A Randomised Controlled Comparison of Early Post-pyloric Versus Early Gastric Feeding to Meet Nutritional Targets in Ventilated Intensive Care Patients

Overview

Journal Crit Care

Specialty Critical Care

Date 2009 Nov 26

PMID 19930728

Citations 30

Authors

Hayden White

Kellie Sosnowski

Khoa Tran

Annelli Reeves

Mark Jones

Affiliations

Soon will be listed here.

Abstract

Introduction: To compare outcomes from early post-pyloric to gastric feeding in ventilated, critically ill patients in a medical intensive care unit (ICU).

Methods: Prospective 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.

Results: A 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.

Conclusions: Early post-pyloric feeding offers no advantage over early gastric feeding in terms of overall nutrition received and complications

Trial Registration:

Clinical Trial: anzctr.org.au:ACTRN12606000367549.

Citing Articles

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