Critical Illness

CI: Gastric vs. Small Bowel Feeding (2011)

• Intervention
  In critically ill adults, does the site of enteral feeding tube tip in the gastric vs. small bowel position impact mortality?

  • Conclusion

    Small bowel feeding is unlikely to reduce mortality in adult critically ill patients. To date, adequately powered studies have not been conducted to demonstrate a significant difference in mortality when comparing gastric vs. small bowel feeding 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: In adult critically ill patients, does the site of enteral feeding tube tip in the gastric vs. small bowel position impact mortality?
    • 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, 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.
      • Hsu CW, Sun SF, Lin SL, Kang SP, Chu KA, Lin CH, Huang HH. Duodenal vs. gastric feeding in medical intensive care unit patients: A prospective, randomized, clinical study. Crit Care Med. 2009 Jun; 37(6): 1,866-1,872.
      • 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.
      • White H, Sosnowski K, Tran K, Reeves A, Jones M. A randomised controlled comparison of early post-pyloric vs. early gastric feeding to meet nutritional targets in ventilated intensive care patients. Crit Care. 2009; 13(6): R187. Epub: 2009 Nov 25. PMID: 19930728.
  • Search Plan and Results: CI: Gastric vs. Small Bowel Feeding Tube Placement 2011
     
  In critically ill adults, does the site of enteral feeding tube tip in the gastric vs. small bowel position impact infectious complications (aspiration pneumonia)?

  • Conclusion

    Clinical trials with the largest number of subjects having pneumonia as a primary outcome suggest that post-pyloric enteral nutrition (EN) reduces aspiration pneumonia in critically ill adult patients.

  • Grade: II
    • 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 critically ill adults, does the site of enteral feeding tube tip in the gastric vs. small bowel position impact infectious complications (aspiration pneumonia)?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Acosta-Escribano J, Fernández-Vivas M, Grau Carmona T, Caturla-Such J, Garcia-Martinez M, Menendez-Mainer A, Solera-Suarez M, Sanchez-Payá J. Gastric vs. transpyloric feeding in severe traumatic brain injury: A prospective, randomized trial. Intensive Care Med. 2010 Sep; 36 (9): 1,532-1,539.
      • 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, 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.
      • Hsu CW, Sun SF, Lin SL, Kang SP, Chu KA, Lin CH, Huang HH. Duodenal vs. gastric feeding in medical intensive care unit patients: A prospective, randomized, clinical study. Crit Care Med. 2009 Jun; 37(6): 1,866-1,872.
      • 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.
      • Metheny NA, Davis-Jackson J, Stewart BJ. Effectiveness of an aspiration risk-reduction protocol. Nurs Res. 2010 Jan-Feb; 59 (1): 18-25.
      • 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.
      • White H, Sosnowski K, Tran K, Reeves A, Jones M. A randomised controlled comparison of early post-pyloric vs. early gastric feeding to meet nutritional targets in ventilated intensive care patients. Crit Care. 2009; 13(6): R187. Epub: 2009 Nov 25. PMID: 19930728.
  • Search Plan and Results: CI: Gastric vs. Small Bowel Feeding Tube Placement 2011
     
  In critically ill adults, does the site of enteral feeding tube tip in the gastric vs. small bowel position impact length of stay (LOS)?

  • Conclusion

    Intensive care unit (ICU) or hospital length of stay (LOS) in adult critically ill patients do not differ when the feeding tube tip is placed in gastric vs. small bowel position. However, adequately powered studies have not been conducted.  

    
     

  • 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: In critically ill adults, does the site of enteral feeding tube tip in the gastric vs. small bowel position impact length of stay (LOS)?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Acosta-Escribano J, Fernández-Vivas M, Grau Carmona T, Caturla-Such J, Garcia-Martinez M, Menendez-Mainer A, Solera-Suarez M, Sanchez-Payá J. Gastric vs. transpyloric feeding in severe traumatic brain injury: A prospective, randomized trial. Intensive Care Med. 2010 Sep; 36 (9): 1,532-1,539.
      • 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.
      • Hsu CW, Sun SF, Lin SL, Kang SP, Chu KA, Lin CH, Huang HH. Duodenal vs. gastric feeding in medical intensive care unit patients: A prospective, randomized, clinical study. Crit Care Med. 2009 Jun; 37(6): 1,866-1,872.
      • 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.
      • Metheny NA, Davis-Jackson J, Stewart BJ. Effectiveness of an aspiration risk-reduction protocol. Nurs Res. 2010 Jan-Feb; 59 (1): 18-25.
      • White H, Sosnowski K, Tran K, Reeves A, Jones M. A randomised controlled comparison of early post-pyloric vs. early gastric feeding to meet nutritional targets in ventilated intensive care patients. Crit Care. 2009; 13(6): R187. Epub: 2009 Nov 25. PMID: 19930728.
  • Search Plan and Results: CI: Gastric vs. Small Bowel Feeding Tube Placement 2011
     
