Intermittent enteral feeding: the influence on respiratory and digestive tract colonization in mechanically ventilated intensive-care-unit patients.

Abstract

Continuous enteral feeding (CEF) has been associated with decreased gastric acidity, thereby stimulating gastric colonization and ventilator-associated pneumonia (VAP). Intermittent enteral feeding (IEF) could induce a temporary increase in gastric acidity and decrease the risk of VAP. We studied the influence of IEF (18 h/d) and CEF (24 h/d) on gastric and oropharyngeal colonization. Sixty patients were randomized to receive either IEF or CEF, and continuous intragastric pH monitoring was performed in 50 patients. Median intragastric pH levels were similar before enteral feeding was instituted (pH 2.5 for CEF and pH 2.4 for IEF), and median pH values increased slightly after institution of nutrition (NS). In patients receiving IEF, median pH decreased from 3.5 to 2.2 (p = 0.0002) when enteral feeding was discontinued. However, despite this, 80% of the patients in both study groups were colonized in the stomach after 7 d in study. In addition, colonization rates of the oropharynx and trachea, the incidence of VAP, and mortality were similar in both study groups. IEF was less well tolerated than CEF. We conclude that almost all patients receiving enteral feeding are colonized in the stomach with gram-negative bacteria. IEF resulted in a slight decrease in intragastric pH without influencing rates of colonization and infection of the respiratory tract.

Incidence and Risk Factors for Ventilator-Associated Pneumonia in Kathmandu University Hospital

“…12 Though enteral feed via nasogastric tube has been stated as a risk factor due to increased gastric pH, volume and regurgitation, it may have improved the nutritional status, decreased gut translocation and prevented VAP in our patients. 14,15 Intermittent feed, semi-recombinant position at 45°, avoidance of gastric over distension and use of prokinetics when required, has decreased the incidence of VAP in some studies. 16,17 Similar finding was observed in our study.…”

Reducing Ventilator-Associated Pneumonia Through Advanced Oral-Dental Care: A 48-Month Study

“…This study is also the first published supported the contention that colonization of the oropharyngeal tissues is primarily responsible for colonization of the stomach or gut. Extensive research has been conducted on procedures that directly or indirectly attempt to control bacterial colonization of gastric fluid [32][33][34] ; however, none of these interventions have been proven definitively to reduce VAP incidence. Elevating the head of the bed also has been advocated as a means of decreasing aspiration in patients receiving mechanical ventilation.…”

Ventilator-Associated Pneumonia

“…111,112,142,144 Pseudomonas aeruginosa, eg, most commonly appears de novo in the trachea and therefore is unlikely to be affected by gastric pH, in contrast to the Enterobacteriaceae, which are often first found in the stomach. 111,145 Consistent with these findings, the delivery site and method of enteral feeding have not convincingly altered the incidence of nosocomial pneumonia, [146][147][148] although postpyloric feeding could theoretically reduce colonization by gastric bacteria.…”