Multicenter, prospective, randomized, single-blind study comparing the efficacy and gastrointestinal complications of early jejunal feeding with early gastric feeding in critically ill patients

Abstract

Gastrointestinal complications are less frequent in ICU patients fed in the jejunum. Nevertheless, it seems to be a necessary learning curve to achieve better results with a postpyloric access. Early enteral nutrition using a nasojejunal route seems not to be an efficacious measure to decrease nosocomial pneumonia in critically ill patients.

Risk factors for gastrointestinal complications in critically ill children with transpyloric enteral nutrition

“…No relationship was found between gastrointestinal complications and the early initiation of the nutrition or the maximum volume of nutrition administered. The frequency of gastrointestinal complications in critically ill adults fed with enteral nutrition can reach 62%, and withdrawal of the nutrition is required in 15% of the patients (Montejo et al, 2002;Ho et al, 2006). In our study, the incidence of gastrointestinal complications was lower similar to the figures reported in other studies in critically ill children (Sánchez Sánchez et al, 2003;Meert et al, 2004;Briassoulis et al, 2005;Pérez-Navero et al, 2005), and the TEN was definitively suspended owing to gastrointestinal complications in only 2.1% of the patients.…”

“…In our study, although gastrointestinal complications were more frequent in the children receiving sedatives and muscle relaxants, the frequency of abdominal distention or a high volume of gastric aspirate was lower than the figure observed in patients with gastric nutrition (Montejo et al, 2002). Our results show that TEN can be used in critically ill children even if they require treatment with sedatives and muscle relaxants, although constipation and abdominal distention must be carefully monitored in children receiving continuous infusions of muscle relaxants.…”

“…The incidence of abdominal distension and/or excessive gastric residues in critically ill adult patients fed with enteral nutrition varies between 20 and 70% (Montejo, 1999;Mentec et al, 2001;Montejo et al, 2002;Ho et al, 2006). Mentec et al (2001) specifically analyzed the risk factors of upper digestive tract intolerance during gastric nutrition in critically ill adults.…”

“…Enteral nutrition is the best model of feeding in the critically ill patients as it favors intestinal trophism, stimulates the immune system, reduces bacterial translocation and the incidence of sepsis and multisystem failure and has few side effects (Hadfield et al, 1995;De Lucas et al, 2000;Galbán et al, 2000;Artinian et al, 2006). However, oral or nasogastric feeding is sometimes poorly tolerated, particularly in the patients on mechanical ventilation, owing to the reduced gastric motility secondary to the administration of drugs or to the disease itself, with the onset of distension, the accumulation of gastric residues and an increased risk of pulmonary aspiration (Montejo, 1999;Mentec et al, 2001;(Montejo et al, 2002). Furthermore, a high percentage of critically ill patients on mechanical ventilation who are fed enterally via a nasogastric tube do not receive their full energy requirements, principally because of the frequent interruptions in the enteral feeding (Rogers et al, 2003;Meert et al, 2004;O'Leary-Kelley et al, 2005).…”

“…Furthermore, a high percentage of critically ill patients on mechanical ventilation who are fed enterally via a nasogastric tube do not receive their full energy requirements, principally because of the frequent interruptions in the enteral feeding (Rogers et al, 2003;Meert et al, 2004;O'Leary-Kelley et al, 2005). Duodeno-jejunal enteral nutrition has been shown to be a good alternative route in critically ill adults (Davies et al, 2002;Montejo et al, 2002) and children (Chellis et al, 1996;Sánchez et al, 2000). However, transpyloric enteral nutrition could also increase the incidence of complications in preterm infants (McGuire and McEwan, 2004).…”