Severity of Illness Influences the Efficacy of Enteral Feeding Route on Clinical Outcomes in Patients with Critical Illness

Huang, Hsiu Hua; Chang, Shang‐Jen; Hsu, Chien Wei; Chang, Tzu Ming; Kang, Shiu Ping; Liu, Ming Yi

doi:10.1016/j.jand.2012.04.013

Cited by 37 publications

(43 citation statements)

References 32 publications

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“…In one of these trials, not all patients were admitted to the ICU but due to inclusion of severe pancreatitis patients with a mortality rate of 25% we decided to include it [32]. Nine trials investigated the use of jejunal feeding tubes [10,20,26,28,30-32,35,36] and six the use of duodenal feeding tubes [21,23-25,33,34], whereas the rest did not specify the location of the feeding tube in the small intestine [22,27,29,37]. VAP preventive strategies were not described consistently in the included studies.…”

Section: Resultsmentioning

confidence: 99%

“…Eight RCTs [10,21,22,26,30,33,34,37] with 835 patients reported pneumonia in ventilated patients as an outcome. Small bowel feeding was associated with a lower risk of VAP (RR = 0.68; 95% CI = 0.53 to 0.89; P = 0.005; I 2 = 0%).…”

Section: Resultsmentioning

confidence: 99%

“…Eight RCTs [10,20,22,26,30,31,33,34] that included 762 patients reported ICU length of stay as an outcome (Figure 7). There was no difference in days of stay in the ICU between both groups (WMD = -0.57; 95% CI = -1.79 to 0.66; P = 0.37; I 2 = 0%; Figure 7).…”

Section: Resultsmentioning

confidence: 99%

“…Six RCTs [10,20,28,31,33,34] with 546 patients reported GI bleeding as an outcome; there was no statistically significant difference between both groups in the risk of GI bleeding (RR = 0.89; 95% CI = 0.56 to 1.42; P = 0.64; I 2 = 0%; Figure 9). …”

Section: Resultsmentioning

confidence: 99%

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Small bowel feeding and risk of pneumonia in adult critically ill patients: a systematic review and meta-analysis of randomized trials

et al. 2013

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IntroductionThis systematic review and meta-analysis aimed to evaluate the effect of small bowel feeding compared with gastric feeding on the frequency of pneumonia and other patient-important outcomes in critically ill patients.MethodsWe searched EMBASE, MEDLINE, clinicaltrials.gov and personal files from 1980 to Dec 2012, and conferences and proceedings from 1993 to Dec 2012 for randomized trials of adult critically ill patients in the intensive care unit (ICU) comparing small bowel feeding to gastric feeding, and evaluating risk of pneumonia, mortality, length of ICU stay, achievement of caloric requirements, duration of mechanical ventilation, vomiting, and aspiration. Independently, in duplicate, we abstracted trial characteristics, outcomes and risk of bias.ResultsWe included 19 trials with 1394 patients. Small bowel feeding compared to gastric feeding was associated with reduced risk of pneumonia (risk ratio [RR] 0.70; 95% CI, 0.55, 0.90; P = 0.004; I2 = 0%) and ventilator-associated pneumonia (RR 0.68; 95% CI 0.53, 0.89; P = 0.005; I2 = 0%), with no difference in mortality (RR 1.08; 95% CI 0.90, 1.29; P = 0.43; I2 = 0%), length of ICU stay (WMD -0.57; 95%CI -1.79, 0.66; P = 0.37; I2 = 0%), duration of mechanical ventilation (WMD -1.01; 95%CI -3.37, 1.35; P = 0.40; I2 = 17%), gastrointestinal bleeding (RR 0.89; 95% CI 0.56, 1.42; P = 0.64; I2 = 0%), aspiration (RR 0.92; 95% CI 0.52, 1.65; P = 0.79; I2 = 0%), and vomiting (RR 0.91; 95% CI 0.53, 1.54; P = 0.72; I2 = 57%). The overall quality of evidence was low for pneumonia outcome.ConclusionsSmall bowel feeding, in comparison with gastric feeding, reduces the risk of pneumonia in critically ill patients without affecting mortality, length of ICU stay or duration of mechanical ventilation. These observations are limited by variation in pneumonia definition, imprecision, risk of bias and small sample size of individual trials.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Small bowel feeding and risk of pneumonia in adult critically ill patients: a systematic review and meta-analysis of randomized trials

et al. 2013

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“…After reviewing these studies, four were excluded because they were systematic reviews [14-17], one had < 50% of enrolled patients admitted to an ICU [28], one did not report clinical outcomes [11] and one [29] was an analysis of data already included.…”

Section: Resultsmentioning

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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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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Post-pyloric versus gastric tube feeding for preventing pneumonia and improving nutritional outcomes in critically ill adults

Alkhawaja

Martin

Butler

et al. 2015

Cochrane Database of Systematic Reviews

107

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Severity of Illness Influences the Efficacy of Enteral Feeding Route on Clinical Outcomes in Patients with Critical Illness

Cited by 37 publications

References 32 publications

Small bowel feeding and risk of pneumonia in adult critically ill patients: a systematic review and meta-analysis of randomized trials

Small bowel feeding and risk of pneumonia in adult critically ill patients: a systematic review and meta-analysis of randomized trials

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

Post-pyloric versus gastric tube feeding for preventing pneumonia and improving nutritional outcomes in critically ill adults

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