Critical Illness

CI: Gastric vs. Small Bowel Feeding Tube Placement (2006)

• Assessment
  In what critically ill patients might small bowel feeding tube placement be most useful?

  • Conclusion

    Small bowel feeding tube placement may not be necessary or feasible for all critically ill patients, but may be useful in high risk critically ill patients (supine positioning, sedation, and/or patients with large GRVs).

  • Grade: IV
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: In what critically ill patients might small bowel feeding tube placement be most useful?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Heyland DK, Dhaliwal R, Drover JW, et al. Canadian clinical practice guidelines for nutrition support in mechanically ventilated, critically ill adult patients. JPEN. 2003; 27: 355-373.
  • Search Plan and Results: CI: Gastric vs. Small Bowel Feeding Tube Placement 2003
     
• Intervention
  Does the site of enteral feeding tube tip in the gastric vs. small bowel position impact infectious complications (aspiration pneumonia) in critically ill patients ?

  • Conclusion

    Adequately powered trials have not been conducted to test whether post-pyloric EN reduces aspiration pneumonia in critically ill patients. Several underpowered trials suggest there is no difference in aspiration by tube position in critically ill patients.

  • Grade: III
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: Does the site of enteral feeding tube tip in the gastric vs. small bowel position impact infectious complications (aspiration pneumonia) in critically ill patients ?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Davies AR, Froomes PRA, French CJ, et al. Randomized comparison of nasojejunal and nasogastric feeding in critically ill patients. Crit Care Med 2002; 30: 586-590
      • Esparza J, Boivin MA, Hartshorne MF, Levy H. Equal aspiration rates in gastrically and transpylorically fed critically ill patients. Intens Care Med 2001; 27: 660-664.
      • Heyland DK, Drover JW, MacDonald S, et al. Effect of postpyloric feeding on gastroesophageal regurgitation and pulmonary microaspiration: Results of a randomized controlled trial. Crit Care Med 2001; 29 (8): 1,495-1,501.
      • Heyland DK, Drover JW, Dhaliwal R, Greenwood J. Optimizing the benefits and minimizing the risks of enteral nutrition in the critically ill: Role of small bowel feeding. JPEN 2002; 26 (6): S51-S57.
      • Heyland DK, Dhaliwal R, Drover JW, et al. Canadian clinical practice guidelines for nutrition support in mechanically ventilated, critically ill adult patients. JPEN. 2003; 27: 355-373.
      • Kearns PJ, Chin D, Mueller L, Wallace K, Jensen WA, Kirsch CM. The incidence of ventilator-associated pneumonia and success in nutrient delivery with gastric vs. small intestinal feeding: A randomized clinical trial. Crit Med. 2000; 28: 1,742-1,746.
      • Kortbeek JB, Haigh PI, Doig C. Duodenal vs. gastric feeding in ventilated blunt trauma patients: A randomized controlled trial. J Trauma. 1999; 46: 992-998.
      • Marik PE, Zaloga GP. Gastric versus post-pyloric feeding: A systematic review. Crit Care. 2003; 7: 46-51.
      • Montecalvo MA, Steger KA, Farber HW, et al. Nutritional outcome and pneumonia in critical care patients randomized to gastic vs. jejunal tube feedings. Crit Care Med. 1992; 20: 1,377-1,387.
      • Montejo JC, Grau T, Acosta J, et al. Multicenter, prospective, randomized, single-blind study comparing the efficacy and gastrointestinal complications of early jejunal feeding in critically ill patients. Crit Care Med 2002; 30: 796-800.
      • Neumann DA, DeLegge MH. Gastric vs small bowel tube feeding in the intensive care unit: A prospective comparison of efficacy. Crit Med 2002; 30: 1,436-1,438.
  • Search Plan and Results: CI: Gastric vs. Small Bowel Feeding Tube Placement 2003
     
  Does the site of enteral feeding tube tip in the gastric vs. small bowel position impact LOS in critically ill patients?

  • Conclusion

    To date, adequately powered studies have not been conducted to demonstrate a significant difference in LOS when comparing gastric vs. small bowel feeding tube position in critically ill patients .

  • Grade: V
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: Does the site of enteral feeding tube tip in the gastric vs. small bowel position impact LOS in critically ill patients?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Boivin MA, Levy H. Gastric feeding with erythromycin is equivalent to transpyloric feeding in the critically ill. Crit Care Med 2001; 39 (10): 1,916-1,919.
      • Kearns PJ, Chin D, Mueller L, Wallace K, Jensen WA, Kirsch CM. The incidence of ventilator-associated pneumonia and success in nutrient delivery with gastric vs. small intestinal feeding: A randomized clinical trial. Crit Med. 2000; 28: 1,742-1,746.
      • Kortbeek JB, Haigh PI, Doig C. Duodenal vs. gastric feeding in ventilated blunt trauma patients: A randomized controlled trial. J Trauma. 1999; 46: 992-998.
      • Marik PE, Zaloga GP. Gastric versus post-pyloric feeding: A systematic review. Crit Care. 2003; 7: 46-51.
  • Search Plan and Results: CI: Gastric vs. Small Bowel Feeding Tube Placement 2003
     
• Monitoring and Evaluation
  Does the site of enteral feeding tube tip in the gastric vs. small bowel position impact mortality in critically ill patients?

  • Conclusion

    To date, adequately powered studies have not been conducted to demonstrate a significant difference in mortality when comparing gastric versus small bowel feeding tube position in critically ill patients.

  • Grade: V
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: Does the site of enteral feeding tube tip in the gastric vs. small bowel position impact mortality in critically ill patients?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Boivin MA, Levy H. Gastric feeding with erythromycin is equivalent to transpyloric feeding in the critically ill. Crit Care Med 2001; 39 (10): 1,916-1,919.
      • Davies AR, Froomes PRA, French CJ, et al. Randomized comparison of nasojejunal and nasogastric feeding in critically ill patients. Crit Care Med 2002; 30: 586-590
      • Esparza J, Boivin MA, Hartshorne MF, Levy H. Equal aspiration rates in gastrically and transpylorically fed critically ill patients. Intens Care Med 2001; 27: 660-664.
      • Heyland DK, Drover JW, Dhaliwal R, Greenwood J. Optimizing the benefits and minimizing the risks of enteral nutrition in the critically ill: Role of small bowel feeding. JPEN 2002; 26 (6): S51-S57.
      • Kearns PJ, Chin D, Mueller L, Wallace K, Jensen WA, Kirsch CM. The incidence of ventilator-associated pneumonia and success in nutrient delivery with gastric vs. small intestinal feeding: A randomized clinical trial. Crit Med. 2000; 28: 1,742-1,746.
      • Kortbeek JB, Haigh PI, Doig C. Duodenal vs. gastric feeding in ventilated blunt trauma patients: A randomized controlled trial. J Trauma. 1999; 46: 992-998.
  • Search Plan and Results: CI: Gastric vs. Small Bowel Feeding Tube Placement 2003
     
  Does the site of enteral feeding tube tip in the gastric vs. small bowel position impact cost of medical care in critically ill patients?

  • Conclusion
    Any evaluation of the impact of feeding tube tip placement on the cost of medical care in critically ill patients was not yet located.
  • Grade: V
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Search Plan and Results: CI: Gastric vs. Small Bowel Feeding Tube Placement 2003