CI: Gastric vs. Small Bowel Feeding Tube Placement (2006)
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.
PubMed ID: 12405623
POSITIVE:To systematically review and statistically aggregate studies that compare gastric vs. small bowel feedings (reported outcomes for ventilator-assisted pneumonia and mortality).
- Randomized Clinical Trial
- Critically ill
- Small bowel vs. gastric feeding.
Pseudorandomized studies
- Literature search
- Assessment method
- Analyze primary end-points of mortality, pneumonia
- Analyze secondary end-points of nutritional adequacy.
- Primary end-point prevalence
- Percent energy needs
- Percent energy, nitrogen needs.
10 RCTs with a total of 612 patients
- Meta-analysis of nine trials showed NS difference in mortality RR 0.93 (95% CI 0.72-1.20); no trial adequately powered to detect difference in mortality
- Meta-analysis of seven studies showed significantly less ventilator associated pneumonia RR 0.76 (95% CI 0.59-0.99)
- Small bowel feeding reduces gastroesophageal reflux.
Small bowel feeding may be associated with a reduction in gastroesophageal regurgitation, an increase in nutrient delivery, shorter time to target nutritional goal, and lower rate of ventilator-associated pneumonia.
| Government: | Ontario Ministry of Health |
RCTs included in meta-analysis: Taylor et al, 1999; Heyland et al, 2001; Esparaza et al, 2001; Bolvin and Levy, 2001; Kortbeek et al, 1999; Montecalvo et al, 1992; Daview 35 al, 2002; Montejo et al, 2002; Minard et al, 2000 and Kearns et al, 2000.
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Quality Criteria Checklist: Review Articles
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| Relevance Questions | |||
| 1. | Will the answer if true, have a direct bearing on the health of patients? | Yes | |
| 2. | Is the outcome or topic something that patients/clients/population groups would care about? | Yes | |
| 3. | Is the problem addressed in the review one that is relevant to dietetics practice? | Yes | |
| 4. | Will the information, if true, require a change in practice? | Yes | |
| Validity Questions | |||
| 1. | Was the question for the review clearly focused and appropriate? | Yes | |
| 2. | Was the search strategy used to locate relevant studies comprehensive? Were the databases searched and the search termsused described? | Yes | |
| 3. | Were explicit methods used to select studies to include in the review? Were inclusion/exclusion criteria specified andappropriate? Wereselectionmethods unbiased? | Yes | |
| 4. | Was there an appraisal of the quality and validity of studies included in the review? Were appraisal methodsspecified,appropriate, andreproducible? | Yes | |
| 5. | Were specific treatments/interventions/exposures described? Were treatments similar enough to be combined? | Yes | |
| 6. | Was the outcome of interest clearly indicated? Were other potential harms and benefits considered? | Yes | |
| 7. | Were processes for data abstraction, synthesis, and analysis described? Were they applied consistently acrossstudies and groups? Was thereappropriate use of qualitative and/or quantitative synthesis? Was variation in findings among studies analyzed? Were heterogeneity issued considered? If data from studies were aggregated for meta-analysis, was the procedure described? | Yes | |
| 8. | Are the results clearly presented in narrative and/or quantitative terms? If summary statistics are used, are levels ofsignificance and/or confidence intervals included? | Yes | |
| 9. | Are conclusions supported by results with biases and limitations taken into consideration? Are limitations ofthe review identified anddiscussed? | Yes | |
| 10. | Was bias due to the review's funding or sponsorship unlikely? | Yes | |