The incidence of ventilator-associated pneumonia and success in nutrient delivery with gastric versus small intestinal feeding: A randomized clinical trial

Abstract

There is no clear difference in the incidence of VAP in SI compared with G enteral nutrition. Patients given feeding into the SI do receive higher calorie and protein intakes.

Statement of the 4th International Consensus Conference in Critical Care on ICU-Acquired Pneumonia – Chicago, Illinois, May 2002

“…The risk of aspiration is unaltered by the size of the feeding tube [106], and inconsistently affected by pro-motility agents and different feeding regimes [107,108]. Post-pyloric placement of feeding tubes decreases neither the risk of aspiration nor of ICU-AP [101,109]. There is not enough data to conclude that timing of feeding, position of feeding tubes, type of tube or type of feeding formula can be used as preventive measure for ICU-AP.…”

The Evolving Role of Post–Ligament of Trietz Nasojejunal Feeding in Enteral Nutrition and the Need for Improved Feeding Tube Design and Placement Methods

“…10 Notwithstanding our disappointing clinical experiences with the technique of nasoduodenal enteral feeding, including in critically ill ICU patients, 10 there has subsequently been considerable interest in the technique of postpyloric enteral feeding in the ICU patient, particularly in respect of reducing the incidence of aspiration pneumonia. [13][14][15][16][17][18][19][20][21][22] In attempting to assess and compare the results of the 10 controlled studies, [13][14][15][16][17][18][19][20][21][22] one is forced to conclude that the term postpyloric almost certainly refers to nasoduodenal tube placement and that some authors may have been somewhat optimistic in thinking that they had achieved intrajejunal tube placement. Overall, the results of the studies have been conflicting, and no clear consensus on the efficacy of postpyloric feeding in reducing the incidence of aspiration pneumonia has been documented.…”

“…8,9,23,24 One possible reason for this is that there is a need to aspirate gastric contents during postpyloric feeding. It is unlikely that this was performed in the above studies, [13][14][15][16][17][18][19][20][21][22] as the available feeding tubes did not incorporate a gastric aspiration port.…”

Evidence on measures for the prevention of ventilator-associated pneumonia

“…In some studies, there were not significant differences in VAP and mortality rates between patients with gastric or postpyloric feeding [138][139][140][141][142][143][144]. In the meta-analysis by MARIK and ZALOGA [145], which enrolled 522 patients from nine studies, analysis of the 422 patients from seven studies that reported the VAP rate [138][139][140][141][142][143][144] found that gastric feeding showed a trend to higher incidences of VAP (odds ratio 1.44, 95% CI 0.84-2.46) and mortality (odds ratio 1.08, 95% CI 0.69-1.68) than post-pyloric feeding; however, the differences were not statistically significant.…”