically ill [14-17]. An update incorporating important recent studies [18-20] was published by Jiyong and colleagues [17].…”

Section: Introductionmentioning

confidence: 99%

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Comparisons between intragastric and small intestinal delivery of enteral nutrition in the critically ill: a systematic review and meta-analysis

et al. 2013

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IntroductionThe largest cohort of critically ill patients evaluating intragastric and small intestinal delivery of nutrients was recently reported. This systematic review included recent data to compare the effects of small bowel and intragastric delivery of enteral nutrients in adult critically ill patients.MethodsThis is a systematic review of all randomised controlled studies published between 1990 and March 2013 that reported the effects of the route of enteral feeding in the critically ill on clinically important outcomes.ResultsData from 15 level-2 studies were included. Small bowel feeding was associated with a reduced risk of pneumonia (Relative Risk, RR, small intestinal vs. intragastric: 0.75 (95% confidence interval 0.60 to 0.93); P = 0.01; I2 = 11%). The point estimate was similar when only studies using microbiological data were included. Duration of ventilation (weighted mean difference: -0.36 days (-2.02 to 1.30); P = 0.65; I2 = 42%), length of ICU stay (WMD: 0.49 days, (-1.36 to 2.33); P = 0.60; I2 = 81%) and mortality (RR 1.01 (0.83 to 1.24); P = 0.92; I2 = 0%) were unaffected by the route of feeding. While data were limited, and there was substantial statistical heterogeneity, there was significantly improved nutrient intake via the small intestinal route (% goal rate received: 11% (5 to 16%); P = 0.0004; I2 = 88%).ConclusionsUse of small intestinal feeding may improve nutritional intake and reduce the incidence of ICU-acquired pneumonia. In unselected critically ill patients other clinically important outcomes were unaffected by the site of the feeding tube.

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Section: Introductionmentioning

confidence: 99%

“…An update incorporating important recent studies [18-20] was published by Jiyong and colleagues [17]. However, a limitation of the latter review is that the authors included a study in which patients received care on the general hospital ward rather than a critical care environment.…”

Section: Introductionmentioning

confidence: 99%

Comparisons between intragastric and small intestinal delivery of enteral nutrition in the critically ill: a systematic review and meta-analysis

et al. 2013

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“…However, with regard to the incidence of vomiting and aspiration, there was no difference between gastric or enteral positioning (17) .…”

Section: Enteric Position Of the Tubementioning

confidence: 85%

“…Thereby, enteral feeding has great potential in reducing the episodes of gastroesophageal reflux in the episodes of aspiration of gastric content and in the incidence of pneumonia, especially in patients with a decreased level of consciousness or sedation (17) .…”

Section: Enteric Position Of the Tubementioning

confidence: 99%

Nursing intervention bundle for enteral nutrition in intensive care: a collective construction

Colaço

Nascimento

2014

Rev. esc. enferm. USP

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Objective The collective construction of a nursing intervention bundle for patients in critical care in the hospital receiving enteral nutrition therapy, supported by evidence-based practice. Method A qualitative convergent-care study with 24 nursing professionals in an intensive care unit of a public hospital in Santa Catarina. Data collection was performed from May to August 2013, with semi-structured interviews and discussion groups. Results Four interventions emerged that constituted the bundle: bedside pH monitoring to confirm the position of the tube; stabilization of the tube; enteric position of the tube; and maintaining the head of the bed elevated at 30° to 45°.  Conclusion The interventions chosen neither required additional professional workload nor extra charges to the institution, which are identified as improving the adoption of the bundle by nursing professionals at the ICU.

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“…This route is also associated with a lower rate of nosocomial infections, particularly for episodes of pneumonia, 1 and the frequency of its incorporation into the management of critically ill patients has been increasing. 14 However, the enteral route is often underestimated and neglected for patients with severe TBI.…”

mentioning

confidence: 99%

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

Wang

Zheng

Chen

et al. 2015

JNS

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Severe traumatic brain injury (TBI) is a catastrophic event that often has destructive familial, economic, and societal consequences. It contributes to many deaths and cases of permanent disability, especially among patients 15-30 years old. 8,10 The average mortality rate for patients with severe TBI is 39%, and 60% of these patients have an unfavorable outcome on the Glasgow Outcome Scale. 24,26 Furthermore, those who survive tend to have significant disabilities, which also can cause a major socioeconomic burden.Patients with severe TBI have reduced immune function and higher risks of nosocomial infections as a result of decreased energy and increased protein catabolism. 4,7 By providing additional daily calories, nutrition support abbreviatioNs APACHE II = Acute Physiology and Chronic Health Evaluation II; GCS = Glasgow Coma Scale; ICU = intensive care unit; ISS = Injury Severity Score; MV = mechanical ventilation; RCT = randomized controlled trial; RR = risk ratio; TBI = traumatic brain injury; VAP = ventilator-associated pneumonia; WMD = weighted mean difference. obJect Nutritional support is highly recommended for reducing the risk of nosocomial infections, such as pneumonitis, in patients with severe traumatic brain injury (TBI). Currently, there is no consensus for the preferred route of feeding. The authors compared the risks of pneumonitis and other important outcomes associated with small intestinal and gastric feeding in patients with severe TBI. methods This systematic review and meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Relevant randomized controlled trials (up to December 16, 2013) that compared small bowel to gastric feeding in patients with severe TBI were identified from searches in the PubMed and Embase databases. The primary outcome was risk of pneumonia. Secondary outcomes included ventilatorassociated pneumonia, mortality, length of intensive care unit stay, length of hospital stay, duration of mechanical ventilation, total number of complications, aspiration, diarrhea, distention, Glasgow Coma Scale score, Injury Severity Score, and Acute Physiology and Chronic Health Evaluation II score. results Five randomized controlled trials with 325 participants in total were included in the meta-analysis. Compared with gastric feeding, small bowel feeding was associated with a significant reduction in the incidence of pneumonitis (risk ratio [RR] 0.67; 95% CI 0.52-0.87; p = 0.002; I 2 = 0.0%) and ventilator-associated pneumonia (RR 0.52; 95% CI 0.34-0.81; p = 0.003; I 2 = 0.0%). Small intestinal feeding was also associated with a decrease in the total number of complications (RR 0.43; 95% CI 0.20-0.93; p = 0.03; I 2 = 68%). However, small intestinal feeding did not seem to significantly convert any of the other end points in the meta-analysis. coNclusioNs The limited evidence suggests that small bowel feeding in patients with severe TBI is associated with a risk of pneumonia that is lower than that with gast...

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Effect of gastric versus post-pyloric feeding on the incidence of pneumonia in critically ill patients: Observations from traditional and Bayesian random-effects meta-analysis

Cited by 69 publications

References 39 publications

Comparisons between intragastric and small intestinal delivery of enteral nutrition in the critically ill: a systematic review and meta-analysis

Comparisons between intragastric and small intestinal delivery of enteral nutrition in the critically ill: a systematic review and meta-analysis

Nursing intervention bundle for enteral nutrition in intensive care: a collective construction

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

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