Gastric Versus Small Bowel Feeding in Critically Ill Adults

Abstract

Critically ill patients often require enteral feedings as a primary supply of nutrition. Whether enteral nutrition (EN) should be delivered as a gastric versus small bowel feeding in the critically ill patient population remains a contentious topic. The Society of Critical Care Medicine (SCCM)/American Society for Parenteral and Enteral Nutrition (ASPEN), the European Society for Parenteral and Enteral Nutrition (ESPEN), and the Canadian Clinical Practice Guidelines (CCPG) are not in consensus on this topic. No research to date demonstrates a significant difference between the two feeding routes in terms of patient mortality, ventilator days, or length of stay in the intensive care unit (ICU); however, studies provide some evidence that there may be other benefits to using a small bowel feeding route in critically ill patients. The purpose of this paper is to examine both sides of this debate and review advantages and disadvantages of both small bowel and gastric routes of EN. Practical issues and challenges to small bowel feeding tube placement are also addressed. Finally, recommendations are provided to help guide the clinician when selecting a feeding route, and suggestions are made for future research.

Nasogastric tube insertion in anaesthetized patients: a comprehensive review

“…Gastric feeding is less invasive [4] and allows the physiologic absorption of nutrients [5], stimulates the gastric phase of digestion and decreases complications such as dumping syndrome [6]. Those which are used for aspiration have a large diameter and are made from polyvinyl chloride [7].…”

Enteral Nutrition: Options for Short‐Term Access

“…Oroenteric and nasoenteric feeding tubes can be placed bedside or using endoscopic or fluoroscopic techniques. Bedside placement of nasoenteric (gastric or small bowel) feeding tubes can be achieved without the use of technology; however, use of certain technology has demonstrated success rates as high as 90% . Stylets or guidewires are provided with most enteric feeding tubes to provide structure and guidance during placement.…”

“…Although there is no change in mortality or length of stay between small bowel and gastric feeding proven in the literature, the notion of feeding into the small bowel is believed to decrease the possibility of pneumonia. Since aspiration pneumonia is a significant EN‐related complication that may affect patient outcomes, it is important to recognize aspiration risk factors, such as mechanical ventilation, supine position, neurologic deficits, impaired level of consciousness, advanced age, and gastroesophageal reflux disease . However, aspiration risk itself is not an absolute contraindication for gastric EN, as patients who exhibit some of the risk factors for aspiration may still tolerate gastric EN .…”

“…SCCM ASPEN, the European Society for Parenteral and Enteral Nutrition (ESPEN), and the Canadian Clinical Practice Guidelines (CCPG) are not in consensus on preferred routes of gastric vs small bowel. No research to date demonstrates a significant difference between the 2 feeding routes in terms of patient mortality, ventilator days, or ICU length of stay; however, studies provide some evidence that there may be additional benefits to using a small bowel feeding route in critically ill patients . A recent meta‐analysis from Li et al in China analyzed 8 RCTs that included 838 mechanically ventilated patients.…”

Methods to determine the internal length of nasogastric feeding tubes: An integrative review

“…Gastric access for feeding is appropriate in most cases. It allows normal absorption of nutrients, more versatility in the diet (Kozeniecki and Fritzshall, 2015); stimulates the gastric phase of digestion and does not divert from the potential sites for the absorption of nutrients (Schlein, 2016). This method is less invasive than other methods of artificial feeding, and the tube is easy to insert and remove (Fletcher, 2011).…”