Risk‐Benefit Profile of Gastric vs Transpyloric Feeding in Mechanically Ventilated Patients

Abstract

Transpyloric feeding in MV adults was associated with significantly less incidence of VAP compared with gastric feeding. No differences were observed in other outcomes, suggesting that the difference observed in the incidence of VAP may be spurious and needs confirmation.

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 .…”

Permissive or Trophic Enteral Nutrition and Full Enteral Nutrition Had Similar Effects on Clinical Outcomes in Intensive Care: A Systematic Review of Randomized Clinical Trials

“…Nutrition support is essential for the management of critically ill patients to attenuate the catabolic and inflammatory response, reduce complications, and decrease intensive care unit (ICU) and hospital length of stay (LOS) . There are many challenges in providing adequate nutrition support for critically ill patients, including the optimal timing for initiation of enteral and/or parenteral nutrition and the safety of initiating nutrition therapy in patients receiving vasopressor support, the amount of energy and protein that should be delivered, and the most appropriate route for enteral feeding—via transpyloric or gastric tubes …”

“…Current recommendations for energy and protein provision in early EN for critically ill patients are 25–30 kcal/kg/day and 1.2–2.0 g/kg/day, respectively . The tube position is another important question because it is related to gastrointestinal (GI) tolerance, absorptive capacity, and ventilator‐associated pneumonia resultant of gastroesophageal reflux . Li et al conducted a meta‐analysis about risks and benefits of gastric and transpyloric feeding and showed that the use of transpyloric feeding was associated with a decreased frequency of ventilator‐associated pneumonia compared with gastric feeding in mechanically ventilated patients.…”

“…Although the importance of nutrition for critically ill patients is well known, health professionals still have difficulties in providing early nutrition support and in achieving and/or maintaining nutrition goals. The main reasons to hesitate to start EN are related to possible complications including bowel ischemia, GI intolerance, and aspiration . Furthermore, frequent interruptions of EN for medical and surgical procedures and signs of GI intolerance hamper the success of the nutrition support.…”