Randomized comparison of nasojejunal and nasogastric feeding in critically ill patients*

Davies, Andrew R.; Froomes, Paul R.; French, Craig; Bellomo, Rinaldo; Gutteridge, Geoffrey A; Nyulasi, Ibolya; Walker, Robyn; Sewell, R. B.

doi:10.1097/00003246-200203000-00016

Cited by 197 publications

(95 citation statements)

References 24 publications

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“…Furthermore, a high percentage of critically ill patients on mechanical ventilation who are fed enterally via a nasogastric tube do not receive their full energy requirements, principally because of the frequent interruptions in the enteral feeding (Rogers et al, 2003;Meert et al, 2004;O'Leary-Kelley et al, 2005). Duodeno-jejunal enteral nutrition has been shown to be a good alternative route in critically ill adults (Davies et al, 2002;Montejo et al, 2002) and children (Chellis et al, 1996;Sánchez et al, 2000). However, transpyloric enteral nutrition could also increase the incidence of complications in preterm infants (McGuire and McEwan, 2004).…”

Section: Introductionmentioning

confidence: 99%

Risk factors for gastrointestinal complications in critically ill children with transpyloric enteral nutrition

et al. 2007

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Objective: To study the risk factors for gastrointestinal complications related to enteral nutrition in critically ill children. Design: A prospective, observational study. Setting: Pediatric intensive care unit Subjects: Five hundred and twenty-six critically ill children who received transpyloric enteral nutrition(TEN). Methods: Univariate and multivariate logistic regression analysis were used to identify risk factors for gastrointestinal complications Results: Sixty six patients (11.5%) presented gastrointestinal complications, 33 (6.2%) abdominal distension and/or excessive gastric residue, 34 (6.4%) diarrhea, one gastrointestinal bleeding, three necrotizing enterocolitis and one duodenal perforation. Enteral nutrition was definitively suspended because of gastrointestinal complications in 11 (2.1%) patients. Fifty patients (9.5%) died. Gastrointestinal complications were more frequent in the patients who died. Death was related to complications of the nutrition in only one patient. The frequency of gastrointestinal complications was significantly higher in children with shock, acute renal failure, hypokalemia, hypophosphatemia and in those receiving dopamine, epinephrine and vecuronium. The stepwise multivariate logistic regression analysis showed that the most important factors associated with gastrointestinal complications were shock, epinephrine at a rate higher than 0.3 mg/kg/min and hypophosphatemia. Conclusions: The tolerance of TEN in critically ill children is good, although the incidence of gastrointestinal complications is higher in patients with shock, acute renal failure, hypokalemia, hypophosphatemia, and those receiving epinephrine, dopamine, and vecuronium.

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Section: Introductionmentioning

confidence: 99%

Risk factors for gastrointestinal complications in critically ill children with transpyloric enteral nutrition

et al. 2007

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“…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.…”

Section: 9mentioning

confidence: 99%

“…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.…”

Section: 9mentioning

confidence: 99%

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

Silk

2011

J Parenter Enteral Nutr

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Nutrition support is an important link in the chain of therapy for intensive care unit patients. The early institution of nutrition support significantly reduces the incidence of septic complications, reduces mortality, and shortens hospital stay. Unfortunately, impaired gastrointestinal function, particularly gastric atony, restricts the use of nasogastric enteral tube feeding, and the use of this route of administration in these patients can lead to regurgitation, aspiration, and the development of pneumonia. Postpyloric enteral feeding was heralded as a means of overcoming many of these problems. Overall, the results of controlled studies do not support a role of postpyloric duodenal feeding in reducing the incidence of aspiration pneumonia. As a consequence, post–ligament of Treitz nasojejunal enteral feeding is proposed as the technique of choice in these patients. Feeding tube design must incorporate a gastric aspiration port to overcome problems of gastroesophageal acid reflux, duodenogastric bile reflux, and increased gastric acid secretion, problems that occur during “downstream” jejunal feeding. Tube placement technique will need to be refined and patients will need to receive a predigested enteral diet. In postoperative surgical patients in the intensive care unit, there is also a need for a newly designed dual‐purpose nasogastric tube capable initially of providing a means of undertaking gastric aspiration and decompression and subsequently a means of initiating nasogastric enteral feeding.

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“…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.…”

Section: Semirecumbent Position (30-45u)mentioning

confidence: 99%

Evidence on measures for the prevention of ventilator-associated pneumonia

Lorente

Blot²,

Rello³

2007

Eur Respir J

136

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Randomized comparison of nasojejunal and nasogastric feeding in critically ill patients*

Abstract: Enteral nutrition delivered via a nasojejunal tube is associated with a significant reduction in gastric residual volume, a strong trend toward improved tolerance of enteral nutrition, and an extremely low requirement for parenteral nutrition.

Cited by 197 publications

References 24 publications

Risk factors for gastrointestinal complications in critically ill children with transpyloric enteral nutrition

Risk factors for gastrointestinal complications in critically ill children with transpyloric enteral nutrition

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

Evidence on measures for the prevention of ventilator-associated pneumonia

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