IntroductionTo compare outcomes from early post-pyloric to gastric feeding in ventilated, critically ill patients in a medical intensive care unit (ICU).MethodsProspective randomized study. Ventilated patients were randomly assigned to receive enteral feed via a nasogastric or a post-pyloric tube. Post-pyloric tubes were inserted by the bedside nurse and placement was confirmed radiographically.ResultsA total of 104 patients were enrolled, 54 in the gastric group and 50 in the post-pyloric group. Bedside post-pyloric tube insertion was successful in 80% of patients. Patients who failed post-pyloric insertion were fed via the nasogastric route, but were analysed on an intent-to treat basis. A per protocol analysis was also performed. Baseline characteristics were similar for all except Acute Physiology and Chronic Health Evaluation II (APACHE II) score, which was higher in the post-pyloric group. There was no difference in length of stay or ventilator days. The gastric group was quicker to initiate feed 4.3 hours (2.9 - 6.5 hours) as compared to post-pyloric group 6.6 hours (4.5 - 13.0 hours) (P = 0.0002). The time to reach target feeds from admission was also faster in gastric group: 8.7 hours (7.6 - 13.0 hours) compared to 12.3 hours (8.9 - 17.5 hours). The average daily energy and protein deficit were lower in gastric group 73 Kcal (2 - 288 Kcal) and 3.5 g (0 - 15 g) compared to 167 Kcal (70 - 411 Kcal) and 6.5 g (2.8 - 17.3 g) respectively but was only statistically significant for the average energy deficit (P = 0.035). This difference disappeared in the per protocol analysis. Complication rates were similar.ConclusionsEarly post-pyloric feeding offers no advantage over early gastric feeding in terms of overall nutrition received and complicationsTrial RegistrationClinical Trial: anzctr.org.au:ACTRN12606000367549

No abstract

No abstract

Aim:  Feeding algorithms have been demonstrated to improve nutrition delivery and influence primary outcomes in critical care units. Most feeding algorithms assist decision‐making related to initiation of enteral nutrition, use of prokinetics and the mode of delivery of feeding. The algorithm that is the subject of this evaluation enabled nursing staff to select type of feed and target feeding rate for enterally fed patients. The aims of this evaluation were to assess acceptance of the algorithm across disciplines, and to determine if energy and protein intakes achieved were comparable with data reported in an international multi‐centre observational study. Methods:  Semistructured interviews were conducted with eight nurses, three doctors and three dietitians, to gauge their attitudes towards usefulness of the algorithm. Data on energy and protein intakes was collected for 108 patients using nursing observation records of volume of feed delivered with deductions for discarded aspirates. Results:  Positive feedback on usability of the algorithm was given by all interview participants. Common themes from the interviews were that the algorithm ‘enabled feeding to start earlier’, ‘was simple to use’ and ‘ensured consistency of approach’. Greater than 80% of estimated nutritional targets were achieved, and enteral feeding commenced on average within 8 hours. Conclusions:  Evaluation of the new feeding algorithm indicated that it was well accepted by users, ensured a consistent approach to enteral feeding delivery and enabled feeding to start earlier within an intensive care unit.