  In critically ill adults, does the site of enteral feeding tube tip in the gastric vs. small bowel position impact days on mechanical ventilation?

  • Conclusion

    Days on mechanical ventilation in adult critically ill patients do not differ when the enteral nutrition (EN) feeding tube tip is placed in gastric vs. small bowel position. However, adequately powered studies have not been conducted.

  • 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: In critically ill adults, does the site of enteral feeding tube tip in the gastric vs. small bowel position impact days on mechanical ventilation?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Acosta-Escribano J, Fernández-Vivas M, Grau Carmona T, Caturla-Such J, Garcia-Martinez M, Menendez-Mainer A, Solera-Suarez M, Sanchez-Payá J. Gastric vs. transpyloric feeding in severe traumatic brain injury: A prospective, randomized trial. Intensive Care Med. 2010 Sep; 36 (9): 1,532-1,539.
      • 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.
      • Hsu CW, Sun SF, Lin SL, Kang SP, Chu KA, Lin CH, Huang HH. Duodenal vs. gastric feeding in medical intensive care unit patients: A prospective, randomized, clinical study. Crit Care Med. 2009 Jun; 37(6): 1,866-1,872.
      • 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.
      • Metheny NA, Davis-Jackson J, Stewart BJ. Effectiveness of an aspiration risk-reduction protocol. Nurs Res. 2010 Jan-Feb; 59 (1): 18-25.
      • White H, Sosnowski K, Tran K, Reeves A, Jones M. A randomised controlled comparison of early post-pyloric vs. early gastric feeding to meet nutritional targets in ventilated intensive care patients. Crit Care. 2009; 13(6): R187. Epub: 2009 Nov 25. PMID: 19930728.
  • Search Plan and Results: CI: Gastric vs. Small Bowel Feeding Tube Placement 2011
     
  In critically ill adults, does the site of enteral feeding tube tip in the gastric vs. small bowel position impact cost of medical care?

  • Conclusion

    No studies evaluating the impact of feeding tube tip placement on the cost of medical care in critically ill patients were 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 2011
     
  In critically ill adults, does the site of enteral feeding tube tip in the gastric vs. small bowel position impact adequacy of nutrient delivery?

  • Conclusion

    It is unclear whether site of enteral feeding tube tip in the gastric vs. small bowel position impacts adequacy of nutrient delivery in adult critically ill patients.

  • Grade: II
    • 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 critically ill adults, does the site of enteral feeding tube tip in the gastric vs. small bowel position impact adequacy of nutrient delivery?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Acosta-Escribano J, Fernández-Vivas M, Grau Carmona T, Caturla-Such J, Garcia-Martinez M, Menendez-Mainer A, Solera-Suarez M, Sanchez-Payá J. Gastric vs. transpyloric feeding in severe traumatic brain injury: A prospective, randomized trial. Intensive Care Med. 2010 Sep; 36 (9): 1,532-1,539.
      • 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.
      • 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.
      • Metheny NA, Davis-Jackson J, Stewart BJ. Effectiveness of an aspiration risk-reduction protocol. Nurs Res. 2010 Jan-Feb; 59 (1): 18-25.
      • 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.
      • White H, Sosnowski K, Tran K, Reeves A, Jones M. A randomised controlled comparison of early post-pyloric vs. early gastric feeding to meet nutritional targets in ventilated intensive care patients. Crit Care. 2009; 13(6): R187. Epub: 2009 Nov 25. PMID: 19930728.
  • Search Plan and Results: CI: Gastric vs. Small Bowel Feeding Tube Placement 2011